Cycles of craving: society’s drugs of choice appear to come in waves: LSD and marijuana, cocaine, now crack

Cycles of craving: society’s drugs of choice appear to come in waves: LSD and marijuana, cocaine, now crack

Dan Hurley

Cycles of Craving

Society’s drugs of choice appear to come in waves: LSD and marijuana, cocaine, now crack. But cutting across the gradual shifts in drug-use patterns and the severe crisis in many of our cities is a growing disenchantment with it all.

Lenard Hebert is an expert of sorts on America’s patterns of drug abuse over the past 25 years. He hasn’t studied them; he’s lived them.

“I did each drug of the decade,” says Hebert, a 40-year-old man now glad to be recovering in New York City’s Phoenix House, one of the largest residential drug treatment centers in the world. Sitting in a lounge at the center, dressed neatly in white shirt and tie, he recalls his time as a Marine in Vietnam in 1967: “We’d wear peace signs on our helmets and love beads around our necks. Drugs were another way to get in touch with home. And LSD was definitely the most popular drug at the time.”

When he returned home in the early’70s, Hebert became a black militant, bought a beret and, as he says, “did strictly reefer. A good militant did natural, herbal things. Then I went disco. I snorted cocaine for 10 years. It was chic because it was so expensive.”

Along came crack, the smokable, highly addictive form of cocaine with its five-minute high. Hebert stopped dealing cocaine and turned his middle-class high-rise apartment into a crack den. Before he made it to Phoenix House, he was sleeping in abandoned cars and shelters for the homeless.

Spotting National Trends

The cycles of drug abuse that nearly ruined Hebert’s life represent fairly well the way that different drugs sweep across our country in waves. “It’s as if we’ve been conducting a huge social experiment since the early 1960s,” said the late Norman E. Zinberg, a psychiatrist at Harvard who, since 1963, had been studying national drug-abuse patterns. (He died in April.) In his view, the nation has gone through four major waves of drug use, beginning with LSD in the early 1960s, marijuana in the mid-to-late-’60s, heroin from 1969 to 1971 (Hebert escaped this heroin wave somehow) and cocaine in the late ’70s and ’80s.

Zinberg believed shifting patterns in drug abuse are signs of the times, reflections of the country’s shifting zeitgeist. “Cocaine became the drug of the ’80s because it’s a stimulant,” he said. “People were looking for action. It fit the mood, just like psychedelics fit the mood of the early ’60s.”

For years, experts have been trying to spot large trends in drug abuse with the hope that they might better prepare and adapt treatment, prevention and law enforcement efforts, according to David E. Smith, a specialist in addiction medicine who opened the Haight Ashbury Free Clinic in 1967 and has been monitoring drug-use patterns ever since. Although we have become increasingly sophisticated in identifying patterns, several factors muddy tidy calendars of drug usage such as Zinberg’s. Most notably, researchers have found that: 1. Drug use varies tremendously from region to region, even city to city; 2. Drugs of choice move with some predictability through the social class structure; and 3. Rather than a simple succession of drugs in use, one drug often will piggyback on another, complicating efforts at prevention.

The East-West Transfer

In 1976 the National Institute on Drug Abuse (NIDA) took the first step toward monitoring regional trends when it formed the Community Epidemiology Work Group, an assembly of drug-abuse experts from 20 cities around the country who meet biannually to exchange data. “Drug-abuse problems sometimes develop very quickly at the local level,” says Nicholas J. Kozel, chief of NIDA’s statistical and epidemiologic analysis branch and chairman of the group.

“Up until about a year and a half ago, there wasn’t much of a crack problem in Washington, DC,” Kozel explains. “Then all of a sudden we had more violence and murder than we’d ever seen, most of it associated with drugs, especially crack. Drug abuse is different from Boston to Buffalo to Washington. It pops up this month and recedes the next. That’s why we need local surveillance. It keeps you on the edge of your seat, trying to stay alert to these changes and their impact on the health of our nation.”

Class Distinctions

Compounding these regional variations is the movement of particular drugs through social classes. In a fairly predictable pattern, drug epidemics seem to begin among a small, elite group, then filter down into the broad middle class and finally permeate the ghetto. In 1983, half of the callers to 1-800-COCAINE, the national cocaine-abuse hot line, were college-educated, 52% had family incomes of at least $25,000 and only 16% were unemployed. By 1987, only 16% of the callers were college-educated, a mere 20% had incomes of $25,000 and fully 54% were among the unemployed.

“Cocaine use is going down among the people who work and can’t afford not to show up for their jobs,” says psychiatrist David F. Musto, a Yale medical historian and author of The American Disease: Origins of Narcotic Control. “The first people to go on a drug are the avant-garde and the wealthy, and they’re the first to go off it, too. But in the inner city, drugs become a source of status and money, at least for the dealers.”

Demand for illegal drugs has been dropping in the middle class for 10 years, according to two national surveys sponsored by NIDA. The most recent National Household Survey on Drug Abuse showed that drug use among 18- to 25-year-olds leveled off between 1979 and 1985. The first substantial decline in cocaine consumption among American high-school seniors, college students and young adults showed up in a 1987 survey conducted by the University of Michigan’s Institute for Social Research. The most recent available poll shows that the decline continued in 1988.

Drugs that Travel Together

Despite regional variations, there do appear to be predictable patterns of abuse once a drug arrives on the scene. For instance, heavy abusers of cocaine or speed often use heroin simultaneously, usually at the end of a binge to ease themselves down. It shouldn’t be surprising, then, that in 27 cities across the country the number of deaths associated with both heroin and cocaine leapt between 1984 and 1988. From 1987 to 1988 alone, domestic heroin seizures by the Drug Enforcement Agency more than doubled, jumping from 382.4 kilograms to 793.9 kilograms.

“It’s predictable that we’ve had an increase in heroin abuse,” says Smith. “Anytime you see a stimulant upswing, you see an opiate upswing. The stimulant epidemic was the door for the opiate epidemic.”

And Smith is now worried by a disturbing new trend–a simultaneous increase in the use of both speed and cocaine. “Normally the trends go in different directions,” he says. “The speed curve went up and the cocaine curve went down. But since the advent of crack, it’s the first time I’ve ever seen both the speed curve and the cocaine curve go up. The current stimulant epidemic is without a doubt the worst I’ve seen since 1967 — and in fact it’s worse than 1967.”

What Shapes the Patterns?

Experts have found the patterns of drug abuse are formed not only by vague national moods and fashions but also by the ordinary stuff of any business: packaging, marketing, distribution, research and development. “Crack has grown because of new marketing techniques,” says Jim Hall, executive director of Up Front, a national drug-information center based in Miami. “When the yuppies were buying cocaine, they bought it in somebody’s apartment, usually at prices of at least $50. The crack user buys it on the street or at a crack den in a vial that costs $10. This less-expensive alternative is what has brought cocaine to a whole new user group in the poverty pockets.” It’s not unlike the single-serving marketing strategy that has been successfully adopted by the food industry.

Arguably the strongest regulator of drug use is the public’s perception of a drug’s safety. America’s first epidemic of cocaine abuse a century ago began when doctors had only good things to say about it. In 1884, Sigmund Freud wrote in Uber Coca that “The psychic effect of cocaine consists of exhilaration and lasting euphoria which does not differ from normal euphoria of a healthy person . . . . Absolutely no craving for further use of cocaine appears after the first or repeated taking of the drug.” Thirty years later, the U.S. Congress passed the Harrison Act, designed to restrict severely traffic in opiates and cocaine, which by then had come to be considered serious public health hazards.

Cocaine’s perceived risks have followed much the same trajectory in its second epidemic. As recently as 1985, psychiatrist Lester Grinspoon and lawyer James B. Bakalar wrote in a chapter of The Comprehensive Textbook of Psychiatry that “High price still restricts consumption for all but the very rich, and those involved in trafficking. . . . If used moderately and occasionally, cocaine creates no serious problems.” In that same year, the University of Michigan’s annual survey of high-school students and young adults found that only 34% believed that trying cocaine once or twice was a “great risk.” By 1987, amidst thundering anti-drug news in the national media, that proportion had jumped to 47.9%, and by 1988 more than half of those polled thought that even experimenting with cocaine was very risky. “The perceived risks have shifted enough that they could fully account for the shifts in use,” says Jerald G. Bachman, one of the survey researchers.

Drugs for the ’90s Even now, as the uproar of negative publicity about crack’s debilitating effects has checked its spread among middle-class users, another stimulant — a smokable, fastacting form of methamphetamine — has entered the drug scene in the West and, according to some experts, has begun moving eastward. Police officers in various areas have been seizing unprecedented numbers of clandestine methamphetamine laboratories, and there has been a sharp rise in both hospital emergency-room reports and deaths related to use of the stimulant.

In contrast to crack, which gained its foothold in the East and then began moving westward, methamphetamine seems to be a West Coast phenomenon. It also differs from crack in that “methamphetamine use tends to be highest among white, blue-collar types,” says Smith. “The clandestine labs tend to be controlled by the white biker gangs, while crack tends to be controlled more by inner-city blacks.”

The growth of methamphetamine seems to stem from the ease with which it is manufactured in secret labs. A drug that can be made here at home avoids the problem of smuggling across our increasingly patrolled borders. In addition, its effects are advertised as similar to those of cocaine, without the reputation for deadliness. Hall, of Up Front, says that the spread of methamphetamine “looms as a potential national drug crisis of the 1990s.”

The Empathy Drug

A case study in the progression of a new drug trend can be seen in the recent emergence of MDMA, better known as Ecstasy. First produced in 1914 but forgotten for years, the drug attracted the attention of psychotherapists in the ’70s because, besides its stimulant and mildly psychedelic qualities, it could also increase patients’ insight and empathy. “There’s very little question in my mind that it can facilitate insight-oriented psychotherapy,” says psychiatrist Lester Grinspoon.

By 1985, however, Ecstasy had become a recreational drug associated with a distinct type of music and dancing called “acid house” that originated on the Spanish island of Ibiza where wealthy people vacation. It served as a sort of new, improved brand of cocaine: It was exclusive, it provided the energy for dancing until dawn, it was allegedly “harmless,” and — perhaps most attractive — it made people not only want to talk — as most stimulants do — but also to listen.

Researchers quickly found, however, that Ecstasy can damage brain cells in animals, even in low doses that correspond to the dosages people use for recreation, and the DEA outlawed it for most purposes in 1985. Recently made illegal in most of Europe, it drew the kind of sensational headlines there last summer that crack had garnered in America. Yet that publicity failed to cross the Atlantic, and Ecstasy continues to enjoy a safe and exclusive image here.

“It’s a very white, very middle-class drug,” says Bill Brusca, general manager of The Tunnel, a popular Manhattan nightclub. “It’s not the kind of drug you’re going to hear a lot about, because it’s not habit-forming.”

But positive accounts such as these, says Nicholas Kozel of NIDA, “are similar to what was said about cocaine in the early ’80s. They’re looking for the safe drug, and we’re realizing that there isn’t any.” Even so, Kozel isn’t prepared to predict that Ecstasy abuse will reach epidemic proportions. “Forecasting is difficult,” he says, “and MDMA is an especially difficult drug to track.”

What Does the Future Hold?

Despite the advances in trend analysis for drug abuse, nobody seems prepared to forecast the future. Some-including, most notably, psychiatrist Jerome Jaffe, the country’s first “drug czar” under President Richard Nixon and the current head of federal addiction research efforts–are skeptical about our ability to make accurate predictions at all. Although he concedes that, without question, drug abuse follows a “trendy, fashionable popularity cycle,” he doesn’t believe we know enough about those cycles to predict what will happen next.

Historian Musto thinks that the most important trend is the decreased use of illegal drugs by the middle class that has cut through all of the various cycles since 1979. “We’re 10 years into a phase of growing intolerance toward drugs,” says Musto. “If history is a guide, it will take 20 to 30 more years for drug use to hit the nadir.” History is indeed a guide to Musto, who investigated long-forgotten documents on America’s first drug epidemic at the turn of the century for The American Disease. To him, the year-to-year shifts in drug use are all-but-imperceptible “blips” in our declining interest in illicit drugs.

According to Musto, “Crack seemed to be the ultimate drug problem, one so frightening that it crystallized our intolerance toward all drugs. It has created a consensus in society against drugs and ended the ambivalence that had been prevalent for decades.”

Musto fears that America’s turn against drugs could have serious social repercussions. “My concern is that as demand goes down in the middle class, instead of channelling efforts into long-term plans to help, people will get angrier and angrier at those in the inner city who still use drugs,” he explains. “If we triple the amount of money we spend to battle the drug problem and if we pass a death-penalty measure expecting to solve the problem in a year, we’ll only become frustrated by the results. The decline in drug use will be a long, gradual process. We’re going down a road, and we’ve still got a long way to go.”

A drug epidemic takes on a different character when it reaches the ghetto: There are more deaths–including the killing of innocent standers-by–and other tragedies such as addiction in newborns. Failure to recognize these people as victims, Musto says, and consequent failure to pursue aggresive public education and jobs programs, will only exacerbate an already difficult social problem.

Breaking the Cycle

Once this, America’s second drug epidemic, bottoms out, will we begin cycling inexorably into a third? Musto is willing to make one prediction: A society that forgets its history of abuse is doomed to repeat it. Unfortunately, says Musto, when America’s first cocaine epidemic began fading in the ’20s, “it became policy in the federal government to mention drugs as little as possible, and if they did mention them, to give descriptions so exaggerated and disgusting that no one would try them even once.” Many adults are familiar with the 1936 propaganda film Reefer Madness that was circulated in the late 1950s and became a cult favorite in the ’60s and ’70s. When the young people who experimented with drugs in the ’60s discovered that the exaggerations couldn’t be trusted, they discarded all cautions to explore the reality of drugs in earnest.

Tragically, America’s ahistorical attitude toward drug abuse continues to this day. “The Department of Education in California recently came up with a new syllabus of American history,” Musto says. “There’s no mention of the history of drug abuse. And in one place it lists drug abuse among the unacceptable topics for history electives. The largest education system in America gives no space on its syllabus for the important history of drug abuse in the United States.”

In Musto’s opinion, “The history of drugs and alcohol should be integrated into American history. If people had had a vivid knowledge of the first cocaine epidemic, the second epidemic might have taken a different route.”

As we live with the fallout of America’s second great drug-abuse epidemic in decline, a national commitment to remember the toll it has taken may be the only way to avoid a third.

COPYRIGHT 1989 Sussex Publishers, Inc.

COPYRIGHT 2004 Gale Group