In almost every case, you have to read between the lies. -- Angie Papadakis
The following is an excerpt from "Ain't Nobody's Business If You Do", by Peter McWilliams. It is a discussion between William F. Buckley, Jr. and Professor Gazzaniga (the Andrew W. Thompson Jr. Professor of Psychiatry [Neuroscience] at Dartmouth Medical School) which was originally published in the February 5, 1990, issue of the National Review.
Buckley: It is said that the drug crack is substantively different from its parent drug, cocaine, in that it is, to use the term of Professor van den Haag, "crimogenic." In other words a certain (unspecified) percentage of those who take crack are prompted to--well, to go out and commit mayhem of some kind. Is that correct?
Gazzaniga: No, not in the way you put it. What you are asking is: Is there something about how crack acts on the brain that makes people who take it likelier to commit crime?
Let's begin by making it clear what crack is. It is simply cocaine that has been mixed with baking soda, water, and then boiled. What this procedure does is to permit cocaine to be smoked. Now any drug ingested in that way -- i.e., absorbed by the lungs--goes more efficiently to the brain, and the result is a quicker, more intense experience. That is what crack gives the consumer. But its impact on the brain is the same as with plain cocaine and, as a matter of fact, amphetamines. No one has ever maintained that these drugs are "crimogenic.'
The only study I know about that inquires into the question of crack breeding crime reports that most homicides involving crack were the result NOT of the use of crack, but of dealer disputes. Crack did not induce users to commit crimes. Do some crack users commit crimes? Of course. After all, involvement in proscribed drug traffic is dangerous. Moreover, people who commit crimes tend to use drugs at a high rate, though which drug they prefer varies from one year to the next.
Buckley: You are telling us that an increase in the use of crack would not mean an increase in crime? Gazzaniga: I am saying that what increase there would be in crime would not be simply the result of the pharmacology of that drug. Look, let's say there are 200,000 users/abusers of crack in New York City--a number that reflects one of the current estimates. If so, and if the drug produced violent tendencies in all crack users, the health-care system would have to come to a screeching halt. It hasn't. In fact, in 1988 the hospitals in New York City (the crack capital of the world) averaged only seven crack- related admissions, city-wide, a day. The perception of crack-based misbehavior is exaggerated because it is the cases that show up in the emergency rooms that receive public notice, and the whole picture begins to look very bleak. All of this is to say: when considering any aspect of the drug problem, keep in mind the matter of selection of evidence.
It is prudent to recall that, in the past, dangerous and criminal behavior has been said to have been generated by other drugs, for instance marijuana (you remember "Reefer Madness"?). And bear it in mind that since cocaine is available everywhere, so is crack available everywhere, since the means of converting the one into the other are easy, and easily learned. It is important to note that only a small percentage of cocaine users actually convert their stuff to crack. Roughly one in six.
Buckley: Then would it follow that even if there were an increase in the use of crack, the legalization of it would actually result in a decrease in crime?
Gazzaniga: That is correct.
Buckley: Isn't crack a drug whose addictive power exceeds that of many other drugs? If that is the case, one assumes that people who opt to take crack do so because it yields the faster and more exhilarating satisfactions to which you make reference.
Gazzaniga: That is certainly the current understanding, but there are no solid data on the question. Current observations are confounded by certain economic variables. Crack is cheap--
Buckley: Why? If cocaine is expensive, how can crack be cheap?
Gazzaniga: Cocaine costs $1,000 per ounce if bought in quantity. Once ounce can produce one thousand vials of crack, each of which sells for $5. The drug abuser is able to experience more drug episodes. Crack being cheap, the next high can come a lot more quickly and since there is a down to every up, or high, the cycle can become intense.
So yes, crack is addictive. So is cocaine. So are amphetamines. The special punch of crack, as the result of going quickly via the lungs to the brain, may prompt some abusers to want more. By the way, it is the public knowledge that crack acts in this way that, as several studies document, causes most regular cocaine users to be cautious about crack. The casual- to-moderate user very clearly wants to stay in that category. So, all you can say is that there is a *perception*, widely shared, that crack is more addictive. Whether it is, isn't really known. One thing we do know is that crack does not begin to approach tobacco as a nationwide health hazard. For every crack-related death, there are three-hundred tobacco-related deaths. Another example of hyperbole is the recent claim that there were 375,000 "crack babies" born last year; how could that possibly be, when the government (the National Institutes on Drug Abuse) informs us that there were only 500,000 crack "users" last year? Exaggeration and misinformation run rampant on this subject.
Buckley: Well, if crack were legally available alongside cocaine and, say, marijuana, what would be the reason for a consumer to take crack?
Gazzaniga: You need to keep your drug classifications straight. if your goal were, pure and simple, to get high, you might try crack or cocaine, or some amphetamine. You wouldn't go for marijuana, which is a mild hallucinogen and tranquilizer. So, if you wanted to be up and you didn't have much time, you might go to crack. But then if it were absolutely established that there was a higher addiction rate with crack, legalization could, paradoxically, diminish its use. This is so because if cocaine were reduced to the same price as crack, the abuser, acknowledging the higher rate of addiction, might forgo the more intensive high of crack, opting for the slower high of cocaine. Crack was introduced years ago as offering an alluring new psychoactive experience. But its special hold on the ghetto is the result of its price. Remember that--on another front--we know that 120- proof alcohol doesn't sell as readily as 86 proof, not by a long shot, even though the higher the proof, the faster the psychological effect that alcohol users are seeking.
Buckley: Is there evidence that the current consumption of drugs is restrained by their illegality? We have read that ninety million Americans have experimented, at one time or another, with illegal drugs. Would more than ninety million have experimented with them if drugs had been legal?
Gazzaniga: I think illegality has little if anything to do with drug consumption--and, incidentally, I am certain that far more than ninety million Americans have at some point or other experimented with an illegal drug.
This gets to the issue of actual availability. Drugs are everywhere, simply everywhere. In terms of availability, drugs might just as well be legal as illegal. Now it has been argued that legalization will create a different social climate, a more permissive, more indulgent climate. It is certainly conceivable, primarily for that reason, that there would be greater initial use--the result of curiosity. But the central point is that human beings in all cultures tend to seek out means of altering their mental state, and that although some will shop around and lose the powers of self-discipline, most will settle down to a base rate of use, and a much smaller rate of abuse, and those rates are pretty much what we have in the U.S. right now.
Buckley: Then the factor of illegality, in your opinion, does not weigh heavily? But, we come to the critical question, if ninety million (or more)Americans have experimented with the use of drugs, why is drug abuse at such a (relatively) low level?
Gazzaniga: If you exclude tobacco, in the whole nation less than 10 per cent of the adult population "abuses" drugs. That is, 9 to 12 million adult Americans abuse drugs. That figure includes alcohol, by the way, and the figure remains fairly constant.
Consider alcohol. In our culture alone, 70 to 80 percent of us use alcohol, and the abuse rate is now estimated at 5 to 6 per cent. We see at work here a major feature of the human response to drug availability, namely, the inclination to moderation. Most people are adjusted and are intent on living productive lives. While most of us, pursuing that goal, enjoy the sensations of euphoria, or anxiety reduction, or (at times) social dis- inhibition or even anesthesia, we don't let the desire for these sensations dominate our behavior. Alcohol fills these needs for many people and its use is managed intelligently.
It is worth nothing that the largest proportion of this drug is sold to the social drinker, not the drunk, just as most cocaine is sold to the casual user, not the addict. Now, early exposure to alcohol is common and inevitable, and youthful drinking can be extreme. Yet studies have shown that it is difficult to determine which drunk at the college party will evolve into a serious alcoholic. What is shown is that the vast majority of early drinkers stop excessive drinking all by themselves. In fact, drug use of all types drops off radically with age.
Buckley: Wait a minute. Are you telling us that there is only a 10 per cent chance that any user will become addicted to a drug, having experimented with it?
Gazzaniga: The 10 per cent figure includes all drugs except tobacco. The actual risk for abuse for some drugs is much lower. Consider last year's national Household Survey (NHS) which was carried out by the National Institutes on Drug Abuse.
Gazzaniga: It is estimated that some 21 million people tried cocaine in 1988. But according to the NHS only three million defined themselves as having used the drug at least once during each month preceding their interview. Most of the three million were casual users. Now think about it. All the cocaine users make up 2 per cent of the adult population, and the addicts make up less than one quarter of 1 per cent of the total popu-lation. These are the government's own figures. Does that sound like an epidemic to you?
Buckley: But surely an epidemic has to do with the rate at which an undesirable occurrence is increasing. How many more cocaine users were there than the year before? Or the year before that?
Gazzaniga: The real question is whether or not more and more Americans are becoming addicted to something. Is the rate of addiction to psycho- active substances going up? The answer to that is a flat no. Are fads during which one drug becomes more popular than another as the drug of abuse? Sure. But, when one drug goes up in consumption, others go down. Heroin use is down, and so is marijuana use. That is why the opiate and marijuana pushers are trying to prove their purity--so they can grab back some of their market share, which apparently they have done for heroin in New York City.
But having said that, you should know that the actual use of cocaine and all other illicit drugs is on the decline, according to the NHS. The just- published National High School Survey carried out by the University of Michigan reports that the same is true among high-school students. Crack is used at such a low rate throughout the country that its use can hardly be measured in most areas.
Buckley: Well, if low addiction rate is the rule, how do we come to terms with the assertion, which has been made in reputable circles, that over 40 per cent of Americans fighting in Vietnam were using heroin and 80 per cent marijuana?
Gazzaniga: Stressful situations provoke a greater use of drugs. Vietnam was one of them. But what happens when the soldiers come home? That point was examined in a large study by Dr. Lee Robbins at Washington University. During the Vietnam War, President Nixon ordered a study on the returning vets who seemed to have a drug problem. (Nixon didn't know what he was looking for, but he was getting a lot of flak on the point that the was producing a generation of drug addicts.) Dr. Robbins chose to study those soldiers returning to the U.S. in 1971. Of the 13,760 Army enlisted men who returned and were included in her sample, 1,400 had a positive urine test for drugs (narcotics, amphetamines, or barbiturates). She was able to retest 495 men from this sample a few months later. The results were crystal clear: Only 8 per cent of the men who had been drug positive in their first urine test remained so. In short, over 90 per cent of them, now that they were back home, walked away from drug use. And all of them knew how to get hold of drugs, if they had wanted them. Incidentally, Dr. Robbins did a follow-up study a couple of years later on the same soldiers. She reported that there had not been an increase in drug use.
Buckley: Aha! You are saying that under special circumstances, the use of drugs increases. Well, granted there was stress in Vietnam. Isn't there also stress in American ghettos?
Gazzaniga: If you live in poverty and frustration, and see few rewards available to you, you are likelier than your better-satisfied counterpart to seek the escape of drugs, although the higher rate of consumption does not result in a higher rate of addiction. Virtually every study finds this to be the case with one possibly interesting twist. A recent Department of Defense study showed that drug use in the military was lower for blacks than for whites, the reverse of civilian life. (It is generally agreed that the military is the only institution in our country that is successfully integrated.) In short, environmental factors play an important role in the incidence of drug use.
Buckley: So you are saying that there are social circumstances that will raise the rate of consumption, but that raising the rate of consumption doesn't in fact raise the rate of addiction. In other words, if 50 per cent of the troops in Vietnam had been using crack, this would not have affected the rate at which, on returning to the U.S., they became addicted. They would have kicked the habit on reaching home.
Gazzaniga: That's the idea. Drug consumption can go up in a particular population, fueled by stress, but the rate of addiction doesn't go up no matter what the degree of stress. Most people can walk away from high drug use if their lives become more normal. Of course, the stress of the ghetto isn't the only situation that fuels high drug consumption. Plenty of affluent people who for some reason or another do not find their lives rewarding also escape into drugs.
Buckley: If it is true, then, that only a small percentage of those who take crack will end up addicted, and that that is no different from the small percentage who, taking one beer every Saturday night, will become alcoholics, what is the correct way in which to describe the relative intensity of the addictive element in a particular drug?
Gazzaniga: That is an interesting question and one that can't satisfactorily be answered until much more research is done. There are conundrums. Again, it is estimated that 21 million people tried cocaine in 1988. Yet, of those, only 3 million currently use it, and only a small percentage are addicted. As for crack, it is estimated that 2.5 million have used it, while only a half million say they still do, and that figure includes the addicted and the casual user. Some reports claim that as many as one half of crack users are addicted. As I have said, crack is cheap, and for that reason may be especially attractive to the poor. That is a non- pharmacological, non-biological factor, the weight of which we have not come to any conclusions about. We don't even have reliable data to tell us that crack creates a greater rate of addiction than, say, cocaine. My own guess is it doesn't. Remember that the drug acts on the same brain systems that cocaine and amphetamines do.
Buckley: To what extent is the addictive factor affected by education? Here is what I mean by this: Taking a drug, say heroin or cocaine or crack - or, for that matter, alcohol - is a form of Russian roulette, using a ten-cartridge revolver. Now, presumably, an educated person, concerned for his livelihood, wouldn't take a revolver with nine empty cartridges and one full cartridge, aim it at his head, and pull the trigger. But granted, decisions of that kind are based on ratiocinative skills. And we have to assume these skills don't exist even among college students. If they did, there would be no drinking in college, let alone drug taking. Comments?
Gazzaniga: Most people perceive themselves as in control of their destiny. They do not think the initial exposure will ruin their lives, because of their perceived self-control, and they are right. Take the most difficult case, tobacco -- the most highly addictive substance around. In a now classic study, Stanley Schachter of Columbia University formally surveyed his highly educated colleagues at Columbia. At the same time, he polled the working residents of Amagansett, a community on Long Island where he summered. He first determined who were ongoing smokers, and who had been smokers. He took into account how long they had smoked, what they had smoked, and all other variables he could think of.
It wasn't long before the picture began to crystallize. Inform a normally intelligent group of people about the tangible hazards of using a particular substance and the vast majority of them simply stop. It wasn't easy for some, but in general they stopped, and they didn't need treatment programs, support programs, and all the rest. Dr. Schachter concluded, after this study, that it is only the thorny cases that show up at the treatment centers, people who have developed a true addiction. For those people, psychological prophylactics, including education, are of little or no value. Yet it is these people that are held up as examples of what happens when one uses drugs. This is misleading. It creates an unworkable framework for thinking about the problem. Most people can voluntarily stop using a psychoactive substance, and those people who do continue to use it can moderate their intake to reduce the possibility of health hazards. This is true, as I say, for most substances, but I repeat, less true for tobacco because of its distinctively addictive nature. The people who unwisely continue to use tobacco tend to smoke themselves into major illness even though they are amply warned that this is likely to happen.
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