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 …