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Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control.

Creating the American Junkie: Addiction Research in the Classic Era of Narcotic Control, by Caroline Jean Acker (Baltimore: Johns Hopkins University Press, 2002), 276 pp., $42 (cloth only).

The history of drug use and drug policy, especially in the United States, is replete with caricatures and stereotypes: irresistible drugs, wicked drug dealers, evil drug lords, and innocent victims. The most familiar of these is the heroin or morphine addict--the junkie. The term conjures up a gaunt, unkempt social deviant, often male and often urban, with a deeply flawed personality, who will lie, cheat, steal or kill to obtain the drug that enslaves him. Since the classic era of narcotics control (1919-1960), such stereotypes have been employed not only by the popular press and pulp fiction writers, but by medical professionals and policy makers. The stock image of the junkie continues to shape drug policy and to effectively keep drug users on the margins of the health care system. And yet, not long before the ascendance of this addict stereotype, opinion about the nature and proper treatment of opiate addiction was remarkably heterodox. How did the professional and public policy consensus coalesce, in the end, around the "fact" of the irredeemable junkie? In her excellent book, Creating the American Junkie, Caroline Acker deftly shows how, between 1919 and 1960, the addict stereotype emerged from the interaction between the first cohort of recreational opiate users (grappling with the challenges of maintaining a habit under a new drug-prohibition regime), researchers in psychiatry and pharmacology (pursuing their own professional agendas), and the U.S. Treasury Department's Division of Narcotics, striving to criminalize non-medical opiate use and end the ambulatory treatment of addicts by private physicians.

Acker begins by introducing some of the early-20th-century opiate addicts and their addiction careers (taken from wonderful surviving case histories from the narcotics ward at Philadelphia General Hospital), and locates these "new" addicts within the context of early-20th-century urban vice reform. The case histories reveal the kernels of truth beneath the addict stereotype. Many of the drug users admitted to the narcotics ward were working-class males; they often began using opiates recreationally, changing their use patterns (e.g., from smoking opium to heroin) as the drug laws became more restrictive. Especially after the 1914 Harrison Narcotic Act, their habits became more firmly tied to the black market (and thus more expensive), and their lives revolved increasingly around acquiring and using drugs while avoiding arrest. Meanwhile, their attention to work, family, and social responsibilities progressively declined. These addicts might enter a hospital to kick their habits but then resume drug use immediately upon discharge. Recreational users were not sympathetic characters. In contrast to "accidental" medical addicts, they seemed irresponsible and self-indulgent, their drug habits more a vice than a necessity. In the eyes of urban vice reformers, such drug habits were as threatening to the public morality and welfare as prostitution, gambling, and saloons. It was partly in response to this reality that narcotics laws were conceived and implemented, and in this context that addicts and addiction were studied, in an attempt to resolve this particular social problem. Although this chapter effectively sets the scene for the book, Acker does not say much about the alcohol problem during these years. For many reformers, alcohol was a much bigger threat to morality and public health than narcotic drugs, and more discussion of the connections between the two social problems would have enhanced this section.

Chapters 2 and 3 introduce several other collaborators in constructing the "junkie": the Bureau of Social Hygiene and American pharmacologists. The Rockefeller family's Bureau of Social Hygiene (BSH) had been established in 1911 to study the problems of prostitution and venereal disease. Finding that drug use was closely linked to those problems, in 1919 the BSH created a Committee on Drug Addiction to study these scientifically. Acker argues that the BSH also helped transform the nature of scientific research into the issues of deviant sexuality and drug use. In both cases the BSH polled prominent scientists to determine the most promising research approaches to these problems, and it supported some research in an opportunistic fashion. It also offered its resources to the National Research Council, which coordinated narrowly focused scientific projects rather than wide-ranging investigations by independent researchers. This process fostered the formation of networks of researchers interested in related problems and helped develop consensus on the status of current research and on the most useful approaches. In a refreshingly clear account of the key players and their negotiations, Acker demonstrates how, during the 1920s, the Bureau of Social Hygiene, the National Research Council, and researchers increasingly defined addiction as a vice rather than a disease, thus framing it as a problem of criminology, not of medicine.

For researchers in pharmacology, the "addiction as vice" consensus manifested as a search for a non-addicting pain-killing substance (which would eliminate the need for any legal opiates) rather than on finding "magic bullets" to cure addiction. Chapter 3 chronicles these efforts and shows how the support of the BSH Committee on Drug Addiction and its successor, the National Research Council's Committee on Drug Addiction, made it possible for American pharmacologists to establish a firm academic and industrial presence and strong collaborative networks, thus bringing their profession up to speed with their colleagues in Europe.

For early-20th-century psychiatrists, as for pharmacologists, the growing problem of drug addiction had presented hopes of legitimation via discovery of effective treatment. These hopes were not realized. And as patterns of addiction shifted, the addicts encountered by psychiatrists in institutions such as Philadelphia General Hospital were, for the most part, manipulative and obstinately unrepentant. Physicians hoping to help such patients through withdrawal and into a more respectable (and drug-free) life were often disappointed and frustrated. To explain their failures, they increasingly drew on diagnostic ideas such as "defective personality" or psychopathy, which assumed that disturbed or deviant behavior was an indicator of mental illness derived from fundamental personality flaws. In Chapter 4, Acker uses the Philadelphia General Hospital case histories to show how these diagnostic ideas were incorporated into clinical research during the 1920s, bringing clinical thinking neatly into line with that of the federal drug control establishment. Importantly, these case histories show that although the clinicians could have drawn different conclusions from their clinical observations, they often chose to ignore different addiction "career patterns" shaped by class or gender.

Chapter 5 focuses on Lawrence Kolb, the Public Health Service psychiatrist who elaborated on and legitimated the "defective personality" theory of drug addiction that dominated medical, scientific, and policy thinking from the 1930s through the 1950s. Here, Acker is especially deft, setting Kolb within the context of a new psychiatry that focused on behavior (especially adaptive behavior) as an index of mental health. This focus allowed psychiatrists to claim a place in the wider world outside the insane asylum (the traditional setting for psychiatry): schools, prisons, social service agencies, and the armed forces. As Acker shows, Kolb's career exemplifies this new trend in psychiatry and its long-term effects on policy.

Kolb both "consolidated the picture of the addict as psychopath" and distinguished such addicts from "accidental" medical addicts. Medical addicts, he said, did not have defective personalities; unlike the "vicious" addict, they did not derive pleasure from drug use and deserved more compassionate care. "Vicious" addicts, in contrast, were deviants, and so probably criminals. Yet in practice Kolb always tried to give addicts the benefit of the doubt when assessing them. He never intended his theory to be used to justify inhumane treatment of addicts, nor did he believe that federal prison-hospitals for addicts were necessary.

As Acker notes, it is thus ironic that Kolb became the first medical director of the Public Health Service Narcotic Hospital at Lexington, Kentucky, which opened in 1935. Chapter 6 examines the "healing vision" and therapeutic hopes of the "narcotic farm" and how that vision played out in reality. In the end, clinical experiences and research at Lexington served to support the addict stereotype of irredeemable deviance, opening the way for more severe drug laws in the 1950s, including mandatory minimum sentencing.

The addicts, marginalized by the addict stereotype and the policies it justified, created a social world of their own. Sociologists studying this world between 1930 and 1960 often provided interpretations of addict behavior radically different from those of psychiatrists and criminal justice personnel. In her final chapter, Acker discusses sociological assessments of addiction, particularly those of Alfred Lindesmith, Bingham Dai, and Howard Becker, that would make possible a critique of federal drug policy grounded in disciplinary research. Such critiques helped bring about, at least for a time, a more humane approach to drug addiction, but the older stereotypes (especially since the alarm over crack cocaine in the 1980s) persist in both law enforcement and treatment.

Creating the American Junkie is a very rich work, drawn from diverse and often intriguing primary materials. Densely woven yet always accessible, Acker's account of the addict stereotype illuminates a complex and pivotal period in American drug policy history and is a welcome (and long-awaited) addition to the drug history literature.
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Author:Speaker, Susan L.
Publication:Contemporary Drug Problems
Article Type:Book Review
Date:Dec 22, 2003
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