20th Century: The Pendulum of Use, Abuse, Regulation and Subsitution

The Psychoactive Epidemic

Psychoactive drugs in the 20th century were to become, like many consumer items, globalised, commoditised, mass produced, marketed, regulated, licenced, but beyond all else, be consumed in variety and numbers higher than any other time in history.

Cocaine, a popular medicinal product of the late 19th century, had little therapeutic value once it’s highly addictive properties emerged. Its use in Western medicine was replaced by synthetic local anaesthetics such as benzocaine, proparacaine, lignocaine, and tetracaine throughout the early 20th century, although it remained available for use only under strict conditions of regulation. It continued to be used in ophthalmic and nasal surgery, and is still employed for this purpose in some countries (including Australia). (u)

Similarly, with huge advancement in the scientific understanding of physiology and pharmacology, alcohol as a medicinal agent, was largely replaced by other substances which had known specific actions in the body. However in its highly purified form of ethyl alcohol (ethanol)  it remained the principle solvent in many pharmaceutical preparations, and continued to be used in the extraction of active ingredients from plant substances. Many substances will dissolve only in ethanol and it acts as a preserving agent in many products. (v)

By the early 20th century, the primary use of both alcohol and cocaine had become recreational, the use of both was endemic and were creating social and health problems of near pandemic proportions.

Medical knowledge of addiction and alcoholism at the time was based on the mid 19th century theory of “degenerationism”, “that biological factors, toxic environmental influences or moral vices may trigger a cascade of social, moral and medical problems, which increase in each generation and will finally lead to the extinction of that family”. It was based on a pre Darwinian concept of acquired traits being passed on to the next generation and assumed that a whole host of different symptoms and diseases, such as impulsivity, alcoholism, strokes, dementia, microcephaly and epilepsy, were all expressions of one underlying pathology, degeneration.

Degenerationism therefore offered a medical explanation for the social problems which were so visible at the end of the 19th century, and excessive alcohol consumption played a crucial role in the concept, as it was seen as a vice which also affects the next generation. Temperance movements which had sprung up in several European countries and in the United States, and the Anti-Saloon League (US), were stimulated by the excessive consumption of liquor that appeared especially problematic among poor working class families during industrialization. As cocaine and other drugs became perceived as vices of the working class, they too were targeted by the temperance movement, which ultimately led to the prohibition of both alcohol and cocaine in the United States, and international agreements which banned the production, distribution and use of narcotics (which cocaine was incorrectly classified as at the time). In its most extreme form, degerationism led to the concept of eugenics in the US, and in Germany in the 1940’s, proposed medical procedures to reduce the fertility of acloholics.(w)

However, over the course of the 2oth century, the rapid increase in knowledge saw the formation of a disease concept of addiction which included the psychosocial and neurolobiological foundations and consequences of addiction. It also led to a growing understanding of it’s pathology and treatment options. (w) The US prohibition of alcohol came to an end in 1933 and subsequently, alcohol consumption became regulated much as it had been throughout history, through social and institutional regulation, and it’s harmful effects at both the individual and community level, were dealt with through better understanding and treatments developed throughout the latter half of the 20th century.

Cocaine, however, remained illegal. As to the reasons why one drug became illegal and the other didn’t, we leave that to another research project. However, having a look at the differing histories of the two drugs, maybe the simple fact that alcohol has been a part of our lives for millennia, familiarity became the driving force for our more moderate view of alcohol compared to that of cocaine.

Berlin Cocaine Dealer, 1920s

As a recreational drug, it has been experienced in two major epidemics. The first was from its discovery in the 1880’s until the 1940’s. Although it was no longer legally available, its use was still widely celebrated throughout the 1920’s but had dwindled by the end of the 1930’s. It became overlooked in the 1940’s by the introduction of a new class of psychoactive stimulant, discovered in the 1880’s but not commercialised until the mid 1930’s– amphetamines.

Amphetamines were sold without restriction over the counter in pharmacies in treatments for nasal congestion, dizziness, obesity and depression. Central nervous stimulants, these new psychoactive drugs were sometimes more than ten or twenty times more active than cocaine, less costly, they could improve concentration and IQ scores, and they were legal. In the form of “methamphetamine”, they were routinely dispensed to soldiers in WWII, by all sides, but as post war supplies of amphetamines flooded the markets, again the potential for addiction and deleterious side effects were seen and by the late 1960’s, these psychopactive stimulants too were added to the restricted lists in most countries.

By the early 1970’s a second wave of cocaine use arose, as amphetamine users switched to cocaine, and the changing social landscape brought a whole new youth inspired drug culture to the mainstream.

By the mid 1980s, “crack” cocaine was in use, and a new epidemic of addictions and social issues came to the fore. Crack is to cocaine what distilled spirits were to alcohol, more powerful, more intoxicating, more addictive and more dangerous, producing 15 deaths to every one attributed to cocaine.

A clear pattern of drug cycle emerges from the 20th century. A “new” wonder drug is marketed without the disadvantages observed in others, later their addictive or destructive capacity becomes evident, then after some years, their use becomes regulated or restricted. By the 1980’s these new drugs were invariably synthetic and regulations were put in place that covered the prohibition of this rapidly emerging class of “designer drugs”. The wide cocktail of available drugs now began to come and go , in and out of use depending on availability, purity, and law enforcement.

Against the background of  synthetic drugs from dubious sources, or questionable content, cocaine has emerged as being perceived as the safest and healthiest option for moderate recreational use, and in the latter years of the 20th century, there was a new resurgence of cocaine use which continues well into the 21st century.

To quote David Courtwright (Forces of Habit) “One thing, however, is not likely to change. It is the political awareness of the dangers of exposing people to psychoactive substances for which, it is increasingly clear, they lack evolutionary preparation. Psychoactive technology, like military technology. has outstripped natural history”.