The Demonization of Heroin by Bruce Alexander: Infamy and Reality

Historically heroin is not the only drug that has been vilified, and drug use in various forms, far from being an affliction of modernity, may be considered a cultural universal. According to Bruce Alexander, the demonization of substances is a modern reinvention of the medieval phenomenon of demon possession, and heroin addiction therefore a kind of myth. His perspective explains the arbitrary nature of changing cultural perceptions of drugs. Specifically which substance is demonized is of little import: - myths exist to provide social guidance, and the drug myth, like that of diabolic possession, demonstrates what shall become of us should we yield to temptation and stray from the narrow path. Such narratives predate heroin, and indeed modernity: - stories from Greek mythology to fairy tales of the old world convey a common message. However, while the heroin myth may be allegorical, this does not imply that it is false. Heroin is clearly a dangerous substance and is responsible for countless deaths and incalculable damage. But neither does the myth implies that heroin is at some fundamental level the worst drug. For a more objective answer to our question, we may need to consider a more empirical approach.

To isolate the ‘worst’ drug it is necessary to clarify what we mean by ‘worst’, so let us attempt a rather facile definition - ‘the drug that kills most people’. Tobacco is responsible for the majority of drug-related deaths and according to UK government statistics causes four times as many deaths as alcohol and all other drugs combined. This definition, however, ignores multiple factors such as harm caused to other people and to society in general, as well as non-lethal side-effects such as damage to mental health and associated problems such as violence and disease. One of the most noteworthy attempts to objectively rank drugs in terms of overall detrimental effect has come from British neuropsychopharmacologist David Nutt, whose studies endeavor to cut through the fog of popular perception and arbitrary assumptions of government litigation, and whose controversial paper ‘Development of a rational scale’ led to his dismissal from the Advisory Council on the Misuse of Drugs. Using data from a wide range of sources and a panel of psychiatrists and independent experts, this paper concluded that heroin was indeed the worst drug. However, his later, more nuanced study concluded that alcohol is most detrimental overall, principally because of the damage it does to others, with crack cocaine followed by heroin as the most harmful to the users themselves. Although his foolhardy approach has perhaps undermined his influence, Nutt’s work confidently demonstrates the flawed nature of the governmental classification system and argues strongly for a re-appraisal of this system. But colorful bar graphs and bold scatter charts present an image which perhaps belies the nuanced complexity of the reality. Factors such as long-term mental health problems may be impossible to evaluate, and as Nutt himself agrees, more work is needed on issues such as polydrug and pharmaceutical drug use . Perhaps more relevant to our question, his a-posteriori approach evaluates the effects of drugs in present-day society, effects which are at least partially due to this context.

Heroin may be widespread, but its illegal status and reputation as 'the demon drug', ensure that the great majority of the population never use it, or even encounter it first-hand. Alcohol, by contrast, is freely available and socially acceptable throughout most of the Western world. Whilst binge drinking culture amongst young people is apparently in decline, it remains associated with a kind of harmless hedonism and, despite its well-documented risks, is an important part of the social life of many. For older people, alcohol consumption may be as much an obligation as a choice, provided one is not driving or ‘on the wagon’, and there is evidence that middle-aged people now drink more than young. The violence inducing effects of alcohol is clearly exacerbated by the context of its consumption, often in public places and with strangers. By contrast, the nature of heroin is to be consumed secretly, if not solitarily, and its highly illegal status and associated stigma make discretion a priority for the user. While needles carry a risk of lethal overdose and transmission of HIV and other diseases, alcohol consumption increases the risk of STDs and damage from loss of control. So while multiple complex factors contribute to the detrimental effect of substances, it is clear that the importance of context should not be underestimated.

According to Bruce Alexander, it is this disregard of context which has led to the popular claim that heroin is almost supernaturally addictive, a claim refuted by two studies from the 1970s. The first, by Lee Robins et al, observed that heroin using American troops returning from the Vietnam War had little inclination to keep using the drug. The second, by Alexander himself, popularly known as the Rat Park experiment, used a very different methodology to reach a broadly similar conclusion. Alexander’s study found that lab rats which became quickly addicted to morphine when isolated had little inclination to continue using it when in a comfortable environment in the company of other rats. These studies offered proof of the contextual aspect of addiction, suggesting a focus on sociological rather than bio-medical approaches to rehabilitation. But like all studies, their proofs are imperfect and incomplete, and both have been widely criticised. The conclusions of the Rat Park experiment have been oversimplified for popular appeal, and later similar experiments yielded inconsistent results. Rat Park remains a source of much 3controversy and has been accused of ‘still spreading bad ideas’ 38 years after it was conducted. Lee Robins’ findings were undermined by the fact that many of the soldiers she studied were occasional rather than frequent heroin users, and were apparently less successful in quitting other, more common illicit drugs. Furthermore, Robins’ comparison with American heroin addicts who had been addicted for a greater timespan was misleading.

In popular imagination, heroin withdrawal is a hellish experience, another claim which is refuted by Bruce Alexander who describes it as uncomfortable and unpleasant, but hardly unbearable. In support of this claim, Alexander cites the experience of listening to a speaker whose only manifest symptoms of withdrawal were his persistent sniffle and tired demeanor. However, this point of view tends to conflict with ethnographic evidence. Bourgois’ graphic description of a ‘dope sick’ addict who “succumbed to extraordinarily painful seizure-like vomiting” after only a few hours without heroin paints a very different picture. His interlocutors’ desperation to use despite their awareness of the risk to health and personal safety also seems to uphold the notion that users will indeed go to any lengths to support their addiction. Furthermore, innumerable personal accounts of heroin use from Burroughs’ ‘Junkie’ to more contemporary offerings such as ‘The Recovering’ tend to concur. 

Although such memoirs are perhaps created for popular appeal rather than scientific accuracy, they may offer insights beyond the scope of anthropologists. While intrepid ethnographers have experimented with heroin, few if any have become regular users and experienced first-hand the highs and lows of the long-term heroin addict. Ethnographic accounts have been accused of focussing on the extreme side of heroin abuse, and have perhaps offered a little contribution to the prevention of addiction. They do however offer a participant eye view of human experience which observations of lab rats, or interviews with war veterans cannot. Alexander Bruce talks with authority about the effects of heroin withdrawal but has never (we presume) experienced it himself. Nonetheless, ethnographical evidence does seem to corroborate one aspect of Alexander’s hypothesis: - that heroin addicts are generally not out of control or ‘chaotic’. Bourgois notes that although heroin addicts are liable to steal from each other, they are curiously tolerant of such trespasses and frequently well organized in their pursuit of heroin. Among heroin-using sex workers, Frenken et al observe similar behavior patterns, and David Moore notes that addicts are capable of being calculated and manipulative and calls for a redefinition of the term ‘chaotic’ itself. So, if there is some veracity in the suggestion that users are intelligent and lucid rather than crazed and unpredictable, or indeed that heroin withdrawal is no worse than the mild flu, why is heroin continually perceived as so addictive?

The critical role that context plays in addiction is by now abundantly clear, and perhaps apparent in the common ground between sociological, ethnographic, and biomedical studies of addiction. This can be seen in the work of Alexander and Robins’ as well as ethnographies such as Frenken et al, which demonstrate that heroin use is an effect rather than a cause of women entering the sex work industry. The biomedical model takes a more deterministic approach to addiction. According to Leshner, continued drug use flips a ‘metaphorical switch’ which causes addicts to keep using, yet he agrees that social context is also a factor in addiction. However, despite this weight of evidence, context is frequently overlooked in treatments.

Fashionable celebrities may flirt with addiction, then go through rehab and appear in magazine articles, but their circumstances are unrepresentative. The experience of detox in an exclusive clinic with clean beds, good food and helpful medicines is not relatable to that of the street addict. Resisting heroin is far harder for a person who is living in greatly reduced circumstances, and whose problems, themselves a catalyst for addiction, have grown exponentially as a result of it. There are perhaps good, if cynical, reasons for the dominance of the bio-medical model: - in a neoliberal system that emphasizes maximum productivity and profit, it allows for swift diagnosis and treatment, and creates an income for pharmaceutical companies and private care providers rather than expenses for government bodies. Certainly, welfare states may provide help in the form of social assistants and rehabilitation centers, but these are invariably hampered by long waiting lists, staff shortages, and lack of resources. Perhaps more crucially they ignore what may be the most difficult challenge for the recovering addict, that of continued abstinence. It is far easier to abstain when wealth allows mobility and choice than when circumstance forces you to be in a terrible place both physically and mentally and to associate with addicts and dealers.

Heroin clearly has a special status in society, yet attitudes towards it are often contrary. As much as it is demonised, it also holds a powerful attraction, and the protagonist of the heroin myth appears as a kind of anti-hero, both despised and revered. Meanwhile, the works of Alexander and Robins, misinterpreted and inconclusive as they may be, have provided a seductive rebuttal to the myth. They have created a kind of myth of their own and been triumphantly summarised in pub conversations as a kind of final proof of the relatively benign nature of heroin, and perhaps of the great conspiratorial nature of government. As for empirical scientific proof of the categorically addictive or otherwise harmful nature of heroin, it is impossible to draw concrete conclusions intertwined with its physical and sociological effects. 

Conjecture of heroin’s ‘true’ nature is therefore meaningless: - heroin is a part of society and cannot exist outside of this context. So in the final analysis, is heroin the worst drug? The answer must be yes, but this is precisely because society has made it so. As Alexander speculates, the heroin myth has become a kind of self-fulfilling prophecy: - the terrible and irresistible power it has perpetuates precisely because it is conceived as terrible and powerful. But it was not always so, and history teaches us that heroin may one day be superseded in its role. We can only speculate as to what will replace it and when. If current trends continue, perhaps alcohol or even the humble cigarette will take its place. Or, if Alexander is correct that heroin fulfills the same societal function as demon possession, then perhaps it will be replaced by some completely different entity. Whatever the case may be, heroin is a powerful drug with terrible personal and societal consequences. If the object of research into heroin use is to find effective ways to eliminate it, then it must be understood for what it is: - not the problem of an individual or tiny subset of society, but part of a vast and complex web which forms the fabric of society itself, and from which it cannot be unravelled or isolated.