Intoxication: Self, State and Society 9783031191701, 9783031191718, 3031191706

Table of contents :
Acknowledgements
Contents
About the Authors
List of Figures
List of Tables
1 Introduction to Intoxication: Self, State and Society
Introduction
Why Study Intoxication?
What Are Drugs?
Measuring Intoxication
How to Use This Book
The Structure of This Book
References
2 Historical Origins and Emergence of Intoxication
Introduction
Intoxication in the Pre-modern Age
Modernity and Intoxication
Intoxication in the Twentieth Century
Summary
References
3 The Regulation and Control of Alcohol
Introduction
Alcohol Legislation: Historical Context
The ‘Noble Experiment’: American and the Prohibition of Alcohol
Prohibition in Muslim Majority Countries
The Price of Drink: Regulating the Alcohol Availability and Demand
Alcohol and Crime
‘Please Drink Responsibly’?: The Problem of Moderation
Summary
References
4 The Regulation and Control of Drugs
Introduction
The Origins of Drug Prohibition
UN Conventions
The Misuse of Drugs Act
Prohibition as the ‘War on Drugs’
Prohibition 2.0
Decriminalisation and Legalisation Debates
Summary
References
5 Theorising Intoxication
Introduction
Physiological Explanations of Intoxication
Social and Cultural Explanations of Intoxication
From Deviance to Subcultures
The Normalisation Debate
Intoxication for Pleasure, Profit and Identity
Summary
References
6 Addiction, Treatment and Recovery
Introduction
The Invention of Addiction
The Criminalisation of Addiction
Types of Treatment
Abstinence Approaches (12 Step, Self Help)
Therapeutic Communities
Opiate Substitution Therapy
Public Health and Harm Reduction Approaches
Behaviour Change Approaches
Summary
References
7 Representing Intoxication
Introduction
Why Representations of Intoxication Matter?
Historical Representations
Representing Drugs in the Twentieth Century
Celebrities and Addiction
Advertising, Alcohol and Drugs
‘Binge Drinking’ and UK Media Representations of Intoxication
Media and Morality: Shock and Disgust
Summary
References
8 Intoxication Across the Life Course
Introduction
Coming of Age Through Intoxication
Intoxication in Adulthood
Intoxication in Later Life
Alcohol and Drug-Related Deaths
Summary
References
9 Intoxication, Gender and Sexuality
Introduction
Gendering Intoxication
The Feminisation of Intoxication
Alcohol, Drugs and Sex
Queering Intoxication
Summary
References
10 Intoxication, Ethnicity, Faith and Nation
Introduction
Drinking Nations and National Drinking Cultures
The Racist Origins of Drugs Prohibition
Contemporary Racism and the War on Drugs
Intoxication, Identity and Inequality
Summary
References
11 Intoxication by Design
Introduction
New Psychoactive Substances (NPS)
Image and Performance Enhancing Drugs
The Pharmaceutical Society
Summary
References
12 Conclusion: Intoxication and Its Futures
Introduction
Self, State and Society: Revisiting the ‘Scales’ of Intoxication
The Futures of Intoxication
References
References
Index

Citation preview

THOMAS THURNELL-READ MARK MONAGHAN

SELF, STATE AND SOCIETY

Intoxication

Thomas Thurnell-Read · Mark Monaghan

Intoxication Self, State and Society

Thomas Thurnell-Read School of Social Sciences and Humanities Loughborough University Loughborough, UK

Mark Monaghan School of Social Sciences and Humanities Loughborough University Loughborough, UK

ISBN 978-3-031-19170-1 ISBN 978-3-031-19171-8  (eBook) https://doi.org/10.1007/978-3-031-19171-8 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cover image © Andrey Korshenkov This Palgrave Macmillan imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Acknowledgements

We would like to express our gratitude to the editorial and production teams at Palgrave Macmillan who have supported this book from its initial inception to publication. Specific thanks go to Josie Taylor, Sarah Hills. We also thank Amanda Atkinson, Steve Case, Laura Fenton, Will Haydock and Henry Yeomans for their useful and insightful comments on chapter drafts. Of course, any errors that remain are down to us. Lastly, and perhaps most importantly, acknowledgement and thanks are also due to our students on various modules at the Universities of Leeds, Birmingham, Coventry and Loughborough through which we have developed teaching materials. Our experiences of teaching students on these modules and the opportunities for discussions involved have shaped the ideas in the chapters in this book and we are extremely grateful. Our hope is that further cohorts of teachers and students benefit from reading and discussing this text and that this can further their own understanding of alcohol and drugs and their place in society.

v

Contents

1

Introduction to Intoxication: Self, State and Society. . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Why Study Intoxication? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . What Are Drugs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Measuring Intoxication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . How to Use This Book. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Structure of This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 1 2 7 11 14 15 17

2

Historical Origins and Emergence of Intoxication . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intoxication in the Pre-modern Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Modernity and Intoxication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intoxication in the Twentieth Century . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

19 19 22 25 34 40 41

3

The Regulation and Control of Alcohol . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alcohol Legislation: Historical Context. . . . . . . . . . . . . . . . . . . . . . . . . . The ‘Noble Experiment’: American and the Prohibition of Alcohol. . . . Prohibition in Muslim Majority Countries. . . . . . . . . . . . . . . . . . . . . . . . The Price of Drink: Regulating the Alcohol Availability and Demand. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alcohol and Crime. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘Please Drink Responsibly’?: The Problem of Moderation. . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43 43 44 47 53 54 58 62 64 65 vii

viii

Contents

4

The Regulation and Control of Drugs. . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Origins of Drug Prohibition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . UN Conventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Misuse of Drugs Act. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prohibition as the ‘War on Drugs’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Prohibition 2.0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Decriminalisation and Legalisation Debates . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

69 69 70 76 77 81 86 89 90 92

5

Theorising Intoxication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Physiological Explanations of Intoxication . . . . . . . . . . . . . . . . . . . . . . . Social and Cultural Explanations of Intoxication. . . . . . . . . . . . . . . . . . . From Deviance to Subcultures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Normalisation Debate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intoxication for Pleasure, Profit and Identity. . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

97 97 98 100 102 107 117 119 121

6

Addiction, Treatment and Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Invention of Addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Criminalisation of Addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Types of Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Abstinence Approaches (12 Step, Self Help). . . . . . . . . . . . . . . . . . . Therapeutic Communities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Opiate Substitution Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Public Health and Harm Reduction Approaches. . . . . . . . . . . . . . . . Behaviour Change Approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

125 125 128 133 134 135 138 140 141 146 147 149

7

Representing Intoxication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Why Representations of Intoxication Matter?. . . . . . . . . . . . . . . . . . . . . Historical Representations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Representing Drugs in the Twentieth Century. . . . . . . . . . . . . . . . . . . . . Celebrities and Addiction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

153 153 154 155 158 165

Contents

ix

Advertising, Alcohol and Drugs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ‘Binge Drinking’ and UK Media Representations of Intoxication. . . . . . Media and Morality: Shock and Disgust . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

166 169 172 175 177

8

Intoxication Across the Life Course . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Coming of Age Through Intoxication. . . . . . . . . . . . . . . . . . . . . . . . . . . . Intoxication in Adulthood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Intoxication in Later Life. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alcohol and Drug-Related Deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

181 181 182 187 190 191 192 193

9

Intoxication, Gender and Sexuality. . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Gendering Intoxication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Feminisation of Intoxication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Alcohol, Drugs and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Queering Intoxication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

197 197 198 206 209 214 215 216

10 Intoxication, Ethnicity, Faith and Nation. . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Drinking Nations and National Drinking Cultures. . . . . . . . . . . . . . . . . . The Racist Origins of Drugs Prohibition . . . . . . . . . . . . . . . . . . . . . . . . . Contemporary Racism and the War on Drugs . . . . . . . . . . . . . . . . . . . . . Intoxication, Identity and Inequality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

221 221 222 225 228 230 234 236

11 Intoxication by Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Psychoactive Substances (NPS). . . . . . . . . . . . . . . . . . . . . . . . . . . . Image and Performance Enhancing Drugs. . . . . . . . . . . . . . . . . . . . . . . . The Pharmaceutical Society. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

239 239 240 243 248 252 254

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Contents

12 Conclusion: Intoxication and Its Futures. . . . . . . . . . . . . . . . . . . . . . . Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Self, State and Society: Revisiting the ‘Scales’ of Intoxication. . . . . . . . The Futures of Intoxication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

257 257 259 261 263

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265 Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

About the Authors

Thomas Thurnell-Read is a Senior Lecturer in Sociology in the School of Social Sciences and Humanities at Loughborough University, UK. His research on drinking culture has been published in leading international journals and he is a regular contributor to national and international media debates relating to pub culture, alcohol and drunkenness. He is the editor of Drinking Dilemmas: Space, culture and identity (Routledge, 2015) and Alcohol, Age, Generation and the Life Course (with Laura Fenton, Palgrave Macmillan, 2022). He was a founding member of the British Sociological Association (BSA)’s Alcohol Study Group. Mark Monaghan  is a Reader in Criminology in the School of Social Sciences and Humanities at Loughborough University, UK. He has also worked at the Universities of Birmingham and Leeds. His research mainly focuses on the links between research and policymaking. From September 2021 to August 2023, he is a Parliamentary Academic Fellow with the Parliamentary Office of Science and Technology. Influenced by realist methods, Mark has published widely on national and international drug policy as well as in the areas of youth justice and state crimes.

xi

List of Figures

Fig. 3.1 Fig. 4.1

Image 2.1 Image 6.1

Image 7.1 Image 7.2

Alcohol-Free Zone Sign in Liverpool, UK . . . . . . . . . . . . . . . . Twelve Supply Alternatives to Status Quo Prohibition (Caulkins et al., 2015). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

60 90

Bottle of ‘Forced March’ sold by Durroughs Wellcome & Co.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 AA chips showing duration of abstinence (6 months) and AA motto ‘To Thy Own Self Be True’ (Photo Jonn Leffmann) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 The Drunkards Progress by Nathaniel Currier (1846) . . . . . . . 157 Reefer Madness (1936) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

xiii

List of Tables

Table 6.1

Table 6.2 Table 6.3

Diagnosis of Alcohol Use Disorder (AUD) in the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). . . . . . . . 132 The twelve steps of AA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Key elements of harm reduction approach. . . . . . . . . . . . . . . . . 142

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1

Introduction to Intoxication: Self, State and Society

Introduction What images come to mind when you read the word ‘intoxication’? What behaviour do you associate with the word ‘drunk’? When you hear the word ‘drug’, does it recall images of smoke, of powder, tablets and needles? Do you imagine dilated pupils, slurred speech, grinding teeth or a semi-conscious fixed gaze? Who is it that you see? A good person? A fun person? Are they male or female? Young or old? Are they alone or surrounded by friends? What if we bring in the word ‘addict’? Do you now see someone different? Someone dangerous? Someone irresponsible? A broken person? A bad person? Do you trust this person? Is the person in need of help, of pity, or should they be punished? Now, think of yourself and who you are? How do you think your answers to these questions have been shaped by your upbringing, by the laws of the country where you live or by the words and images of the websites you read and the films you watch? How might someone of a different gender, age, generation, ethnicity, religion or political persuasion respond differently to these questions? Would they have greater tolerance, or be quicker to judge? The fact that we can ask these questions, and our hope that the realisation that answering them is far from straightforward, underpins the purpose and approach of this book. In it, we will explore the role of intoxication in contemporary society by examining the individual, group and institutional responses to the benefits and harms caused by particular intoxicants. We use the adjective ‘particular’ here in a deliberate way. It helps us think about the answer to the following question. What are these intoxicants? Look around you. Intoxicants and intoxication are everywhere and often go unnoticed or unremarked upon. A cigarette. A cup of coffee. A glass of beer or wine. Nicotine, caffeine and alcohol are all intoxicants, © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_1

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1  Introduction to Intoxication: Self, State and Society

albeit those benefiting from only rarely being called drugs. Drugs, of course, include many substances. They are naturally occurring, cultivated, manufactured and even designed. Often, they have been carefully selected and they are transported, packed, promoted and sold with specific promises: a certain effect on the human body, to transform how you feel, how you behave, how you perceive the world, perhaps to modify how you treat others or how they treat you. Answering these questions requires something more than a detailed knowledge of the chemical structures of specific intoxicating substances and understanding their physiological effects on the human mind and body. Those substances, to which there is rightly a vast amount of research dedicated to medical and clinical settings, only come alive in their use for diverse purposes, through the language used to describe them and their effects and through the dynamism with which they work themselves into the social and cultural fabric of certain contexts.

Why Study Intoxication? Intoxication has always been a social issue and histories of intoxication are social histories. That most of the major intoxicants that we now know as ‘drugs’ became illegal only in the early twentieth century but had far longer histories, often including periods of banal acceptance or even celebration, should immediately indicate to us that both drugs and the intoxication they induce in those ingesting them are subjects of their social and cultural context (Berridge, 2013). Alcohol ‘has accrued over the millennia a rich and almost infinitely diverse set of symbolic contexts in which it may be taken, whether the aim be celebratory, consolatory, medicinal, scholastic, sacramental or gastronomic’ (Walton, 2001: 5). Although many drugs have their origins in naturally occurring substances, they are rarely incorporated into human behaviour without being processed, but we also add meanings to them and build cultures around them in dynamic and creative ways. Intoxicants are, according to Hunt and Frank (2016: 331) ‘inherently social substances’ and ‘Intoxication is inherently and constantly a social practice governed by changing social and cultural norms and values’ (Hunt & Frank, 2016: 331). Whilst anthropologists mapped the cultural origins of drug use, social historians and sociologists have explained how the economies and cultures of drug taking have co-developed with social change. Thus, the ‘mods’ of the 1960s repurposed medical amphetamines to suite a subcultural pursuit of hedonistic pleasure (Wilson, 2008) whilst MDMA, first synthesised in a lab and initially promising to develop a therapeutic community around its use, later became irrev-

Why Study Intoxication?

3

ocably associated with the rave culture of the 1980s and early 1990s (Saunders, 1995). Intoxication has, at times, been seen as a menace to bourgeois society and a threat to the fabric of society, more generally (as in the late nineteenth century) as well as the cause and symptom of all society’s ills (Sournia, 1990). For example, as embedded in the cultural life of Britain as alcohol was both before and since, during World War I, alcohol and drunkenness were seen as threats to the national war effort and legislation sought to limit pub opening time, whilst even going as far as to outlaw ‘treating’ for the fear that soldiers would survive the horrors of the Western Front only to succumb to alcohol poisoning when bought a congratulatory drink by every resident of their village on their return. In the 1960s, the hippie counterculture that emerged from the Western US saw cannabis and LSD as having a revolutionary potential, liberating the individual and shaking suburban America out of the stifling conformity and conservatism of the post-war decades. Such examples demonstrate several things. First, that intoxication should be understood in the specific cultural and social context from which it arises and, second, that understanding intoxication, individual and group experiences of it and societal responses to it, is revelatory of other social issues and concerns which are often far reaching in their scope. Whilst Hunt and Frank (2016: 323) reflect, scholars and writers who have ‘focused on intoxication within its entirety, are in the minority’ (Hunt & Frank, 2016: 323), the cultural historian Stuart Walton (2001) goes as far as to suggest that ‘intoxicology’ could be its own field of academic study given the extensive presence of intoxicants and intoxication in historical and modern societies. Yet, there are a steadily increasing number of texts which address both alcohol and drugs. These include Bancroft’s (2009) Drugs, Intoxication and Society, Herring and colleagues’ (2012) Intoxication and Society: Problematic Pleasures of Drugs and Alcohol and, most recently, the excellent collection Cultures of Intoxication: Key Issues and Debates edited by Fiona Hutton (2020a, 2020b). For our purposes, intoxication addresses both alcohol and drugs and allows for a blurring or, better still a willing acceptance of the need to move between legal and illegal distinctions. Intoxication, then, has the potential to be a term or focus that can help to unify numerous scholarly tribes. Intoxication describes the physiological effects of intoxicants on the human body but also readily invokes the behavioural and interactional manifestations of those effects which are, typically, what animate the interest of scholars working from academic disciplines such as sociology, anthropology, criminology and youth studies. Intoxication can involve behavioural change that society often finds unsettling, but individuals find liberating. This tension between the individual and society

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1  Introduction to Intoxication: Self, State and Society

underpins a lot of social science, and the difficulty of disentangling the two without siding in a partisan fashion with polarised liberal and prohibitive positions prioritising either individual freedom or societal stability, respectively, is a task that many scholars of alcohol and drugs face. Intoxication is unequal, at least in who can achieve it with or without the freedom of moral or legal censure. Tolerance of the desire for intoxication varies dramatically based on the age, gender, sexuality, ethnicity and religion of the intoxicated person. Attitudes and responses to intoxication possess a revelatory mirror-like quality, holding up a looking glass to society and reflecting its prejudices and flaws. Part of the task of this book is to reflect on these puzzles and curiosities and to consider how the relationship between macro and micro dimensions (Beccaria & Prina, 2016) is part of the explanatory mix of how we have historically understood intoxication and how this knowledge has evolved over time and place. Indeed, each observed aspect of intoxicant use is a product of history, culture, social structure and attitudes, but is disguised in the concepts we use to describe them: ‘addiction, drug abuse, drunkenness, recreational drug use or medication and the catch-all “drugs” itself’ (Bancroft, 2009: 10). As we will see in the next chapter, but as succinctly stated by Pryce (2012: 6), ‘the contemporary use of the term “drug” is politically and morally loaded’ (Pryce, 2012: 6). Unpacking and understanding this, we contend, requires consideration of the interplay of three themes or areas of interest across a scale. These are: Self: A developed appreciation of intoxication requires an understanding of its relationship with the bundle of personal motivations, experiences and meanings that we might label the ‘self’. At regular points in the book, we suggest that a scholarly focus on intoxication necessitates insight into the lived experiences of individuals, for it is in their navigation of pleasures and harms, and both their conscious and unconscious integration of these into their lives and identities, that we can understand not just why an individual takes drugs or drinks alcohol but why they do in certain ways that may be accepted socially. We therefore follow Bancroft (2009: 20) who has made an important contribution in outlining an ‘intoxication order’ by which: a coding and arranging of intoxication by gender, geography, nationality, class, ethnicity, sex, sexuality, and form of governance, all of which are in and operate on the body of the user. These orders are partly encoded in the substance itself and partly in the conditions of its production and consumption.

Across the book we draw readily on the latest empirical insights into these questions of how, when and why people choose to become intoxicated and whether

Why Study Intoxication?

5

such moments are experienced as pleasurable, as an escape or as a shameful burden. Many of the examples we draw on across the book, but particularly in section “Why Study Intoxication?”, are chosen for the clarity with which they illustrate the stories of specific individuals or groups of people, for it is in these personal journeys that we can understand the richly layered meaning of intoxication. Addiction, for example, often stems from personal traumas and, for many, the experience of drug or alcohol dependency is a struggle with the inner self as much as the present conditions in which one lives. State: At the next level on our scale, the ‘state’—that is political entities such as governments and the institutions, organisations and bodies through which they mobilise resources and exert power and influence on the population—is a critical concern of any scholarship on intoxication. As we shall see on numerous occasions, it is the decisions made at state level that reposition a substance, and those who make, sell or use it, from one side of the line between legality and illegality to the other. The developments in state-initiated or, at least, state-endorsed regulation and control are subject of much of the most pressing discussion both within academia and amongst the various factions that make up the complex and often antagonistic public sphere in which debates about alcohol and drugs take place. Indeed, the shortcomings of state-led regulatory campaigns are seen in the failure of global prohibition and a ‘war on drugs’ that has cost vast amounts of money yet left illicit drugs remaining as one of the biggest industries in the world with drugs more widely available, in more forms and used in more situations (Pryce, 2012). It is at the level of state that the centrality of power, its unequal distribution, and the often-unintended consequences of its operation, become most visible. This is seen in the state provision of legal apparatus that not just punishes individual transgressors but may, one would hope, also defend, or remedy the catastrophic harms caused by intoxicating substances as seen, for example, in the ‘opioid crisis’ or the past decade and the legal class actions against pharmaceutical corporations who continued to manufacture, promote and generate huge profits from highly addictive opiate pain killers such as OxyContin. The state confers status and authority in a range of public and semi-public bodies to administer and regulate intoxicants and intoxication. City authorities, for example‚ can also facilitate intoxication by providing the infrastructure upon which a drunken night out takes place. From the 1980s onwards, what became known as the night-time economy gave city venues like bars, clubs and pubs a relative free rein to promote and ‘sell’ experiences of hedonistic intoxication, so long as they continued to create jobs and bring in money, any resulting law and order issues being largely seen

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1  Introduction to Intoxication: Self, State and Society

as an acceptable trade off to the greater good of rejuvenating the economies of down-at-heel post-industrial cities. Society: The final level of our scale is the most all-encompassing. At the level of society, attitudes to alcohol and drugs are upheld and maintained by shared cultures and practices and prohibition or regulations are most commonly justified by a desire to ‘protect’ society from harm. As a term, society draws together various social and cultural factors which, from our perspective, are a component of understanding alcohol and drugs without which only a partial and incomplete picture can be achieved. For an example of this, we need look no further than the proposed distinction between so-called ‘wet’ drinking cultures, such as those of southern Europe, which embed drinking alcohol into daily rhythms of family life but have a relatively low tolerance of overt drunkenness and the ‘dry’ drinking cultures of northern Europe where alcohol is formally restricted but when it is used tend to result in drunken excess and moments of cathartic excess we now readily term ‘binge drinking’. Intoxication frequently takes place within social settings and where cultural rituals and practices that transcend the individual exist. A good example of this is the normalisation thesis, which will be explored in more detail in Chapter 5, that contents that in the UK and many other countries of the Global North, recreational drug use amongst adolescents and young adults became so common place from the 1990s onwards as to be rendered ‘normal’, just another unremarkable feature of the way young people express themselves and seek out excitement and pleasure amongst friends. These changes do not happen without shifts in the cultural fabric of society and understanding them is incomplete without an appreciation of how the societal level not just frames but permeates all lived experiences of intoxication. We do not always stop to state that a particular point is being made about either the self, state or society. Indeed, there are few topics covered within this book that in some way bridge more than one, if not all three of the levels. This interplay is exactly our point. Our understanding of even the largest global issues is often advanced through the pursuit of nuanced insights at the micro level. Often banal and, on the face of it, everyday occurrences are products of complex histories and both cultural innovations and legacies which stem from and feed into broad social and cultural trends. The minutia of individual lived experiences of intoxication, such as an individual’s path into and struggles to climb out of addiction, can be apprehended at the same time as a wider frame considerate of big socio-economic and legal developments. In fact, these connections are an implicit element of much drug taking. Do a group of friends squeezing into the bathroom cubicle of a London nightclub to share lines of coke appreciate that moment as

What Are Drugs?

7

being part of a chain of action and consequences tracing back to both the destabilising conditions of the drugs cultivation, production and trafficking from South America into Europe? In what follows we try to recognise the multifaceted nature of intoxication. As Hutton (2020a) notes, one thing that has been consistent in reactions to intoxication has been the preponderance of media and public discourse to view it negatively. This is particularly so when it is seen as being part of the pursuit of pleasure. As this is so, Hutton (2020a: 5) states that ‘much of the literature on intoxication focuses on alcohol’ more specifically the effects of excessive consumption, but also following Hutton (2020b) we take a more rounded view focusing on both alcohol and other drugs. Another way of thinking about this is that intoxication can be viewed on a scale from minor, or what Keane (2020) refers to as micro-intoxication such as that obtained from smoking a cigarette or drinking coffee, through to more spectacular intoxications associated with alcohol and other drugs. Whilst not downplaying the significance of the minor, we tend towards the spectacular in our discussion.

What Are Drugs? This question is not as straightforward as it seems. According to the cultural historian, Mike Jay, the word drug came into use in England around 1400, probably from the word for dried goods (Jay, 2010: 54). In contemporary times, however, in pharmacology the classification of drugs is linked to or even determined by the nature of the effects of the drug on the user (Adapted from Bennett and Holloway [2005: 2]. Nutt (2012) explains how drugs are substances that modify the functions of a living organism. In humans, the effects of drugs can be seen in how they impact on the central nervous system and how they change a person’s mental state. In this sense drugs can be ‘Analgesics’ which act as painkillers. They can be ‘Stimulants’ that increase activity of the central nervous system to produce wakefulness, alertness and euphoria. Drugs can be ‘Depressants’ which subdue, depress or reduce the function of the nervous system to produce tranquillity and sleep. Drugs can also be ‘Hallucinogens’ which affect perceptions, sensations and emotions. It is also important, then, to state that alcohol is indeed also a drug. We can ask a series of other questions when looking at how to define drugs. Indeed, alongside classifying drugs by effect. We could also ask whether they are legal or illegal? Who makes or supplies them? Are they ‘natural’ or ‘chemical’? Who uses them and why? What are the risks and harms associated with their use, not

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1  Introduction to Intoxication: Self, State and Society

just for the user but for others and for society at large? We will be exploring these questions in this book. Of course, the tensions between scientific and legal definitions of drugs and how they shape, and influence legislation are not new. Again, we will explore some of these debates over the following chapters. For now, to return to the issue of psychoactivity. Long before discussions over the regulation of Novel Psychoactive Substances, Jay (2010) contended that psychoactivity alone is not the threshold for whether a substance becomes illegal. Other norms, values and social and cultural sanctions must be considered. Often these depend on the social standing of the users of specific substances. In Chapter 5 we return to these issues when we consider debates over for whom drug use has become ‘normalised’ and those for whom drug use is stigmatised. A long-standing and un-settled issue in debates concerning intoxication is what constitutes a drug and what constitutes a medicine. The legal and medical frameworks that frame these categories are of little help to us. In UK legislation, there are substances that are at the same time considered to be drugs and medicines and much depends here on the mode of acquisition and reasons for their use. Cannabis provides a case in point. Prior to 2018, it was officially seen, in legislation at least, as having no medicinal use. Cannabis is controlled under class B of the Misuse of Drugs Act. Alongside the Misuse of Drugs Act are the Misuse of Drugs Regulations 2001. Part of the purpose of the regulations is to determine which drugs controlled by the Act can be prescribed as medicines. The Regulations group substances from Schedules I to V. Schedule I substances are seen to have no medical value. Substances outside Schedule I are seen to have medicinal or therapeutic value, here the scheduling relates to the stringency of control and the context in which the substances can be obtained. Schedule II substances are available as medicines but can only be prescribed in controlled conditions. There have been periodic developments to the Regulations since 2001, yet a key moment (at least symbolically) came in 2018 with the passing of the 2018 Misuse of Drugs Regulations Amendment. This change concerned the status of cannabis and whether it could be seen to have medicinal properties. Until 2018, cannabis had been placed in Schedule 1. The 2001 Regulations alongside the Human Medicines Regulations of 2012 provide the legal framework on which the legitimacy of cannabis for medicine is established. The official legal term is ‘cannabis-based products for medicinal use in humans’. This is often shortened to medical cannabis or medicinal cannabis. In 2018, the regulations were amended. This was in response to some high-profile cases widely documented in the media concerning the lack of availability of cannabis in the UK as a treatment for rare

What Are Drugs?

9

forms of epilepsy in young people, cannabis-based medicines were rescheduled from Schedule I to Schedule II. This means that in law there is a tacit acceptance that cannabis can have medicinal and therapeutic properties, but this too is also to overstate the case. It is not strictly the case that cannabis can be used in medicine, but medicines derived from cannabis can in very restricted circumstances (see Monaghan et al., 2021). It also demonstrates the important role of the media in either reflecting or contributing to the ebb and flow of public opinion making changes in legal classifications challenging for the authorities. Debates over the distinction between drugs and medicines are frequently technical, but they are also of long-standing philosophical interest (see Alexander & Roberts, 2012). Seddon (2009) neatly summarises this by noting that ‘to label a substance a `drug’ is an evaluative rather than descriptive act, a form of decree which is usually `of a prohibitive nature’. As we have said, much depends on the social standing of the users. Seddon, goes on to note that: Prior to, or outside of, these evaluations, there exist simply plants and chemicals - whether naturally occurring, processed or entirely synthetic - which have a variety of properties when ingested by humans (poison, stimulant, sedative, nourishment, analgesic, hallucinogen, and so on). The different labels we attach to them are human constructions, some of which are legal in character, some not. Contrary to much public and political discourse on the matter, these labels are not settled or universal but, rather, are historically and culturally contingent, that is, they change over time and vary from place to place. (Seddon, 2009: 394)

The reflections made by Seddon have been brought into sharper focus as cannabis and other drugs less frequently have begun to make the journey from part of the repertoire of illicit drug user’s habits or pastimes to a more prominent part of the pharmacopeia. Cannabis has been used across the globe for millennia and for a variety of reasons (Matthews, 1999; Mills, 2003). The situations under which cannabis use is legitimate, at least in legal terms, varies across time and place and in recent decades cannabis has become widely available for both medicinal and non-medicinal purposes in various parts of the world. There have been experiments with alternative forms of control both recently, in the case of the UK, and longer, across the Americas, (e.g. Caulkins et al, 2016; Pacula & Sevigny, 2014) with the rationales for the (il)legality of both medicinal and non-medicinal use, focusing on therapeutic benefits and pleasurable freedoms, respectively, coming in and out of fashion and popular acceptance. In the US, marihuana or cannabis, to use its scientific name, had started to be used in a reasonably widespread way as an intoxicating substance in the early

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1  Introduction to Intoxication: Self, State and Society

twentieth century initially associated with the Mexican immigrant communities and then by the emerging jazz music subculture (Shapiro, 1988; Davenport-Hines, 2004). The pioneering work of Howard Becker (1963) attempted to bring a more nuanced understanding to the nature of cannabis smoking by considering the activity from the point of view of those who used it, rather than on the representations, often imbibed with misinformation and xenophobia, that had typified the era of Reefer Madness in the 1930s. Much of this misrepresentation of the harms of cannabis was driven by moral entrepreneurs such as Harry Anslinger, the erstwhile head of the Federal Bureau of Narcotics, who did more than anyone to cement the association between cannabis as a madness inducing drug making its users capable of acts of barbarity and brutality (Hari, 2015). Indeed, as we shall see in subsequent chapters, the racist ideologies and agendas framing the representation of cannabis and its users in twentieth-century America cast a long shadow over attitudes to drugs and their prohibition. Throughout history, however, claims of the harmful effects of cannabis have been met with proclamations of its potential medicinal uses and indeed, its use for pleasure. Duff (2008) notes how the pleasure associated with cannabis is not solely linked to its Dionysian effects. Although, as Becker (1953) had previously found, once users had come to recognise the effects of cannabis use, that the sensory pleasures it afforded its users was frequently the underlying reason for continued use. For Duff, pleasure is often part of the alleviation of suffering. The medicinal properties of cannabis are still emerging and its officially sanctioned use for conditions varies from jurisdiction to jurisdiction. Cannabis has, however, been seen to aid the alleviation of nausea and vomiting from chemotherapy, wasting in AIDS patients and chronic pain which have hitherto been unresponsive to treatment from opioids (Monaghan et al., 2021). The technicalities surrounding the protracted acknowledgement in the UK that cannabis could be a legitimate medicine are then not unique to the UK. The journey made by cannabis from illicit drug to a potentially accepted medicine with acknowledged therapeutic benefits for mind and body and over which control and expertise of the medical profession is increasingly powerful show the living, dynamic, processes which shape our understanding of any given substance. Knowledge about and acceptance of certain substances and both their use and acceptance of their use, as formally legal or not and socially accepted or stigmatised, can vary profoundly over time. As we see in the slow acceptance of medicinal cannabis, the benefits, medical or otherwise, and harms or risks of use of a substance such as cannabis are interrelated in complicated ways. These debates cannot be separated from longer standing ones over how we view intoxicants and whether they should be a criminal issue, a matter of health or one of

Measuring Intoxication

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morality. Indeed, we see at the outset how intoxicating substances are evasive of containment within a singularly legal, medical or cultural framing. Each intoxicant has its own complex history. Indeed, as Bancroft (2009) suggests, as a unifying and legible term, ‘drug’ is a modern concept, the retained common sense use of which belies a nuanced history whereby substances have moved in and out of such a categorical designation. Alcohol, for instance, has spent periods of ancient and modern history as both drug and non-drug, depending on the vagaries of scientific, political, religious and cultural opinion. Similarly, as we shall see, in the eighteenth and nineteenth centuries at a time when newly created substances like morphine and cocaine emerged, they were seen as not just respectable but sought after and even celebrated as the cutting edge of modern medicine with the potential to cure the many maladies of the body and of society at large.

Measuring Intoxication Measuring the prevalence of intoxication is not easy. Where drugs are concerned, it is a task made even more difficult by prohibition and criminalisation, which can lead to stigmatisation and obfuscation. As with most things that are either formally prohibited by law or informally censured and stigmatised by social norms and values, the use of intoxicants, particularly to excess or in manners which are seen as harmful to the individual and to others, are often hidden from view. This stigmatisation can spread to those researching the issue. There have been recent calls for drug policy researchers to ‘come out’ and acknowledge their own drug use (Ross et al., 2020). and to start to try and break down some of these barriers to knowledge. Indeed, Walton has noted that intoxication has cast ‘a long shadow of guilt’ lasting generations (Walton, 2001: 7), which makes the process of knowing about intoxication that much more challenging. Indeed, many readers of this book, whether students or scholars, are likely to have their own direct and extensive experiences of intoxication. Whilst we accept that many contexts in which this book will be read and discussed will not necessarily map onto a willingness to disclose such experiences, we do urge readers to put their own subjective experiences and opinions in dialogue with what they read over the coming pages. When we talk about prevalence, we are talking about the extent of drug use in any given society. We will look at some of the main methods in which this data is captured bearing in mind that because drug use is frequently a hidden activity. The word ‘frequently’ does a lot of heavy lifting here as it is not the case that all drug use is equally hidden. Alcohol use is, for example, normalised and socially and culturally sanctioned. We have, therefore, quite effective means of under-

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1  Introduction to Intoxication: Self, State and Society

standing the nature and extent of alcohol and its use in society and the harms that frequently relate to this. The same is not the case for all illicit substances. Although as we will see in Chapter 5, certain kinds of drug use are increasingly normalised for certain sections of the population at certain times, and, as Chapter 7 will examine, there is a long history of both overt and covert references to drugs and their use in popular culture, there are still difficulties in capturing the data on the nature and extent of illicit drug use. We do have measures for the harms associated with drug use through data collected by the substance misuse treatment system and, unfortunately, by coroners. In Chapter 2 we consider the origins of intoxication charting their role in rituals and social events throughout time and location. This sets up a discussion in the following chapters on the Great Regulatory Divide (Seddon, 2009). This refers to the way that some substances (cannabis, cocaine, heroin, etc.) fell on one side of the criminal law in terms of possession, cultivation, sale importation, exportation, etc., whilst others such as alcohol and tobacco, did not. Not only is this of historical curiosity, it has had a lasting impact on what we know about intoxication and why. Indeed, prohibiting certain substances and making their use more clandestine, means that the historical records of prevalence are at best estimates. In other words, it is difficult, if not impossible to know the true extent of drug use in contemporary society, let alone in the past. Drug possession therefore is one of the primary contributors to ‘the dark figure of crime’. This refers to the total amount of crime not reported to or recorded by the police. There can be a range of reasons as to why crimes may not be reported to the police. Many of these relate to the status of the victim. Indeed, most crimes come to the attention of the police when victims report them. Where substance misuse is concerned some of these are of particular importance. Low level drug possession of substances such as cannabis are often seen to be victimless crimes. The only offence being drug possession in which the supplier and consumer are, in most instances, complicit. These issues become particularly acute under the conditions of drug normalisation and, more specifically, the normalisation of what gets called social supply, whereby most people access drugs through existing networks of friendships and informal acquaintances rather than, as in many representations, a direct engagement with ‘dealers’ and other representatives of a criminal underworld (see Coomber et al., 2016). The normalisation of social supply refers to the situation in which most drug transactions take place between or within friendship groups or by friends of friends. It is unlikely that most current illicit drug users and suppliers ever encounter the Police as drug supply networks are shielded from policing through friendship

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ties and kinship. This is, of course, only one way in which drug supply can distort the data, but it gives a flavour as to why other methods for recording the extent of drug use in society have been developed. Overcoming some of the weaknesses of the official statistics is self-report data, which take the form of victimisation studies such as the Crime Survey for England and Wales CSEW). Even though drug possession often being seen as a victimless crime, the CSEW has been monitoring drug use under the aegis of the Home Office and more recently the Office for National Statistics. Previously known as the British Crime Survey, the CSEW, is a face-to-face victimisation survey. It currently asks approximately 43,000 respondents per annum, about their experiences of a range of crimes in the 12 months prior to the interview taking place. As the name suggests the CSEW gives only partial coverage of the UK as Scotland and Northern Ireland have their own versions The main aim of the CSEW is to provide robust trends for the crime types and population it covers; the survey does not aim to provide an absolute count of crime. The BSC/CSEW has been asking questions about drug use since 1992. Changes in methodology, from paper based to computer aided mean that comparisons and trends are more accurate from 1994 onwards (Ramsay & Percy, 1997). The CSEW is then a useful indicator of long-term trends. This is not to say that it has not been the subject of critique. Recent response rates to the survey range between 60 to 70%. Young (2016) has pointed out how such a significant non-response rate could ‘easily skew every finding’ that criminologists (and others) draw from the survey. Where drugs are concerned the issue is also one of sampling. As the CSEW is a household survey respondent from non-traditional households for example, students, the homeless and prisoners are likely to be missing from the sample, but heavily represented in the recent substance using population. Indeed, student drug use has become a pressing policy concern. Prison drug use has long been of concern to policymakers torn between the need to punish offenders and offer them treatment (Duke, 2003). These issues have become more acute in the aftermath of the emergence of novel psychoactive substances such as Spice—a synthetic cannabinoid—which has become increasingly widespread due to difficulties of detection in mandatory drug detection (Ralphs et al., 2017). Drug use amongst the homeless, meanwhile, continues to present a challenge to policymakers with this group suffering the ‘dual jeopardy’ (Neale, 2001) of substance use and insecure housing leading to poor outcomes such as premature death. The latter is partly explained by the homeless population being overrepresented in statistics of drug users with blood-borne viruses such as Hepatitis C (Neale, 2008).

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1  Introduction to Intoxication: Self, State and Society

Outside of criminal statistics such as the CSEW, other attempts to measure drug use and related statistics exist and, notwithstanding the difficulties described above in terms of measuring the extent of drug prevalence, there is now an established body of evidence that, at least, allows for general trends and patterns to be accepted with relative confidence. The Lisbon-based European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), for example, was established to ‘provide the EU and its Member States with a factual overview of European drug problems and a solid evidence-base to support the drugs debate’ whilst the Global Drugs Survey, produced by an independent research company based in London, ‘aims to make drug use safer, regardless of the legal status of the drug, by sharing information with individuals, communities, health and policy organisations’. Cannabis is by far the most popular illicit substance used and, according to the CSEW up to the year ending March 2020 in England and Wales close to a third of people aged between 15 and 64 will have used cannabis at some point in their life. There appears to be then a substantial drop off to other substances with 2.7% of UK adults having used cocaine in the past year and 9.1% having used ecstasy in the past year. Other trends emerge from the data, such as a notable gender disparity amongst young adults with 11.8% men compared to 5.5% of women UK young adults aged 15–34 having used any illegal drug in the past month.

How to Use This Book How you use this book will depend a lot on who you are and the context in which your interest in issues relating to drugs and alcohol has been raised. In being written from a social and cultural perspective, the book will appeal to those working or studying in the fields of sociology, criminology, social policy and human geography. As the book is written by a sociologist and a criminologist, we write with students and scholars from these disciplines at the forefront of our mind. However, we have been mindful of and grateful for the growing interest in the themes of this book amongst scholars and students of public health and health sciences and from those in training or currently in practice as social workers, health professionals and various branches of the criminal justice sector. For these audiences, we hope the book to be a valuable supplement to their more specific training and professional practice. This is, we hope, a text which will widen the frame, as it were, and prompt reflection and understanding through a broad appreciation of the complexity of interrelated social and cultural facets of intoxication. For many readers, then, it will complement and add to their varied intellectual paths.

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In each chapter you will find features designed to enhance your learning. It may be that those who read some or all the chapters of this book as part of a programme of teaching offered within a university setting are asked to draw on these materials in preparation for or as part of class-room activities. Within each chapter you will encounter text boxes labelled ‘Intoxication in Contrast’. These short items summarise and compare two recent empirical studies which address a similar topic or theme but do so in quite different cultural or geographical contexts. The anticipation here is that such comparisons both demonstrate the contingency of intoxication and its role in different cultures but also, we hope, allows the reader to decentre their understandings of intoxication from the perspectives most familiar to them. It is hoped that reflecting on the similarities and differences between the two cases furthers the reader’s understanding and insight. At the end of each chapter, we present several ‘Points for Discussion’ intended to prompt reflection and debate. We suggest that you pause and consider the question when first reading it, but also later when finishing the book. Then, in comparing these two occasions, consider how your answers to each question may have changed given new knowledge or evidence presented. Finally, at the end of each chapter you will be prompted by suggestions for resources to ‘Read, Watch, Listen’. Each is offered to provide readers with a means of continuing their examination and reflection beyond the scope of the chapter. Critically, these resources acknowledge that a good deal of interesting, yet by no means perfect, material relating to alcohol and drugs exists beyond the confines of academic texts. In suggesting reports, documentaries or blogs we intend to augment and diversify the readers ‘diet’ of intoxication-related content. Not every item suggested is fully endorsed. Rather, we suggest recent materials in a range of media and trust our readers to make up their own minds about the content of each.

The Structure of This Book Following this Introduction Chapter, the first five chapters offer the reader a thorough grounding in the key debates relating to intoxication, its problematic and contested role in society and state response to the widespread realities of intoxicant use. This starts with offering an overview of the historical origins of intoxication in Chapter 2 which provides a foundation for what follows. Chapters 3 and 4 then examine the various developments in the regulating of alcohol and drugs, respectively. Chapter 5 addresses how intoxication has been theorised by academics and draws on key theories and concepts from across the social sciences, many of which will reappear at regular intervals elsewhere in

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the book. Chapter 6 explores the contested and problematic term ‘addiction’, alongside some of its alternatives, and outlining some of the main approaches to treatment, recovery and harm reduction or limitation. Lastly, Chapter 7 reviews how alcohol and drugs have been represented in culture and unpicks the role played by the media in shaping attitudes and response to intoxication in society. Building on the foundational understanding set out in the first half of the book, three interrelated chapters draw widely on the seminal and current empirical studies of the role of intoxication in the lives of individuals and groups. In these chapters we therefore seek to demonstrate how drinking, drunkenness and drug taking are bound up with individual identity and social group formation. Thus, the meaning, practice and experience of intoxication is shown, in turn, to be significantly shaped by age (Chapter 8), gender and sexuality (Chapter 9) and national identity, ethnicity and religion (Chapter 10). The final two chapters of the book will each tackle an area of inquiry where recent debates have been strongest, fastest moving and most fiercely contested. Chapter 11 considers recent developments which have seen new substances and new cultures around their use emerge in what we term the ‘design’ of novel substances. Then, in Chapter 12 we close the book with both a summary of the main themes covered in the preceding chapters and finally, in a section titled ‘The Futures of Intoxication’, make bold speculations about the future role of intoxication and responses to it and outlines the challenges that future generations may face. Points for Discussion

What does intoxication mean to you? What aspects of intoxication are you most and least familiar with? What aspects of intoxication are you most and least interested in learning more about or understanding better?

Read, Watch, Listen #1 Read: There are several hundred stories relating to drugs and alcohol issues on The Conversation, a news website where content is written by academics and researchers based on their latest research. Many articles, such as 2016’s Fentanyl: widely used, deadly when abused, offer short explanations which can be useful introductory reading.

References

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Watch: The YouTube channel Global Drug Survey hosts short videos addressing a range of issues relating to drugs and their use and includes the ‘GDS Corona Conversations’ strand of interviews recorded with experts during the Pandemic. Listen: In each episode of the Say Why To Drugs podcast, psychologist Dr Suzi Gage discusses a different issue relating to drugs.

References Alexander, A., & Roberts, M. S. (Eds.). (2012). High culture: Reflections on addiction and modernity. State University Press of New York. Bancroft, A. (2009). Drugs, intoxication and society. Polity. Beccaria, F., & Prina, F. (2016). Sociological Approaches. In T. Kolind, B. Thom, & G. Hunt (Eds.), The SAGE handbook of drug and alcohol studies: Social science approaches (pp. 30–48). SAGE. Becker, H. S. (1953). Becoming a marihuana user. American Journal of Sociology, 59(3), 235–242. Becker, H. S. (1963). Outsiders: Studies in the sociology of deviance. The Free Press. Bennett, T., & Holloway, K. (2005). Understanding drugs, alcohol and crime. Open University Press. Berridge, V. (2013). Demons: Our changing attitudes to alcohol, tobacco, and drugs. Oxford University Press. Caulkins, J. P., Kilmer, B., & Kleiman, M. A. (2016). Marijuana legalization: What everyone needs to know. Oxford University Press. Coomber, R., Moyle, L., & South, N. (2016). The normalisation of drug supply: The social supply of drugs as the “other side” of the history of normalisation. Drugs: Education, Prevention and Policy, 23(3), 255–263. Davenport-Hines, R. (2004). The Pursuit of Oblivion: A social history of drugs. Hachette. Duff, C. (2008). The pleasure in context. International Journal of Drug Policy, 19(5), 384– 392. Duke, K. (2003). Drugs, prisons, and policy-making. Palgrave Macmillan. Hari, J. (2015). Chasing the scream: The first and last days of the war on drugs. Bloomsbury. Herring, J., Regan, C., Weinberg, D., & Withington, P. (Eds.). (2012). Intoxication and society: problematic pleasures of drugs and alcohol. Bloomsbury Publishing. Hunt, G., & Frank, V. A. (2016). Reflecting on Intoxication. In T. Kolind, B. Thom, & G. Hunt (Eds.), The SAGE handbook of drug and alcohol studies: Social science approaches (pp. 322–336). Sage. Hutton, F. (2020a). Introduction. In F. Hutton (Eds.), Cultures of intoxication (1–14). Palgrave Macmillan.

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Hutton, F. (2020b). Cultures of intoxication: ‘New’ Psychoactive substances. Cultures of intoxication (pp. 87–110). Palgrave Macmillan. Jay, M. (2010). High society: Mind-altering drugs in history and culture. Thames & Hudson. Keane, H. (2020). Smoking and intoxication: From control to the buzz. In F. Hutton (Ed.), Cultures of intoxication (pp. 45–66). Palgrave Macmillan. Matthews, P. (1999). Cannabis culture: A journey through disputed territory. Bloomsbury. Mills, J. H. (2003). Cannabis Britannica: Empire, trade, and prohibition 1800–1928. Oxford University Press. Monaghan, M., Wincup, E., & Hamilton, I. (2021). Scandalous decisions: Explaining shifts in UK medicinal cannabis policy. Addiction, 116(7), 1925–1933. Neale, J. (2001). Homelessness amongst drug users: A double jeopardy explored. International Journal of Drug Policy, 12(4), 353–369. Neale, J. (2008). Homelessness, drug use and hepatitis C: A complex problem explored within the context of social exclusion. International Journal of Drug Policy, 19(6), 429–435. Nutt, D. (2012). Drugs-without the hot air: Minimising the harms of legal and illegal drugs. UIT Press. Pacula, R. L., & Sevigny, E. L. (2014). Marijuana liberalizations policies: Why we can’t learn much from policy still in motion. Journal of Policy Analysis and Management: [The Journal of the Association for Public Policy Analysis and Management], 33(1), 212. Pryce, S. (2012). Fixing drugs: The politics of drug prohibition. Palgrave Macmillan. Ralphs, R., Williams, L., Askew, R., & Norton, A. (2017). Adding spice to the porridge: The development of a synthetic cannabinoid market in an English prison. International Journal of Drug Policy, 40, 57–69. Ramsay, M., & Percy, A. (1997). A national household survey of drug misuse in Britain: A decade of development. Addiction, 92(8), 931–937. Ross, A., Potter, G. R., Barratt, M. J., & Aldridge, J. A. (2020). “Coming out”: Stigma, reflexivity and the drug researcher’s drug use. Contemporary Drug Problems, 47(4), 268–285. Saunders, N. (1995). Ecstasy and the dance culture. Nicholas Saunders. Seddon, T. (2009). A history of drugs: Drugs and freedom in the liberal age. Routledge-Cavendish. Shapiro, H. (1988). Waiting for the man: The story of drugs and popular music. Quartet Books. Sournia, J. C., & Porter, R. (1990). A history of alcoholism. Blackwell. Stevens, A., Fortson, R., Measham, F., & Sumnall, H. (2015). Legally flawed, scientifically problematic, potentially harmful: The UK psychoactive substance bill. International Journal of Drug Policy, 26(12), 1167–1170. Walton, S. (2001). Out of it: A cultural history of intoxication. Penguin. Wilson, A. (2008). Mixing the medicine: The unintended consequence of amphetamine control on the Northern Soul Scene. The Internet Journal of Criminology. Young, J. (2016). Voodoo criminology and the numbers game. In Cultural criminology unleashed (pp. 27–42). Routledge-Cavendish.

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Historical Origins and Emergence of Intoxication

Introduction The apparent consistency with which humans have sought out and consumed intoxicating substances throughout their history and across diverse geographical and cultural locations suggests that the history of intoxication is a necessary starting point, a platform from which we can build our understanding of contemporary practices. Yet, the path leading back from such contemporary practices to the pre-modern experimentations with naturally occurring intoxicants is a knotted one. The history of intoxication regulation is overwhelmingly one where certain substances are regulated or controlled for (illicit drugs) and others (alcohol, tobacco, caffeine) are widely available and socially accepted. The discovery of new and varied intoxicants, their trade between and across continents, increasing experimentation for both therapeutic and non-therapeutic (recreational) purposes accompanied by a collision of pronouncements on the medical, moral and social consequences of drug use on individuals and societies is not a footnote or sideshow to history. One only needs to imagine the image of the heated political debate and verbal repartee of coffee houses of early eighteenth-century Paris or London, the spliff smoking and LSD tripping hippies of 1960s or even the IPA swirling hipsters of modern day gentrified Shoreditch, Brooklyn or Vesterbro to know that intoxicants and cultures of intoxication that they beget invariably feel very much of their time and their place. Likewise, consider the case of tobacco which had a long history of use by the pre-colonial people of the American continent before being dispersed as a global commodity, generating fortunes and becoming a commonplace if often deadly practice in a staggering number of countries before, after a ‘turning point’ being reframed as a public health scourge (Burns, 2006). © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_2

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The history of intoxication is complex. Starting with the spread of tobacco cocoa, tea and distilled alcohol between the late sixteenth and early eighteenth centuries it can be charted into the closing decades of the nineteenth century and into the early twentieth century with opium, cocaine and cannabis becoming more prominent in society (Bancroft, 2009). Post-WWII, the emergence of lifestyle cultures to which drug taking was a central element, can then be witnessed as amphetamines used by Mods, LSD and cannabis by 1960s counterculture became of interest to scholars and journalists alike. This continued into the 1980s and onwards with the emergence of dance cultures and the use of ecstasy, MDMA which was central to this. Across these eras, it is important to understand how these historical developments shape our current understanding of drugs, their use and their regulation. It is no hyperbole, then, to suggest that intoxication has a rich history and alcohol and drugs have played their part in the great upheavals of the ages. The early attempts to explain why people chose to alter their consciousness through intoxication were bound up in accounts over whether intoxicants should be considered medicines and subsequently whether these could be understood through the emerging science of addiction in the nineteenth century. In the UK, as we have seen, early discussions about substances that we now know as ‘drugs’ were not originally considered as a problem, they were much more likely to be viewed as a panacea. Davenport-Hines (2004) demonstrates how the developments of various substances, by isolating specific components of plants, was often done on the premise that the new substances could alleviate issues with earlier ones, so morphine was isolated to offset issues with opium and heroin was subsequently isolated to deal with the deleterious effects of morphine. The early history of cocaine is one where its use was first thought to be beneficial in ophthalmology before concerns became apparent due to its addiction threshold (Grzybowski, 2007). By drawing on the work of Braithwaite and Drahos, (2000), Seddon shows how if we view drug policy through a lens of regulation theory, we can see how the picture of drugs as a panacea and/or problems was painted: In other words, we see here that the first meaning of `drug’ as a medicine is not effaced as the modern drug concept emerges during this period but, in fact, makes up a significant branch within its genealogy. Indeed, Braithwaite and Drahos explicitly locate the creation of what they term the `illicit drugs regime’ as part of a progressive splitting of the regulation of the pharmaceutical domain into five separate regulatory regimes (the others being for prescription drugs, non-prescription drugs, alcohol, and tobacco). This helps us to understand some of the enduring ambiguities and blurred boundaries that persist between what counts as medical or non-medical use of some substances and the regulatory challenge this then presents (Seddon, 2016)

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The history of intoxicants inextricably bound up with the processes of modernity and, in this chapter, we make a distinction between the pre-modern origins of intoxication and, from roughly the sixteenth century onwards, the modern era where intoxicants quickly embedded themselves in the economic, social, cultural and political infrastructure of many societies. Put another way, the intoxicating substances we recognise as drugs today did not suddenly appear fully formed as we now understand, nor did their naturally occurring pre-cursors exist in some untouched state of nature. Rather, the history of intoxication and intoxicants is human history itself. We must acknowledge the presence of intoxicants and the role of intoxication in the social and cultural fabric of pre-modern societies. We may then benefit from examining the processes by which modern drugs and the political, cultural and economic conditions of their use transformed alongside, and as part of, the emergence of modern capitalism, riding along with the many innovations and upheavals we accept as being integral to human progress. These innovations in transport, communication, commodification, branding begot the conditions for the discovery, dispersal and entrenchment of drug taking. Even in their most elemental forms, drugs need some form of social coordination, be it shared knowledge about how to forage for certain roots, seeds or leaves or when and how to allow fruit, grains or honey to ferment through to how to cultivate and harvest, process and store or transport particular substances so that they can be collectively consumed. The cooperation required in communities to achieve this, including the use of equipment, the passing on of knowledge and the general agreement that such labour is worthwhile, has itself evolved and advanced over time. This fascinating history is interesting to students and scholars of drugs and drug taking because it simultaneously attunes us to both the correspondences and divergences in the practices and experiences of intoxication across the ages. Likewise, drugs and drug taking are interesting to historians because their stories are those of the major formations shaping tumultuous emergence of the modern world born as it was through centuries long processes of urbanisation, enlightenment, colonial conquest and capitalistic avarice. Despite this, there is also a fair degree of cultural amnesia when it comes to remembering and acknowledging the deep roots of intoxication in the development of modern economies, cultures and societies. For many readers who feel the most pressing concern with contemporary issues, this diversion into historical narrative may do little more than offer a few points of amusing trivia, like coca in Coca-Cola or opium taking writers and artists, or that perhaps the most fervent advocate of cocaine was none other than the father of psychotherapy Sigmund Feud. However, we can observe a general lack of wider knowledge of complicity of European colonial powers in estab-

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lishing both the demand for and infrastructure of a thriving international trade in intoxicants. This chapter addresses this by making clear how the production, trade and consumption of intoxicating substances are central to the formation of not just contemporary attitudes to drugs, drug taking and their regulation but to the shaping of society itself and the position of individuals, institutions and nations within it.

Intoxication in the Pre-modern Age The origins of human consumption of varied naturally occurring intoxicating substances are obscured in prehistory and survive in myths and sacred narratives. Going back tens of thousands of years, humans from different cultures learnt that fruit, grain, sap or honey mixed with water and allowed to ferment produced a nourishing and intoxicating liquid. The further realisation that liquids prepared in such a way, thanks to the mildly antibacterial qualities of alcohol, could be stored for longer without spoiling and, even better, protect the drinker from maladies and illnesses that we now know to be diseases born in unclean drinking water must have proved a wondrous discovery. Beyond alcohol, almost certainly most other intoxicating substances were first encountered when humans observed the responses of animals eating them. Examples here include goats observed eating coffee berries, khat leaves and coca leaves. The results of which were seen and presumably imitated with some relish by humans (Walton, 2001: 148). We can only imagine, then, the moment of individual inspiration when, for instance, the first person to realise that roasting coffee berries with flames both increased the stimulant effect and enhanced the flavour of the inner ‘bean’. It is only with hindsight that we can see that this placed a step on the path to contemporary coffee culture and the global phenomenon of the latte-dependant office worker. Regardless of the initial inspiration to attempt the consumption of intoxicating plants, there is something in the suggestion that across human cultures there is an attraction to the mind-altering effects of substances. Many such substances, chemically speaking at least, are toxins poisonous to the human body at least if consumed in large enough quantities. Yet, it is testament to some inner human tendency, both to seek out new experiences and to cooperate socially, that toxins most likely occuring to protect a certain plant from predation are, once discovered, so readily incorporated into human activity. Humans across the ages have proven adept at developing the ingestion of such substances into elaborate forms, serving particular social functions such as group bonding, complete with attendant cultural practices, social rules, economic realities and, often, political tensions. The wide-

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spread use of different intoxicants in pre-modern societies is then quintessentially part of the story of early forms of human organisation into coherent communities. The regularity with which evidence of the cultivation, preparation and use of some form of intoxicating substance attests to an almost universal appeal of these items. Indeed, across different continents, as soon as humans have foregone nomadic hunter-gatherer lifestyles for more settled social organisation it appears some communal efforts are made to procure and, one would assume, enjoy experiences of intoxication. Archaeological discoveries confirm evidence of the use of coca leaf in South America up to 7000 years ago (Walton, 2001). Residues of fermented beverages have been found in pottery at sites in China dating from 7000 to 5600 BC and in the Anatolian peninsula dating from 5400 to 5000 BC (Chrzan, 2013). Alcohol production as beer from grain and wine from grape are bound up with the formation of stable agricultural societies (Bancroft, 2009). Indeed, the co-occurrence of the earliest human settlements with evidence of the collective production of fermented beverages and food stuffs might even imply that producing intoxicants was a contributing factor in shifts away from a previously nomadic existence. Even in their naturally occurring states, intoxicating substances readily attach themselves to rules, rituals and proscribed ways of consuming and experiencing. It is the sophisticated cultural practices which grew up around intoxication that leave us with the clearest indication of their centrality to the social, cultural and religious lives of our ancestors. The relative regularity with which artefacts from pre-modern societies form across different continents have been found to depict intoxicants and intoxication, not just in a contextual sense but as central themes and recurring motifs, allows us to deduce their importance to these people and their ancient cultures. In any period of human history, perhaps save our own era of smartphone ubiquity and visual overabundance, creating visual representations of any things or activity as images or objects has been a hugely time-consuming and resource intensive collective task. To etch the exterior of a bowl with patterns of vines, grapes and reclining drinkers or to guild a drinking horn with silver and jewels, and in doing so render both them and the intoxicating beverages to be drunk from them special and symbolically meaningful objects, takes time, skill and, most importantly, a social agreement that what is depicted is important to the group of people both producing and using those artefacts. Most conspicuously, the ancient Greek worshipers of Dionysus and the celebrants of her later incarnation as the Roman god Bacchus demonstrate how elaborate cultural practices around intoxication, in this case the profuse and uninhibited consumption of wine, became integral to the fabric of lives at the time. ‘The Dionysian rites were an outlet, a safety valve, for the forces repressed

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in human beings in the day-to-day conduct of their civic lives, a point not lost— several centuries later—on either Freud or Nietzsche’ (Walton, 2001: 48). The Greek historian Posidonius who traveled to the Celtic tribal regions of Northern Europe in the first century BC observed the differences between northern beer cultures and the Greek and Roman wine-based drinking cultures of the southern and Eastern Mediterranean (Chrzan, 2013). The martial tribal systems of Celtic and Scandinavian Northern Europe, involved the distribution of mead and beer which reinforced the Chief’s rule. In short, in being used to mark status, signal group acceptance and tighten communal bonds or help observe collectively agreed moments of celebration or lamentation, alcohol assisted or, literally, lubricated the social functioning of these increasingly sophisticated societies. We see clear resonances with modern day intoxication—rule bound hedonism, sociability and conviviality. The use of intoxicants is specific to geographical, social and cultural contexts. It is these matters that have fascinated many anthropologists and sociologists who, as we shall see in Chapter 4, find in the social functions of intoxication a means to explore social and cultural issues. It is not hard to imagine then the varied ways in which intoxicants such as alcohol could become part of the economic and social life of early human culture. The codification of substances that produce some effect or change upon the mind and body has a long history. Pedanius Dioscorides born in Asia-Minor around the time of Christ wrote a Mareria medica listing over 1000 drugs and their possible uses (Jay, 2010). Dioscorides also notes varying effects and dosages that could cause pleasurable sleep through to death. As we shall see, these intellectual endeavours aiming to explicate the uses of such substances on the human mind and body would find a parallel in the new scientific thinking of the Renaissance and Enlightenment. The task of refining or isolating the intoxicating elements of substances such as alcohol involved a beguiling mixture of technological innovation and near spiritual curiosity. A forerunner of modern advances in pharmacological technologies, the advent of distillation gives us some idea of the radical way such innovations reshape the human relationship with intoxication. Although we would hardly give it a second thought when entering a pub and deciding between a pint of beer or a vodka mixed with coke, distillation was the technological marvel of its day (Bancroft, 2009). Twelfth-century Jews and Christians of the Arabic world who made first use of distilled spirits sold for intoxication arrack distilled from dates and currants (Bancroft, 2009: 26). Distillation before the eighteenth century was a branch of alchemy, a separation of the purest soul or ‘spirit’ from the wine and was viewed as having health giving medicinal properties. Rough spirits were flavoured with herbs to cover the foul taste and then added to medicinal apoth-

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ecary. Gin originated in Holland as a diuretic (Walton, 2001: 108). The Latin phrase ‘aqua vitae’ (water of life) describes spirits as the origin of whisky and is still found in Scandinavia spirits akvavit (Walton, 2001). This admittedly brief examination of the pre-modern origins of intoxication reminds us that humans have used intoxication for various purposes and, with what we can confidently infer from archaeological evidence, with great zeal for as long as they have organised themselves into any form of communal society. From such origins, the evolution of religious, moral, medical framings of intoxicants would carry on a pace into the period of modernity where technological innovations would create new intoxicants and reshape our relationships with existing ones.

Modernity and Intoxication It is tempting, or at least amusing, to draw an uninterrupted 5000-year line running from gathering of tribal kin who drank a porridge-like concoction of fermented grains in ancient Mesopotamia and a group of undergraduate students of today downing an inexpertly prepared mix of supermarket vodka and energy drink ahead of a night of festivities. Indeed, it is entirely possible that the rituals of joking, name-calling and laughter that accompany the latter might be recognised by the former. However, it is vitally important to acknowledge that in the past few hundred years what we might term a process of modernisation accelerated the human relationship with intoxication in a way that our beer drinking Mesopotamians could hardly imagine. Modernity is not static nor is it a single monolithic entity. What we now refer to as modernity is a complex array of transformations and developments relating to human social organisation including industrialisation, urbanisation and secularisation that have reshaped, time and again, the technologies of production, communication, mobility and consumption that underpin not just how and where we drink or consume drugs but how the very fabric of our societies is woven. Indeed, the historian Phil Withington (2011) argues that in the modern era onwards intoxication gradually becomes central to how modern people, of all classes but especially social and cultural elites, kept and maintained social relations. With the impossibility of cultivating opium fields in Kent or coca plantations in the Yorkshire Dales, new drugs of this period all sprang from the intercontinental connections established through colonial expansion and conquest. As the nations of Western Europe sought to spread their influence, first with the Spanish and Portuguese from the fifteenth century and then the French, Belgium and

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British from the seventeenth century, colonial explorers were brought into contact with new substances. Between early and mid-1500s, Spanish colonisation moved from initial attempts to restrict and eradicate coca leaf to its regulation and permitted use. The Iberian power’s brutal incursions into the Americas introduced new substances, e.g. coca leaf. Coca used by the incas, was at times restricted to the royalty as well as their chasqui (official messengers and runners who could carry message vast distances on coca fuelled missions) and yaravecs (court orators and storytellers) (Madge, 2001). Throughout the sixteenth century, the Spanish and Portuguese in South America first observed the practice of chewing coca leaves and then rapidly facilitated its commodification, building an economy around it so that mine workers laboured and landowners could pay taxes in coca leaf (Davenport-Hines, 2004). The Dutch also established coca plantations in their Javanese colonies and, once methods of production and extraction were improvised, began shipping huge quantities to the trading rooms of Amsterdam (Madge, 2001). As such, in a relatively short space of time the coca used by Andeans underwent transformation into a global commodity (Gootenberg, 2008). The diversity of intoxicants available in the present are unthinkable without these colonial encounters of the past. English trading connections with the Ottoman Empire increased contact with opium use in the Middle East during the seventeenth century (Davenport-Hines, 2004). Napoleon’s troops were exposed to hashish in their occupation of Cairo in 1800. European travellers to South America also returned with accounts of the widespread chewing of coca leaf. For example, Tim Madge, in his cultural history of cocaine, quotes at length from J. J. Von Tschudi (‘He observed that Indians who regularly masticated coca required little food and could do arduous work for long periods with apparent ease’, Madge, 2001, 43). Around the same time, Europeans were also exposed to hashish taking as bhang (a drink of crushed leaves and cannabis seeds, often mixed with milk and spices) in Bengal (Davenport-Hines, 2004). The arrival of coffee into Western Europe in the early seventeenth century gives an early example of the rapidity with which a newly ‘discovered’ intoxicating substance could take root in the lives of individuals, the social lives of cities and the economies of nations. As the historian Walton (2001: 127) observes of coffee, ‘no drug has ever established itself so quickly and so ineradicably in any culture or group of cultures, nor had such pervasive effects on the nature of the society that flourished on it’. As the military might of European powers helped consolidate international trade routes and secure access to the increasingly valuable crops and their varied markets, the eighteenth and nineteenth centuries saw an unprecedented surge in publications speculating on the miraculous properties of first opium, then coca

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leaf and its derivative cocaine and other substances. An early example of this was the 1700 publication Mysteries of Opium Reveal’d by Welsh physician John Jones which whilst being the first English language treatment of the medical potential of opium also set a tone for much medical speculation that would by proclaiming opium to be a ‘cure all’ for conditions including gout, dropsy, asthma, dysentery and smallpox as well as its effect on sexual endurance and performance (Davenport-Hines, 2004). In 1762 the Swedish botanist Carl Linnaeus, famous then and now as the pioneer of an emerging obsession with classificatory systems, published an exhaustive catalogue of mind-altering substances and their properties titled Inebriantia (Jay, 2010). From our twenty-first-century vantage point, it is difficult to imagine how accepted, praised even, the expirations with new substances were. The Cornish chemist and inventor Sir Humphry Davy’s 1799 isolation of nitrous oxide, which he named ‘laughing gas’ based on its effects when inhaled by friends and likeminded individuals gathered for one of his demonstrations at Hotwells near Bristol (Jay, 2010). Whilst the use of the gas as an anaesthetic is the legacy, the greater excitement at the time was its example as a miraculous substance, seemingly created from nothing yet able to confer on those imbibing it astonishing moments of unbridled joy (Jay, 2010). For a brief period at the start of the eighteenth century, what became knowing as the gin craze emerged from a perfect storm of social and economic conditions and gives us the first example of a modern moral panic relating to intoxication. At a time when tax on gin produced in England was dropped and excises on imported wine and brandy from France increased, new mechanisation and other technological advances in agriculture produced a sustained glut of corn. Once fermented and distilled, this surplus grain could be transported, sold, and consumed by the urban poor. In this way, intoxication ‘itself becomes a critical and potentially destabilizing, problematic for the project of modernity’ (Nicholls, 2003: 126) leading to a perceived loss of productivity for the workers The Gin Act of 1729 and those that followed sought to address this by raising duty on gin by over 1400%. This, like many other attempts to control intoxication, had the unintended consequence of making matters worse and was a impetus to widespread rioting and civil unrest. Yet nothing indicates the paradoxes of intoxication history and frequently its underlying xenophobia and misogyny like the case of alcohol and the contrast between Gin and Beer. Immortalised in Hogarth’s depictions, Gin Lane is characterised by debauchery, squalor and despair in contrast to Beer Lane, which is healthy and productive. The central figure of Gin Lane is a drunken woman, a ruined mother, whose baby is forever suspended tumbling into oblivion. The message was simple. Drinking beer was healthy, and even safer than drinking

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water. Such thinking was reinforced in the 1850s’ cholera epidemic. Analysing in detail the pattern of the outbreak in London in 1854, the obstetrician John Snow was able to isolate the cause of the outbreak to a contaminated water pump in Broad Street, Soho. In doing so, he dispelled the long-standing Miasma Theory that cholera was an airborne virus and gave impetus to the emerging germ theory (Tulchinsky, 2018). By removing the handle of the water pump in Broad Street, the infection rates began to decline significantly. Of course, Snow’s analysis and inquiry was more detailed than this sketch allows, but of note in Snow’s inquiries was that none of the workers in the nearby Brewery caught cholera. Snow commented: There is a brewery in Broad Street, near the pump, and … no brewer’s men were registered as having died of cholera, … above seventy workmen employed in the brewery, none of them had suffered from cholera … at the time the disease prevailed. The men … do not drink water at all …. There is a deep well in the brewery, in addition to the New River water. (cited in Tulchensky, 2018)

The brewery workers had access to both a clean supply of water and a ration of ale. This meant that they were not exposed to the contaminated water like others in the vicinity. This further cemented the health-maintaining status of beer in the mindset of the general public, in spite of widespread and well-reported incidences of the adulteration of beer production, and gave impetus to its continued commodification. Alcohol proved with its early commodification that it was an ideal product for mass production under the new methods and principles of modern social organisation. Drinks produced within the domestic settings and consumed within the immediate vicinity became produced in larger and larger scales, distributed over wider geographical areas and increasingly standardised. Brand names emerged. This processes also led to the production of beer from being produced primarily by female brewsters often augmenting household incomes to male entrepreneurs. Drinks produced within the domestic settings and consumed within the immediate vicinity became produced in larger and larger scales, distributed over wider geographical areas and increasingly standardised. Brand names emerged. This process also led to the production of beer from being produced primarily by female brewsters often augmenting household incomes to male entrepreneurs. The eighteenth and nineteenth centuries can be best typified as a steady march towards widespread dispersal of intoxicants and such neurochemical enhancement would continue into the twentieth century. In 1898 Bayer patented a morphine substitute under brand name Heroin. Also in 1903 aspirin and Veronal—the

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first commercially available barbiturate tranquilizer—both came to take over opioids. The century spanning the latter half of the eighteenth century and the first half of the nineteenth century is a critical period in the development of the drugs landscape, notable for the surge in scientific interest in intoxicants which was in keeping with the spirit of the age and the ‘discovery’ by Europeans of intoxicants that would go on, in various forms, to form the cannon of prominent illicit substances familiar to us today. Scientific enquiry produced an emerging thirst for novelties which saw inventors gaining acclaim and making fortunes tapping into new ways of thinking about the self as something to be worked upon. A German doctor who travelled in Peru between 1838 and 1842 and whose written account of the habits of growing, preparation and chewing of coca leaf piqued the interest of other Europeans such as Friedrich Wohler and his assistant Albert Niemann (Madge, 2001). Niemann published his paper on the isolation of cocaine in 1860. Robert Christison’s 1876 Observations on the Effects of Coca or Cuca (Bancroft, 2009: 41) followed soon after with the 1884 paper On Coca 1884 by Freud, who widely proscribed it in Vienna of the time (Walton, 2001: 148), consolidating the substance as part of the pharmacopia. New techniques such as isolation and distillation as we have seen‚ by which the ‘spirit’ or quintessence of a substance could be isolated and better understood/ or put to use (Jay, 2010) began before the pioneering work of Niemann. Theophrastus von Hohenheim, better known as Paracelsus, sixteenth-century Swizz alchemist and physician travelled Europe and the Near East extolling virtues of isolating substances into powders, spirits, etc. (Jay, 2010). The isolation of active ingredients from plants is a key aspect in understanding the history of drug use. This is not least because, as Nutt (2012) points out, there was no evolutionary advantage to be gained from doing so and that understanding the psychoactivity of substances is intricately linked to the pursuit of pleasure. The pursuit of pleasure is neatly typified by accounts of Jacques-Joseph Moreau’s three-year trip to Egypt in the 1830s. Moreau returned with dawamesc or hashish, ingested as an experiment. Moreau hosted fellow bohemians in his notorious Club des Haschischins. Balzac, Dumas and most notable Charles Baudelaire whose account of hashish taking set the tone for drug accounts to come in France. Indeed, the French occupation of Algeria starting in 1830 brought colonial troops and administrators into contact with cultures of recreational hashish use. Rather than creeping into European culture illicitly by the backdoor, drugs were ushered in with much fanfare and could count on the leading literary and scientific minds of the days as their most fervent of supporters. Opium and its affects were known for thousands of years, including ancient Greece and Rome, Persia and throughout the middle east, before its principal

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agent, the alkaloid was identified and isolated in 1803 (Daventport-Hines, 2004). German pharmacist Friedrich Sertürner creates morphine in 1803, named after Morpheus the Roman god of sleep (Jay, 2010)—experimentation on self to identify effects. Sertürner was the first to isolate morphine from opium. He called the isolated alkaloid ‘morphium’ after the Greek god of dreams, Morpheus. Paolo Mantegazza, Italian doctor who spent time in Argentina and observed coca leaves being chewed would experiment likewise and published in 1859 On the Hygienic and Medical Values of Coca. Alfred Niemann at the University of Gothenberg read this and requested a shipment of coca leaves from which, in 1860, he would produce the white crystalline alkaloid he named ‘cocain’. Around the same time, the isolation of Caffeine from coffee in 1820, nicotine from tobacco in 1828 and Codine, again from poppy occurred. Similarly, in 1832, theobromine from chocolate was also discovered (Jay, 2010). The isolation of what became known as the active agents of naturally occurring intoxicants chimed perfectly with the ethos of human mastery over nature that was the spirit of the age and was part of a wider processes by which the emergent European scientific community, rapidly consolidating its power and influence, took ownership of substances that had in their original forms been integral to their origin cultures for centuries if not millennia. With these developments, expertise passed from indigenous elders and spiritual guides to a nascent scientific community eager to shake off the vestiges of culture developed over innumerable generations and to remake substances derived from coca or opium as the medical marvels of the age. What we see from these processes are emerging ways of talking about and understanding the effects of substances in humans. In the same way that Auguste Comte saw the development of the new discipline of sociology as the culmination of thinking about society based on scientific principles, as opposed to theological and metaphysical, new ways of viewing behaviours were also emerging. Indeed, the fervent craving for the new pharmacological products must be understood in the context of rapid social change which resulted in rising disease levels in rapidly urbanising towns and cities alongside increasing mental disorders. In this context, the quest for a ‘miracle cure’ shaped early experimentations with cocaine (Madge, 2001) as part of a gradual emergence of a distinct medical expertise, which first constructed excessive alcohol consumption, for instance, as inebriation then as addiction and which slowly disentangled itself from moralist stances and supplanted lay knowledge (Berridge, 2013; Clemis, 2013). The medicinal qualities of alcohol as ‘spirit of wine’, were discussed well into the eighteenth century under the belief of the humoral system (Clemis, 2013) and it is here that we can start to witness the origins of separation of alcohol from other drugs in medical and popular discourse. Processes of isolating chemicals

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and distilling substances over time became linked to their commodification often as remedies to a range of maladies. Paracelsus’s laudanum was promoted for sleep and pain relief as a panacea. The Corsican chemist Angelo Mariani who in 1863 introduced a restorative beverage infusing coca leaf in Boudreaux wine, expertly marketed as the restorative Vin Mariani. Mariani’s own repute as the leading expert of the new intoxicant was consolidated in the 1890 treatise Coca and its Therapeutic Applications. The German Army doctor Theodor Aschenbrandt in 1883 tested with dosing army recruits with cocaine to improve stamina and reduce the need for food and sleep in the field. Sigmund Freud in Vienna experiments published an essay that praised coca as a ‘gift’ from nature that gives ‘the most gorgeous excitement’ (Jay, 2010: 91). Coca leaf soon found its way into a surprising array of the latest products such as tonic wines and most notoriously Coca-Cola. Well into the twentieth century, products such as the ‘Forced March’ tablets, marketed by Durroughs Wellcome & Co, boasted that the kola nut and coca leaves contained within ‘alleys hunger and prolongs the power of endurance’ (Image 2.1). That a name as esteemed as Feud’s could be linked to a now long-criminalised drug may seem shocking from our contemporary vantage point, but is entirely in keeping with the era and, indeed, shows how social and legal concerns of different epochs shift so remarkably. It was Thomas Sydenham (seventeenth century) who popularised and standardised the preparation of laudanum, alcohol solution containing opium. Two ounces of opium in a pint of good red wine spiced with saffron, cloves and cinnamon. A landmark, as substances no longer varied by nature, locality and preparation process, but purity and dosage come under human control. Thomas Dover 1732—Dover’s Powder, opium powdered, containing an emetic that would ensure user would vomit up if too much was used. This continued to sell into the 1930s. Few episodes of British history better exemplify the centrality of drugs to the project of modernity than the so-called Opium Wars, fought by the British to impose by force acceptance of the importation of opium that had been wreaking havoc in Chinese society. By the early seventeenth century the Portuguese were shipping opium into China from their colonial settlements in Goa and Macao. However, it was the British who established opium trade routes between their colonies in the Indian subcontinent, most notably in the regions which now fall within Afghanistan, and ports along the Chinese seaboard. Robert Clive commanding a small military force took Patna, then the centre of opium production, for the East India Company (Davenport-Hines, 2004: 22). Chinese tea and silk were highly desirable in England‚ but England had few commodities so desired by Chinese consumers, meaning opium was seen as being able to

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Image 2.1   Bottle of ‘Forced March’ sold by Durroughs Wellcome & Co.

redress the trade deficit. The Opium wars (1838 and 1856) were motivated by a situation where England tried to force opium made from the British controlled plantations in India upon China. The trade in drugs was central to state formation and empire expansion. For the British, this one shameful episode involved the full brutality of the modern state, technologies of shipping, warfare, finance, storage, also propaganda and public relations to justify the war. The Opium Wars fought so that the British state could maintain its lucrative trade in drugs into East Asia is just one telling example of how important drugs were to nineteenth-century society. Drugs also gained increasing social acceptance, desirability even and prominence at a cultural level. Withington, P. (2011). There is no surer indication of the enthusiastic uptake of these new intoxicants than their apparent prevalence amongst the great and good of Georgian and Victorian Britain. Early nineteenth-century laudanum was widely used by aristocrats,

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politicians and literary figures as well as none other than the Prince Regent, then King of England, George IV who copiously used laudanum alongside prodigious quantities of wine, brandy, etc. (Davenport-Hines, 2004). Queen Victoria prescribed marijuana for menstrual pains (Walton, 2001). Angelo Mariani’s Vin Marinani endorsements from the celebrity of the age included literary figures such as Alexander Dumas, Jules Verne, Zola, US President William McKinley, British, Russian and Swedish Royalty and at least two Popes! (Madge, 2001: 70–71). The poet Samuel Taylor Coleridge, who had participated in Davy’s trials of nitrous oxide, began taking opium via opium-based patent medicines like Kendal Black Drop which mixed opium with vinegar and spices. Thomas De Quincey serialised in magazine in 1821 and a book in 1822 Confessions of and English Opium Eater. Would ‘set a moral template for the public presentation of drug use that would endure, and that continues to proliferate in modern day tabloid “My Drug Hell” confessionals’ (Jay, 2010: 81). Copious consumption was far in excess of medical recommendations (25–50 drops recommended but at his height De Quincey took up to 8000 drops—Davenport-Hines, 2004). Intoxication itself and the often fraught relationship between substance and user were, as such, newly revealed subjective experiences which required new modes of expression to capture. Both De Quincey and Coleridge took opium first for pain relief then increasingly for pleasure, relief from existential woes, failures, etc. De Quincey took opium for weekly visits to concerts and operas where the drug heightened his appreciation of the musical experience (Davenport-Hines, 2004). This prescient of the supposed creativity induced by LSD and appreciation of music by ecstasy in the second half of the twentieth century (see Shapiro, 1988). De Quincey and Coleridge and others were a perfect demonstration of the impossibility of separating medicinal and recreational use. Writing in the late nineteenth century, Madge (2001: 62–63) states: ‘By the 1890s cocaine, as well as coca, could be bought at any downtown American pharmacy, in a wide variety of forms…as a cure for alcoholism, asthma, the common cold, whooping cough, dysentery, haemorrhoids, neuralgia, seasickness, vomiting in pregnancy, sore nipples, vaginismus, gonorrhoea and syphilis’ and a cure for morphine and opium addiction. (Madge, 2001: 62–63)

By late nineteenth century, drugs based on opium, coca and hashish were widely proscribed to treat a range of conditions, nervousness, etc., which were difficult to define but relating to the stresses and strains of modern industrial life (Jay, 2010). A shared trait across these is not just the innovation but the conditions produced in wider society and in individuals which made such effects desirable. Drugs such

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as cocaine ‘made and marketed as cures for modern life, as medication for the soul’ (Bancroft, 2009: 41). At the same time, new technologies and, as we shall see in Chapter 5, a burgeoning medical profession, meant that the introduction of hypodermic needles from the 1880s would increase rapidity of the delivery of substances and would coincide with the emerging science of addiction (Walton, 2001).

Intoxication in the Twentieth Century Increasingly as the twentieth century dawned, new drugs were developed for their direct commercial application and with the complicity of the medical profession. New knowledge would also emerge showing how drugs would work upon the individual to increase their capacities for work or for pleasure, to ameliorate the monotony of modern life, break through the stifling restrictions of modern life. By 1927 Gordon Alles had synthesised amphetamine from the Asian herbal stimulant ephedra plant. Tested widely in medical circles and used with soldiers and pilets during World War 2, Amphetamine was readily available over the counter in the post-war years (Jay, 2010) and was widely used in major conflicts of the twentieth century including World War 2 and Vietnam to improve soldiers’ stamina and maintain morale (Walton, 2001: 143). The discovery of new substances outpaced attempts to control them. We discuss the control of intoxicants in the following two chapters. For now, it is apposite to say that the opening decades of the twentieth century mirror the trends that would collide during the subsequent century. On the one hand, we can see increasingly ardent efforts to control the manufacture, supply, sale and use of alcohol and drugs and, on the other, the increasing normalisation of intoxication as it spread from bohemian and other minority communities to more widespread use. These two contradictory trends would characterise alcohol and drugs in the twentieth century. In the remainder of this chapter, we concentrate on the latter. In the early twentieth century, drug use which had once been the preserve of bohemians, artists, aristocrats and other elites, began moving into street and marginal groups, soldiers and sailors, and black jazz museums. ‘The public image of the drug user was changing from medical patient to dangerous thrill-seeker. In the process, the term “drug” was acquiring its modern meaning’ (Jay, 2010: 95). The process would continue as drug use became increasingly ‘othered’ in the twentieth century as new terminology was developed to describe drug takers. In New York, in the early twentieth century, heroin addicts selling scrap to fund their habits became known as ‘junkies’; a derogatory label that remains to this day. This is not to suggest, however, that experimentation and discovery ceased entirely as the case of hallucinogens and psychedelic substances shows.

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Intoxication in Contrast 2

The prohibition of drugs is often considered to be a Western or even American policy, dating back to the early twentieth century. The rhetoric for why prohibition of drugs was needed was frequently xenophobic and sought to blame drug use on ‘foreign’ influences which were corrupting (middle-class) American society. Bewley-Taylor (2003) has shown how a power bloc was created by the US who were the driving force behind the UN Conventions that introduced a system of drug control across the planet. Whilst there is no doubt some truth to this, other thinkers have started to look at the role of Eastern countries in shaping the system of global drug control. Windle (2013), for example, has traced the role of the ‘East’ as a driving force behind global drug prohibition. Read the articles below and see which you find most convincing or whether there is any potential in synthesising them to develop a more rounded explanation of why drugs became prohibited across the world in the twentieth century. Bewley-Taylor, D. R. (2003). The American crusade: The internationalization of drug prohibition. Addiction Research & Theory, 11(2), 71–81. Windle, J. (2013). How the east influenced drug prohibition. The International History Review, 35(5), 1185–1199. Whilst there was long been awareness of hallucinogenic substances (e.g. Peyote cactus, as mescaline, the American ethnographer James Mooney’s use in 1890 with the Sioux tribes who wanted to demonstrate their own religion and rituals) it didn’t receive the same attention as stimulants and opiates. This would change in spectacular fashion in the second half of the twentieth century. On 19 April 1943 Albert Hofmann, a chemist in Basel Switzerland self-administered lysergic acid diethylamide and cycled home tripping! (Jay, 2010). Used in therapeutic situations allowing patients to make breakthroughs, a purpose for its use which has since rediscovered (Nutt, 2022), post-war experiments with LSD, in particular, took on a more sinister turn. Blackman (2004) notes how the era after the second world war was one in which any vestiges of pleasure in the discourse around drugs started to disappear. This is best illustrated through the way various ex high ranking Nazi’s covertly joined the payroll of the US Government to wage war against Communists and other political dissidents. Through espionage and forms of coercive diplomacy, the US was able to secure its global prohibitionist framework, but perhaps more disconcertingly as Blackman (2004: 30) testifies:

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2  Historical Origins and Emergence of Intoxication American President Harry S Truman oversaw two key developments in drug war politics during the post Second World War period…First, in 1946 the Paperclip Project whose mission was to bring over 1500 Nazi war criminals described as ‘scientists’ to the United States to gain access to their research knowledge and organizational expertise, including notes and visual recordings of human subjects under experimentation…Second, in 1947 the introduction of the loyalty oath was designed to exclude disloyal Americans from engaging in what were referred to as ‘subversive’ or ‘un American’ activities in order to enhance US national security. (Blackman, 2004: 30)

A key aspect of the research knowledge that was particularly intriguing to the US power elite of the time was research into truth serums and mind control. Although there had been experimentation beforehand, Blackman (2004: 32) shows how the US military’s search for a truth drug began in 1947 with Project CHATTER followed soon after with Project BLUEBIRD, which subsequently became known as Project ARTICHOKE. The CIA would get involved in the 1950s initiating the MK-ULTRA programme which looked at how drug-enhanced interrogation techniques could be furthered. It has since become apparent that the American public were unaware that Nazi scientists and science were influencing a programme of research at the time. Blackman (2004: 32) goes on to note how, ‘the CIA programme of super-secret research into the power of drugs to modify human actions for purposes of espionage proceeded from mescaline, cannabis and cocaine through LSD’. The experimentations with LSD trialled by the CIA during Cold War focused on its use as a debriefing drug. They tested the theory that a potential Soviet spy suitably dosed with LSD would be rendered incapable of subterfuge. The initial recipients of government LSD testing were, according to Blackman, North Korean prisoners, but during the 1950s the generation’s leading figures of revolutionary youth culture would form a part of the sample. These figures included Timothy Leary, Allen Ginsburg and Ken Kesey. It was also around this time that the drug seeped out of experimental controls and into the illicit market, surprising authorities in the meantime on the grounds that they could not understand why young people would want to voluntarily take LSD and even enjoy the resulting mind-altering disorientation. LSD would also transition from Government labs to university labs as Timothy Leary and Richard Alpert began their psychedelics trials with undergraduates at Harvard eventually leading to their dismissal. Another key moment was the 1954 publication of Aldous Huxley’s 1954 Doors of Perception, which focuses on the author’s first psychedelic experience with mescaline. Hall and Farrell (2022) comment on how Huxley was part of the vanguard in providing ‘intellectual celebrity endorsement of psychedelic drug use for spiritual purposes’ and in doing so providing a guide for how others could

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follow. In line with the side-lining of the drugs-pleasure discourse of the time, Huxley’s wishes for LSD would be dashed after it was banned in the US under the 1970 Controlled Substances Act and internationally under the 1971 UN Convention on Psychotropic Substances. According to Sessa and Nutt (2007) banning drugs such as LSD and later MDMA has set medicine back decades in terms of finding treatments for various mental disorders such as depression and post-traumatic shock. The counterculture emerging from 1950, with its apex in the late 1960s characterised by LSD experimentation and changes to perception and mind expansion and, more visibly, by the Kesey following the Merry Pranksters recording their LSD fuelled adventures in their bus painted inside and out with swirling day glow mandalas was short-lived. That said, the emergence of LSD, the varied resistance to its use and its eventual decline provide a revealing social history. Commentators have noted how ‘early LSD use, stimulated by curiosity and adventure seeking, focused on the personal, existential, and spiritual insights attributed (sometimes erroneously) to the drug’ whilst opposition ‘developed as LSD became a focus or symbol for generational conflict, parental worries, political dissent, irrational behaviour and violence, personal cognitive dissonance, and treat to traditional values and institutions’ (Baumeister & Placidi, 1983: 25). It would not be long before similar patterns and processes would lead to history repeating itself. As with LSD, another drug first synthesised in laboratories before breaking out into the wider cultural imagination through a particular youth subculture was methylenedioxymethamphetamine (MDMA) also known as Ecstasy. Alexander Shulgin a former DEA chemist synthesised MDMA) in 1976 (although it had been isolated in the early 1900s see below). It would subsequently find widespread appeal in the nightclubs of North American and the Balearic Islands in Spain. As with LSD, it would later be used in therapeutic contexts although this journey has been slow. MDMA and amphetamine, another substance linked to youth cultures and recreational use were developed in German chemistry labs. MDMA was first isolated in 1912 by E. Merck and Company whilst researching appetite suppressants. As indicated, 70 years later it became more widely known within House music. Originating from Chicago and New York, House music became central to Rave Culture. which would in turn and over time metamorphose into clubbing via the illegal rave scene. From its therapeutic use in niche psychiatry circles, ecstasy would prove to be the perfect accompaniment to the repetitive beat of House music. Critcher (2000: 160) defines rave as the epitome of a case study in the ‘moral regulation of leisure’. Working as an empathogen, Ecstasy provided

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a non-aggressive atmosphere for rave which was essential to the social context and sensory experience valued by subcultural participants. In this sense, it could be contrasted with the more anti-social and often hostile spaces (particularly for women and visible minority groups created by alcohol intoxication). Unlike LSD, MDMA was the subject of swift and certain regulatory intervention prior to its use becoming widespread, at least in the UK. MDMA was prohibited as a class A drug in the late 1970s before it had gained a foothold in rave culture. Ecstasy also provides a prime example of the moral panic around drug use that has been present in public debates about drugs since the 1920s and the outlawing of cannabis in the US under the era of ‘Reefer Madness’. We discuss this in subsequent chapters, but early attempts at cannabis control were influenced by over-inflated claims as to its potential for harm, by moral entrepreneurs such as Harry Anslinger—erstwhile head of the Federal Bureau of Narcotics. Anslinger, more than anyone, consolidated the link between young people, music, style, and drugs. Drugs, such as cannabis, for Anslinger were a destructive force that threatened to corrupt the youth of America (particularly the white, prosperous youth of America). As we will demonstrate in Chapter 4, this meant that much of the early more sociological accounts of drug taking and use, tended to focus on the way it was used by (often white working-class) young men as a form of resistance to the more puritanical norms and values of (middle-class) society. Rave culture was different. Commercially successful, rave culture entered the formal economy in the early 1990s. Alongside this ecstasy use soon became a normalised part of dance focused youth culture, a readily available and familiar feature of the growing, if fragmented, club cultures of urban Britain (Parker et al., 1998; Sanders, 2005). If Huxley’s accounts of LSD sought to offer an alternative discourse into how to understand the role of drugs in society, these were again reversed with the panic that ensued around Ecstasy into the 1990s. Initially this focused on the hedonistic nature of rave culture but morphed into broader concern with the risks and harms of ecstasy use after its association with some high-profile deaths of young women in the 1990s. The case of Leah Betts exemplifies this. Leah Betts died on the 16 November 1995, five days after being admitted to hospital in a coma after taking ecstasy for the first time. The image of Betts on a life-support machine was featured across the mainstream press and spurred a moral panic against the drug. The key element of this was, according to critics, the distortion of risk (Forsyth, 2001). Statistically, ecstasy is responsible for very few drug-related deaths. When ecstasy-related fatalities do occur, they are often a result of dehydration or over consumption of water to combat potential dehydration. Despite this, a key study conducted over newspaper reporting of drug-related deaths in Scotland throughout the 1990s, showed that every single death was

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reported where Ecstasy was linked. For heroin deaths the number was 1 in 5 and amphetamine 1 in 3 (Forsyth, 2001). Despite these media-led moral panics and swift regulatory interventions, through providing near religious experiences—including perceptions of birth, death, etc. ‘transpersonal’ out-of-body experiences and intersubjectivity—at a time of increasing secularisation, particularly in the West, drug use continued to spread widely in the 1990s as substances found their fit with particular locales and subcultures or (neo) tribes. This was a poly drug culture where a mix n match approach was adopted as drugs were adapted to the context of their use (Parker et al., 1998). Indeed, drug use became central to the re-emergence of the night-time economy towards the end of the twentieth century, where Government policies were directed towards getting people to consume in towns and cities across the country as a way of overcoming the destructive effects of post-industrialisation and the erosion of mass employment in the heavy industries of coal mining, ship building and manufacturing. Although initially hostile to the popularity of drug consumption, the alcohol industry soon sought ways to harness its popularity through rebranding drinks to appeal to the nightclub clientele (Measham & Moore, 2009). Measham (2004) suggests that there are three key waves of alcohol beverage development, which ‘resulted in the recommodification of alcoholic drinks in the UK’: This began in the mid-1990s with the development of first generation high strength bottled beers, ice lagers, and white ciders such as Diamond White; and alcopops such as Hooch introduced from Australia in 1995, which, it has been argued elsewhere, led to early indications of increased sessional consumption of alcohol by young people (Measham, 1996; Brain and Parker, 1997). In the late 1990s came the launch of second generation alcopops and high strength bottled spirit mixers known as ready to drink (RTDs) and flavoured alcoholic beverages (FABs) (such as Smirnoff Ice and Barcardi Breezer). In the early 2000s there has been a third development in the form of shots, aftershots or shooters – cheap drinks combining several different types of alcohol spirits and liqueurs in one measure, usually costing about £1 or £2 – which are a popular feature of city centre bar chains frequented by young adults in many British cities. Given the discounts offered on multiple purchases of shots and the tendency for them to be consumed in one gulp as ‘chasers’ alongside customers’ usual alcoholic drinks, the development of shots alongside the two previous waves of innovation in the beverage alcohol market can be seen to facilitate immoderate sessional consumption beyond recommended ‘sensible’ drinking levels. (Measham, 2004: 317)

Despite the regulatory efforts of the state, the cultivation of moral panics and the best efforts of the alcohol industry, the use of alcohol and drugs are so widespread that it is difficult to single out instances of their use. Rather, intoxication is a broad and common part of modern life. The night-time economy of pubs, bars and nightclubs has become vital to the economic and social fabric of many cities

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from the 1990s onwards. Further still, a trend not noted by Measham in her mapping above, is the shift to home drinking of wine. This trend has done more than most to embed intoxication into the everyday lives of many adults in the UK even though it’s the shots downing youths of the night-time economy who offer the most visible examples. This is not to say that there is now a tacit acceptance of drugs in society or excessive alcohol consumption for that matter.

Summary This chapter has sought to offer an overview of the historical emergence of drugs, alcohol and intoxication that fosters an appreciation of the great length of time over which humans have made use of intoxicants and intoxication in pursuit of pleasure, release, community or transgression. The hope is that this has been achieved without either presenting too monolithic an account of intoxication as something universal and static, an unchanging human tendency. At the same time, there must be caution against a relativism where each period of history, and each specific cultural context in which drugs or alcohol feature, as being distinct and specific. Rather, whilst we can find both striking continuities and dramatic changes when we compare one epoch with another, the task is to note some recurring themes and important trends and tendencies. Against the sweep of history—that brings us to the present day where drug use is on the one hand widespread and normalised in a dizzying range of contexts and on the other widely stigmatised and the subject of militarised interventions—it is possible to draw a number of observations that prove useful in underpinning our understanding of contemporary issues relating to intoxication. It is this tension or paradox that must be understood and appreciated. The age of enlightenment, the era of prohibition and the recent and ongoing years in which a protracted War on Drugs, both of which we will examine in the following chapters, each exhibit their own defining mood in which intoxicants are celebrated as miracle cures or cast as the source of society’s woe’s and worthy of draconian state-backed interventions. Our efforts to understand alcohol and drugs ought not to be abstracted from the material and cultural circumstances of their emergence. The introduction of each new intoxicating substance, from distilled spirits, to opium, cocaine, LSD and MDMA, bear with them their own assortment of transformations in technologies, communications and social relations without which they would be unlikely and incomprehensible. Most drugs including cocaine and opium went through periods of widespread use and associated normalisation which seem discordant with today’s narratives so rooted in moralism and criminalisation. Beyond their physiological and neurological effects on the body and mind of users, intoxicants are products of infrastructures of production, trade, communi-

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cation and configurations of knowledge and value. A key point has been that our attitudes to alcohol and drugs has been shaped by processes such as industrialisation, urbanisation, colonialism and secularisation. Whilst we can ask of the individual act of intoxication what effect the intoxicant has on the body and mind of the user, we should also ask why those effects are desired by the individual and how the wider conditions that person lives in make that effect desirable, possible, etc. To this we turn in Chapter 5 to how intoxication has been theorised, but before this it is necessary to explore the development of drug and alcohol regulation and control. Points for Discussion

Why did drugs such as cocaine and heroin appear and proliferate when they did? How similar are historical attitudes to alcohol and drugs to those you are familiar with today?

Read, Watch, Listen #2 Read: There are a number of fascinating social histories of specific intoxicants. These include 2006’s The Smoke of the Gods: A Social History of Tobacco by Eric Burns, Cocaine by Dominic Streatfeild (2002) and Drink: A Cultural History of Alcohol by Iain Gatley (2008). Watch: In the three-part documentary series Prohibition, American filmmakers Ken Burns and Lynn Novick offers a detailed examination of the implementation and eventual repeal of legislation prohibiting the sale of alcohol in the USA. Listen: The BBC series The Forum includes several episodes relating to the history of drugs and intoxications. This includes episodes from 2019 on the histories of morphine and opium.

References Bancroft, A. (2009). Drugs, intoxication and society. Polity. Baumeister, R. F., & Placidi, K. S. (1983). A social history and analysis of the LSD controversy. Journal of Humanistic Psychology, 23(4), 25–58. Berridge, V. (2013). Demons: Our changing attitudes to alcohol, tobacco, and drugs. Oxford University Press.

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Blackman, S. (2004). Chilling out: The cultural politics of substance consumption, youth and drug policy. McGraw-Hill Education. Braithwaite, J., & Drahos, P. (2000). Global business regulation. Cambridge University Press. Burns, E. (2006). The smoke of the gods: A social history of tobacco. Temple University Press. Chrzan, J. (2013). Alcohol: Social drinking in cultural context. Routledge. Clemis, D. (2013). Medical expertise and the understandings of intoxication in Britain, 1660 to 1830. In Intoxication and society (pp. 33–51). Macmillan Education. Critcher, C. (2000). ‘Still raving’: Social reaction to ecstasy. Leisure Studies, 19(3), 145– 162. Davenport-Hines, R. (2004). The pursuit of oblivion: A social history of drugs. Hachette. Forsyth, A. J. (2001). Distorted? A quantitative exploration of drug fatality reports in the popular press. International Journal of Drug Policy, 12(5–6), 435–453. Grzybowski, A. (2007). The history of cocaine in medicine and its importance to the discovery of the different forms of anaesthesia. Klinika Oczna, 109(1–3), 101–105. Gootenberg, P. (2008). Andean cocaine: The making of a global drug. University of North Carolina Press. Hall, W., & Farrell, M. (2022). Aldous Huxley’s the doors of perception. Addiction, 117(6), 1811–1815. Jay, M. (2010). High society: Mind-altering drugs in history and culture. Thames & Hudson. Madge, T. (2001). White mischief: The cultural history of cocaine. Mainstream Publishers. Measham, F. (2004). The decline of ecstasy, the rise of ‘binge’drinking and the persistence of pleasure. Probation Journal, 51(4), 309–326. Measham, F., & Moore, K. (2009). Repertoires of distinction: Exploring patterns of weekend polydrug use within local leisure scenes across the English night time economy. Criminology & Criminal Justice, 9(4), 437–464. Nicholls, J. (2003). Gin Lane revisited: Intoxication and society in the gin epidemic. Journal for Cultural Research, 7(2), 125–146. Nutt, D. (2012). Drugs Without the Hot Air. Cambridge UIT. Nutt, D. (2022). Psychedelic drugs—A new era in psychiatry? Dialogues in clinical neuroscience. Parker, H., Aldridge, J., & Measham, F. (1998). Illegal leisure: The normalisation of adolescent recreational drug use. Routledge. Sanders, B. (2005). In the club: Ecstasy use and supply in a London nightclub. Sociology, 39(2), 241–258. Seddon, T. (2016). Inventing drugs: A genealogy of a regulatory concept. Journal of Law and Society, 43(3), 393–415. Sessa, B., & Nutt, D. J. (2007). MDMA, politics and medical research: Have we thrown the baby out with the bathwater?. Journal of Psychopharmacology, 21(8), 787–791. Shapiro, H. (1988). Waiting for the man: The story of drugs and popular music. Quartet Books. Sournia, J. C., & Porter, R. (1990). A history of alcoholism. Blackwell. Tulchinsky, T. H. (2018). John Snow, Cholera, the broad street pump; waterborne diseases then and now. Case studies in public health, 77. Walton, S. (2001). Out of It: A cultural history of intoxication. Penguin. Withington, P. (2011). Intoxicants and society in early modern England. The Historical Journal, 54(3), 631–657.

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The Regulation and Control of Alcohol

Introduction We have become accustomed to thinking about the control of substances in terms of what Seddon (2009) frames ‘the great regulatory divide’ to describe the way in which certain substances are controlled by criminal laws, particularly those focused on the enforcement of prohibition, whereas others are regulated in other ways, such as controls on who, when and where substances can be made, sold, purchased and consumed. This issue of why some intoxicating substances have been regarded as dangerous drugs to control with the full force of the criminal law whereas others, such as alcohol, tobacco and those we call medicines, is one that has preoccupied scholars of intoxication. At the same time, as the historian James Nicholls observes (2009) in relation to alcohol regulation, across hundreds of years policies have been underpinned by recurring concerns about social order, public health and economic responsibility. The histories of regulation and control are, as such, more than simple context. Rather, from the vantage point of the twenty-first century, it’s difficult not to be fascinated by the recurrence of these age-old concerns in contemporary approaches to regulation of alcohol and drugs. It is also quite common to feel that the periodic optimism that a new approach, novel policy turns or, more usually, a ratchetting up of the enforcement of already draconian laws, might finally settle the issue of intoxication and its many harms is misplaced. Indeed, throughout this and the following chapter a recurring tension concerning regulation strategies is the question of whether they intend to entirely eradicate intoxicating substances or, alternatively, do they concede to the human desire for intoxication, accept its unavoidable presence and instead channel efforts into minimising any collateral harms caused to individuals or to society.

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Nowhere were the challenges of regulation more apparent than with attempts to prohibit alcohol in the US in the 1920s and 1930s. As we will see in more detail below, whilst alcohol was prohibited by constitutional amendment it was still produced and consumed in vast quantities. Prohibition simply transformed alcohol into an illegal commodity and its production and supply into clandestine, and lucrative, activities for the criminal organisations. Away from the momentary yet zealous experiment with prohibition in the US, and notwithstanding the many contemporary examples of alcohol prohibition in Muslim majority states, the history of alcohol regulation is one of control of supply and demand. The great majority of alcohol policies are therefore aimed at one or more actions focused on controlling the availability of alcohol; reducing demand for alcohol to levels seen as ‘safe’; disassociating certain activities, such as driving, from the consumption of alcohol. This is in quite stark contrast to all but the most recent examples of drug regulation which have tended to focus on criminal prohibition and, particularly in the latter decades of the twentieth century, quasi-militaristic enforcement. There is, then, enough of a difference with the strategies used to regulate alcohol and drugs for us to impose a somewhat blunt divide and address each in separate chapters. However, as we shall see in the next chapter, the prohibitionist edifice that was established around drugs in the twentieth century has begun to collapse (Decorte et al., 2020), with the decriminalisation and legalisation of previously prohibited substances now a notable global trend. At the same time, we are witnessing changes around alcohol and tobacco where, at least in many parts of the global north, public health policy has driven incrementally greater restrictions on their sale and use. Monaghan and Yeomans (2016) have referred to this as a partial convergence of alcohol and drug policy. For now, in this chapter, we will consider both historical and contemporary attempts to regulate and control alcohol and observe how concerns over risks and harms, notably those relating to public health and crime, have shaped a complex patchwork of controls and restrictions.

Alcohol Legislation: Historical Context Alcohol provides an example of one of the oldest and longest running attempts by the state to regulate intoxication and symbolises the vexed task of providing an effective legal basis for intoxication to be allowed but controlled within defined parameters. In this section, we explore the incremental development of legislation designed to permit but control alcohol in society. In 1552 the Alehouse Act introduced a licensing system for the sale of alcohol administered

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locally whereby licences were bestowed and renewed by local Justices of the Peace (i.e. magistrates). Prior to the act, anyone could brew ale and sell it from their home. The key aspect for the introduction of this system was to regulate who could sell beer, wine and spirits for ‘on’ and ‘off’ trade consumption and for protecting the ‘public good’ by limiting disorder, preventing adulteration and receiving taxation. There is some room to suggest that it was the latter two of these three concerns that primarily worried the state, with the production and sale of alcoholic beverages being so widespread and so lucrative as requiring state intervention and control. The 1864 Public House Closing Act was the next milestone piece of legislation. It was at this point that we can witness further restrictions placed on the timings of alcohol consumption as pubs were forced to close between 1 and 4 a.m. Here, we do see the emergence of concern, evident ever since, relating to population control and social (dis)order. The forced closure of venues selling alcohol and permitting drinking, even if only for a few short hours, was hoped to act as a curb on bawdy all night and multi-day drinking sessions. Restricted opening hours was a theme that characterised subsequent pieces of legislation. The 1872 Licensing Act introduced midnight closing in London and closing times of 11 p.m. elsewhere. This, however, told part of the story as Gentlemen’s Clubs—often frequented by those in the upper social echelons were exempt. There was, then, an intrinsic class bias reflective of the strict class hierarchies of the day. Working-class drinking was seen as threatening and in need of control, lest the farm labourers and factory workers fail to be productive cogs in the capitalist machinery. Meanwhile, upper-class drinking was condoned and facilitated, it being accepted even in excess that these were respectable people, in control of their faculties. Into the twentieth century the policy goal of restricted opening hours continued and, notably, advanced significantly when, at the onset of World War I, with the passing of the Defence of the Realm Act in 1914 introducing afternoon closing of pubs with the specific intent of ensuring the productivity of munitions factory workers and other labour vital to the war efforts. This legislation stayed in place until 1988, which then ushered in a period of liberalising of alcohol licensing, which reached its apogee with the Licensing Act of 2003. This latter piece of legislation extended licensing as part of ‘revitalising’ city centres by boosting an unfettered night-time economy and push for ‘continental’ style drinking. Alongside the changes around licensing were other movements aimed at restricting the role of alcohol in society. During the nineteenth century the issue of ‘intemperance’ and the regulation of alcohol increasingly became a political as well as a social and moral issue (Greenaway, 2003: 20). The period from 1840

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to 1940, during which successive pieces of restrictive licensing legislation were enacted, represents how intemperance was one of the main social problems. Frequent and habitual drunkenness was pinpointed as both cause and symptom of society’s ills. Rather than the outcomes of increasingly exploitative and unequal economic and social arrangements that saw urban populations swell and living standards decline, the moral laxity of individuals could be blamed. This would subsequently attract the attention of politics eager to address the evident failings of Victorian society. Enfranchisement via 1832, 1867 and 1884 Reform Acts gave rise to party political system with Liberals (Whigs) and Conservatives (Tories) competing on the ‘drink question’. This coincided with the emergence of the Temperance Movement—a largely middle-class movement intended to ‘save’ the working-classes from their fate and to help them ‘improve’. In this sense, it was very much shaped by the twin features of philanthropy and paternalism, two specific Victorian features of social policy. Unpacking the Victorian Temperance Movement and its legacies is a task undertaken by the British criminologist Henry Yeomans. According to Yeomans (2011) there were two main positions within the Temperance Movement. On the one hand, the ‘Suasionists’ believed in individual responsibility and abstention from alcohol as a moral imperative. On the other were the ‘Interventionists’ who expended significant amounts of capital in lobbying the for state-enforced prohibition. As the historian James Nicholls (2013) notes, the: Single factor which distinguished the Victorian temperance movement from the raft of anti-drink activity that preceded it was the emergence of organised temperance societies. That is, local, and later national, associations whose defining feature was their goal of reducing or eradicating alcohol consumption across society.

Similarly, Yeomans (2014: 242) shows how through their organisational prowess, the Temperance Movements of the 1830s ‘targeted all drinks and drinkers’ based on ‘the problematisation of alcohol itself’ (Yeomans, 2014: 242). Although derided as being paternalistic, Yeomans (2011) points out that some support for it derived from appeals to the new urban working-class desire for ‘respectability’ and social mobility. Rather than an exclusively top-down state imposition, the movement appealed to many in society because it offered a tantalising diagnosis of personal and social problems. If you are the honest labourer of humble means, the proposition goes, ‘take the pledge’ to renounce the ‘demon drink’ and you will be rewarded with prosperity and respect. As a ‘good’ citizen you will also be entitled to look down on those others whose poverty, illness and possible destitution is just rewards for their slovenly and intemperate ways. The

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Temperance Movement was therefore part of the Victorian zeitgeist for various reasons. It provided a moral lens for viewing society and explaining its ills. It was a cause readily taken up by the emerging middle-classes who lacked the wealth and privilege of the landed upper-class but who would take an increasingly prominent role as the self-appointed moral crusaders of Victorian society. It is notable, then, that a lot of support and much of the movement’s cultural force came from the middle-classes, with Christian groups and women’s activists central to a powerful coalition for social change. Industrialists too would see the opportunity of using moral regulation to instil an imperative of consumer citizenship where renouncing drink opened a new realm of upward social mobility, often evidenced through new forms of consumption. As one advertisement for drinking cocoa in the 1880s would suggest, the drinking of alcohol put him and his family on a path to financial ruination whereas the other path, drinking cocoa had him relaxing amongst the trappings of domestic respectability, with humble but cosy furnishing with well-dressed wife and wholesome offspring besides.

The ‘Noble Experiment’: American and the Prohibition of Alcohol Whereas in the UK the Temperance argument of the Suasionists seemed to have the upper hand in that alcohol was never prohibited at the state level, in the US the Interventionist movement was predominant. Federal prohibition of alcohol became law with the Eighteenth Amendment to the United States Constitution, known as the Volstead Act—which came into effect on 17 January 1920. This has been referred to as the ‘Noble Experiment’. However, the hope that alcohol and its associated social problems could be banished from American society with the stroke of a lawmaker’s pen was almost instantaneously crushed. Within an hour of the act coming into force a consignment of medicinal spirits, permitted under prohibition but now made so valuable as to garner instant attention from criminal gangs, had been hijacked by an armed band in Chicago (Walton, 2001: 206). Almost immediately, prohibition came in since ‘violations were so common that courts were placed under great pressure’ and, in spite of the huge and growing expense of enforcing a country wide ban, ‘actual drinking habits had not changed in any way: those who had been abstemious continued to be so and drinkers continued to buy and consume, albeit in secrecy’ (Sournia & Porter, 1990: 123). In a situation which many critics of the contemporary War on Drugs find a ready parallel with, the costs of enforcing a ban on production, supply, sale and consumption and, critically, of trying to outwit the criminal gangs ennobled with wealth

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and power through the newly illicit trade, failed to result in anything approaching equivalent reductions in any aspect of the trade or the many social ills which had been assiduously associated with it in the build up to prohibition. Prohibition lasted until 1933 when the twenty-first amendment to the constitution which repealed the Eighteenth Amendment. One question that remains is how widely supported was the policy by the public. Prohibition did not emerge at random. There was a prohibitionist zeal that was spreading across the planet at the time, not just with alcohol but with other drugs too (see Berridge, 2013). Where alcohol was concerned, Blocker (2006) notes: …Americans were not alone during the first quarter of the 20th century in adopting prohibition on a large scale: other jurisdictions enacting similar measures included Iceland, Finland, Norway, both czarist Russia and the Soviet Union, Canadian provinces, and Canada’s federal government. A majority of New Zealand voters twice approved national prohibition but never got it.

Blocker states it was the culmination of nearly 100 years of ‘temperance agitation’, which had created a cultural climate ‘deeply hostile to alcohol, and this antagonism manifested itself clearly through a wave of successful referenda on state-wide prohibition’ (p. 233). For Hall (2010) a key issue in understanding prohibition and its repeal relates to public support. This is important, especially when dealing with historical issues, as the evidence can be distorted and contorted to fit a prevailing position. Thus, those who campaigned for a repeal of the Volstead Act (wets) foregrounded evidence of the iatrogenic (harm causing) nature of the policy. Others who supported prohibition (drys) tended to promote the evidence linking prohibition to positive outcomes such as the booming economy of the 1920s. To assess public support, Schrad (2007) utilised punctuated equilibrium theory. Broadly speaking punctuated equilibrium states that policy is characterised by periods of stability that at infrequent junctures give way to rapid social change. To put it simplistically, Baumgartner and Jones (2010) contend that all policies are subject to certain kinds of flak or critique. Policymaking is also subject to ‘negative information feedback processes’. These relate to how most policymakers and policy actors see the world and policy in a similar way. This acts as a barrier to change ensuring that the flak does not seem to penetrate the system of policymaking. Sometimes, however, the flak or critique finds a powerful supporter in policy and the negative feedback information processes become more positive. At this point, forces external to the policy process can generate change. Public opinion is a powerful external force that can sometimes impact on policy thinking and pol-

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icymaking, particularly when this opinion is harnessed in the form of large-scale social surveys (Ingold & Monaghan, 2016). According to Schrad (2007) new information and data can emerge that help sway the policy process out of periods of stability to bring about change. These bring about change by shifting the attention of policymakers towards the issue. Thus prior to the passing of the Volstead Act, the harms of alcohol and the benefits of abstinence were promoted by powerful groups, creating a favourable political climate for change. Although alternative models for alcohol control were known—such as the system of state controlled supply, also known as the Gothenburg system—it was felt that outright prohibition was the favoured project of the Temperance Movement and was being incrementally introduced across the US at State if not yet at Federal level. Prohibition subsequently found powerful sponsors in Government and the media. The Temperance Movement was able to overcome its own internal splits, such as those that favoured moderation over abstinence, to fix upon the policy of prohibition. Timing here was important, Schrad (2007) sums up the situation as follows: The change of policy venue would be accompanied by a dramatic shift in policy image with the looming war in Europe after 1914. The frenzied emotions associated with war mobilization allowed prohibitionists to recast prohibition from an issue of personal morality to one of patriotism, sacrifice, and national security by urging and subsequently achieving wartime bans on distilling and brewing between 1917 and 1919. The increase in the coverage of the rising prospects for national prohibition in the media was mirrored by an increased coverage of prohibitory legislation at both the state and international levels. The submission of the Eighteenth Amendment to the states for ratification in 1918 was preceded by a wave of prohibition legislation at the state level—between 1915 and 1918, the number of prohibition states increased from 10 to 32. Likewise, by 1918, the United States would join the ranks of Russia, Finland, Iceland, Canada, and Newfoundland as prohibition countries, with numerous other European states incorporating increased restrictions on alcohol production. (Schrad, 2007: 445–446)

The subsiding of the wave of patriotism that followed the war can be used to explain the steady clamour for the repeal of the 18th amendment or at least the context for it. Schrad (2007) states that each perspective on the emergence of prohibition also explains the emergence of the repeal of the Volstead Act 13 years after enactment. More specifically, Schrad identifies a number of key factors that brought about the demise of prohibition. Firstly, prohibition did not ban use, it did ban sale, manufacture and transportation. As a result, there was always some ambivalence about the law. Enforcement of the law was neither the sole responsibility of the federal agencies or the state, which created the conditions for cor-

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ruption or shirking responsibility. Political debate tended to focus more on ways of making the law workable even when early on in the policy cycle it was looking like the opposite was commonplace. Eventually, this was settled along party political lines with the 1932 Democratic landslide victory of Franklin D Roosevelt who campaigned for repeal giving the ‘wets’ a mandate for repeal. The final key factor is the 1929 Stock Market crash ushering in the Great Depression. Alcohol sales and taxation were thus framed as a legitimate source of potential revenue at a time when it was much needed. This reading of history has generally framed alcohol prohibition in the US as a failure. Indeed, this has become so commonly known that Hall (2010) states it is frequently discussed in academic debates without the standard requirement of support from academic sources. The failure of prohibition can be summarised in the following sequence (a) as prohibition did not ban use, it did not fully impact on overall levels of consumption, but (b) it typifies the iron law of prohibition in that consumers did not obey the directive to not use, but sought out stronger forms of intoxication turning to spirits rather than beer and wine because; (c) producers produced more spirits as lower volume production and sales could yield higher profits; (d) the profits generated from sales of spirits were secured by illegal producers often overseen by organised crime syndicates; (e) this meant there was little quality control of products; which (f) created higher risks for consumers who could be arrested and prosecuted for their alcohol possession and could also suffer adverse health consequence, both chronic and acute, from drinking unregulated products and; (g) prosecution could, furthermore, undermine support for the rule of law if the law was seen to be unnecessary, unfair or unpopular. Hall also notes how alcohol prohibition has become a key reference point for those wishing to repeal the prohibition of cannabis as well those who argue against tighter controls over alcohol pricing or access to tobacco or even those who wish to allow the use of performance enhancing drugs in sport. The standard arguments about the failure of alcohol prohibition in the US can be, according to Hall (2010) contrasted with those of historians of public health who point to the fact that prohibition actually improved public health at least in the early days, but that these benefits diminished over time. For Hall (2010) it is too simplistic to merely say that prohibition was a failure. Often prohibitionist policies are judged against public health criteria. Critics point out that if prohibition fails to eradicate use, then by definition it must have failed, but for Hall the metric of eradication is unfeasible. Despite various attempts to control tobacco control through messaging linking cigarettes with lung cancer, smoking cigarettes has not been eradicated. In many places in the West, rates of cigarette smoking have significantly declined and along with them

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various harms caused by this activity. Hall points out how there is contemporaneous evidence showing how national prohibition of alcohol did lead to positive health outcomes. Hall points to a study by Warburton (1934) who used several different measures to estimate the size of the alcohol market during prohibition. The measures included data on estimates of the proportion of alcohol smuggled over the border from Canada into the US based on data of agricultural materials sold in the manufacture of wine, beer and spirits. Secondly, Warburton looked at deaths from diseases such as cirrhosis of the liver to estimate the extent of alcohol consumption (drawing on the known association between these); finally, he used data from criminal justice, more specifically arrestees’ data for public drunkenness in 383 towns and cities. He triangulated these data sets to come up with estimates of consumption. After gaining an overall picture of alcohol consumption, Warburton was able to conclude that national prohibition had reduced alcohol consumption, which had the economic benefit of transferring spending elsewhere. The booming economy of the 1920s in the US was, therefore, said to be linked to prohibition as consumers were spending more on automobiles and the things that Merton (1938) would later describe as cultural goals such as white goods and leisure. Other thinkers according to Hall (2010) would use similar ways to estimate the extent of alcohol use and then look to analyse whether there had been any reduction in harms such as reductions in Cirrhosis or public displays of drunkenness. Mirroring, some of the discussions we had in the introduction to this book about how prohibition makes the process of researching intoxication that much more challenging, critics of this approach (often those described as ‘wets’) who wanted to repeal the Volstead act would question the reliability of the data and say that any declines in such occurrences could be down to under-reporting of them under the conditions of prohibition. The data for instances of deaths from cirrhosis and public drunkenness are shown to decline around 1920 in data presented by thinkers such as Gebhart (1930), but as prohibition goes on, there is also a sense of regression to the mean and, therefore, evidence of diminishing returns (see Hall, 2010: 1169). So, whether prohibition was the outright failure that is often widely held to be, is according to Hall, open to some debate. The overarching question and one that must be borne in mind in evaluation research in social policy is whether any potential benefits from a policy, programme or intervention were obtained at an acceptable social and economic cost. One of the difficulties of analysing the economic effects of prohibition is that they are almost inseparable from the Great Depression of the 1930s. Where social costs are concerned, we can turn to data on crime and in doing so address some of the common sense criticisms of pro-

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hibition listed earlier. Again Hall (2010) provides an overview of some of the contemporaneous data, which can be summarised as when taking rates of alcohol-related cirrhosis as a measure of the extent of use, ‘prohibition was correlated negatively with cirrhosis of the liver, but positively with murder rate’ (Miron & Zwiebel, 1991). Miron and Zwiebel (1991) conclude that this is because in illegal markets, disputes are settled through violence rather than other means. Ultimately, of the experiment of national alcohol prohibition Hall (2010: 1171) notes that it is hard to reach any other conclusion that the benefits of prohibition did not come at acceptable social and economic costs: The standard account of the effects of national prohibition in the United States is wrong in claiming that it had no effect on alcohol use. On balance, Prohibition probably reduced per capita alcohol use and alcohol-related harm, but these benefits eroded over time as an organized black market developed and public support for NP declined. Those who remain unconvinced by the historical evidence of its effects on alcohol use should similarly moderate their confidence in conclusions about its effects on crime, because the same type of evidence is used in each case.

There are those who suggest a more nuanced evaluation of prohibition is long overdue. Blocker (2006), for example, suggests that many of the temperance aims which eventually gave rise to the Volstead Act were successful. The liquor industry was decimated and took many decades to recover. This, Blocker (2006) argues, gave a generation coming into drinking age around the end of the time of the repeal of prohibition the opportunity to mature into adulthood under less pressure to drink. Indeed, consumption in the US did not reach pre-Prohibition levels until the 1970s, allowing for vast health benefits to be achieved even if they were not sustained. There is also, though, some suggestion that one legacy of prohibition was to lay the foundation for a dramatic shift away from public drinking to domestic consumption within the home. In more recent time, however, the American experiment with national prohibition is most frequently framed as a lasting warning of the fallacies of prohibition or, increasingly simply as an appealing backdrop for modern cultural representations steeped in nostalgia for a time of bootleggers, speakeasies, mobsters and their molls. Prohibition and its complexities offer a useful insight into the politics of drink. Nicholls (2013: 1–2) has stated that the ‘social, political, economic and ethical questions posed by drink have never been fully resolved and have never gone away’. We pick up some of these issues later in this book. For now, we can say that despite the widespread challenges brought about by alcohol prohibition and even though the noble experiment was short-lived, the banning of the sale, manufacture,

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importation, exportation and cultivation of other substances became the chosen global response to other drugs and in many ways, it has been a case of history repeating itself.

Prohibition in Muslim Majority Countries Whilst it is common to speak of prohibition as a thing of the past is also important to acknowledge that alcohol remains prohibited in many countries where Islam is the dominant religion. Developing from the eighth century onwards, Islam spread throughout much of the Middle East, North Africa and Southern and South-eastern Asia. In key Islamic texts the term khamr, often translated as wine, is referred to as something clouding the mind, distracting from prayers and leading to social disorder (Powell, 2004). In several aya, verses of the Qur’an, alcohol is spoken of as a sin causing hostility and hatred and, in more detail still, the deeds and sayings of the Prophet Muhammad known as the Hadith makes numerous proclamations that the consumption, production, sale or profit from alcohol, even in modest amounts is haraam, forbidden. In an overview of alcohol and Islam, Michalak and Trocki (2006: 531) suggest the prohibition of alcohol in Islam followed several stages, taking it ‘from a behaviour that was tolerated, then discouraged, then forbidden, then strongly forbidden, as can be seen in the Quran, the Hadith, and traditions relating to the practice of Muhammad and his successors’. Of course, Islam is a diverse religion and not all Muslim majorities impose full prohibition in principle or practice. Taking two extremes, in Saudi Arabia the production, sale or consumption of alcohol are all punishable by fines, lengthy prison sentences, public flogging and, for foreign residents, deportation whilst, in contrast, in Turkey beer, wine and raki are widely available and consumed (Michalak & Trocki, 2006). Muslim majority countries strictly enforce total prohibition yet allow for narrow concessions, typically relating to non-Muslim citizens or expatriates (Al‐Ansari et al., 2016). In spite of such probations, clandestine alcohol consumption, both in moderate and excessive amounts, does exist in various Muslim countries although, as Al Marri and Oei (2009) observe, there is a continued lack of empirical evidence and clinical knowledge about its extent and nature. Alcohol consumption levels in countries such as Saudi Arabia and Somalia are reported, at least officially, as zero. However, a great many Muslim majority countries report negligible amounts close to but actually at zero in acknowledgement of clandestine use and consumption by non-Muslim minorities. The forces of globalisation mean that the

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availability of alcohol and its consumption have increased in recent decades in many Muslim majority countries and present a number of challenges to alcohol probation. These include the increased influence of the alcohol industry, often using peer-to-peer marketing to circumvent restrictions on advertising and promotion and the exposure of citizens to alcohol via media, social media or interaction with non-Muslim residents (Al‐Ansari et al., 2016).

The Price of Drink: Regulating the Alcohol Availability and Demand In many countries, alcohol is widely enjoyed and typically drunk in moderation. Yet, alcohol consumption and drunkenness are associated with a range of harms and problems in society. It is this tension that makes the regulation of the availability of alcohol and the demand for it so troublesome. As Martin Plant and colleagues note in opening a review of alcohol harm minimisation approaches (Plant et al., 1997: 3): The very popularity of alcohol makes the control of alcohol-related problems highly controversial and politicised. Often the debate about how to curb such problems is charged by ideological fervour, vested interest or prejudice. Discussions about the best approaches to reduce levels of alcohol-related problems are also frequently restricted by uncertainty about what the effects of some of the possible strategies might be.

Away from the historical and contemporary examples of total prohibition explored in the previous two sections, the modern history of alcohol control is mostly that of regulated availability. In contemporary times, the regulation of alcohol typically involves a combination of restrictions on control and supply coupled, increasingly so in recent years, with various attempts to steer demand to ‘safe’ levels. If people are to drink alcohol, then many states seek to retain a degree of influence over where and when this is. Summarising this, Stockwell (2006: 270) draws a distinction between harm reduction strategies which seek to reduce the likelihood of harm without necessarily requiring a reduction in levels of consumption either by individuals or populations and contrasts this with both demand reduction and supply reduction strategies which aim to reduce consumer motivation to drink and limit the availability and ease of acquisition of alcohol, respectively. Supply-side regulation focuses on who can make and sell alcohol then restricts who can buy it and where and when it can be bought. Many focus on managing the availability of alcohol through restrictions on who can sell alcohol and

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where and when it can be purchased. Licensing in the primary mechanism for this. Taxation is a widespread, yet typically blunt, tool for states to exert some degree of control over alcohol sales. In the UK, tax on alcohol comes in the form of duties paid to HM Revenue & Customs on alcohol sales. Duties are structured by drink category, with separate duties being set for beer, cider, wine and spirits and tiers within categories structured by strength to allow for higher rates to be levied against stronger beers, ciders and wines. Whilst taxation of alcohol has historically been primarily a means of state revenue generation, in recent years it has increasingly been justified as a public health measure based on the logic that in being price responsive, price increases can precipitate a reduction in alcohol consumption levels that, it is hoped, translates into reduced harms to individuals and society (Plant & Plant, 2006). Even harm reduction policies that receive widespread support and have resulted in tangible outcomes have their own complex histories of implementation. Reducing drink driving offences, for example, required years of public education campaigning coupled with clearly defined laws and swiftly enforced punishment, typically with the immediate confiscation of the offenders driving licence, which gave the impression of a high chance of being caught by random breathalyser testing (see Stewart & Sweedler, 1997). However, again looking away from the UK and North America for examples, we can see attempts to restrict the supply of and limit the demand for alcohol implemented and supported on a national scale. In the twentieth century, all the Scandinavian countries of Northern Europe implemented some form of centralised state control over the production and sale of alcoholic beverages. The rationale for this move was to eliminate private profit motives from the sale of alcohol and, in an increased emphasis over the decades, manage the potential harms of alcohol on society. Both Norway and Iceland established state monopolies of alcohol sales in 1922 with Finland also doing so in 1932. In Sweden, where alcohol sales had been severely restricted during the First World War, a system of municipal-run retail and rationing known as the Bratt system was implemented in 1917, and continued after a 1922 referendum narrowly failed to implement a formal state-wide prohibition of alcohol. Under the Bratt system, those wishing to purchase wine or spirits had to visit a Systembolaget store, presenting a ‘motbok’ to be stamped logging, and in the process restricting, the quantity of alcohol purchased. Organised on municipal lines, the system would be amalgamated into a single statewide monopoly on the sale of alcohol in 1955. Nordic monopolies typically meant all but the lowest strength beverages had to be bought from state-run shops which often kept limited opening hours and presented alcoholic drinks for purchase in an intentionally austere setting devoid of branding and promotions. Pro-

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ceeds of alcohol sales could be used to finance research into the health and social impacts of alcohol harm and, more generally, fund social welfare. However, in recent years the Nordic model has been somewhat weakened. Membership of the European Union, and its predecessor the European Economic Area, for many Nordic states resulted in some reworking of the model (Örnberg & Ólafsdóttir, 2008). However, restrictions placed on alcohol in Scandinavian countries and, in particular, the system of state retail monopoly retains widespread support (Karlsson et al., 2020; Lindeman et al., 2013). The implementation of new restrictive alcohol policies is a complex negotiation. This is demonstrated by efforts to introduce legal price thresholds beneath which alcoholic products may not be sold. This approach has become known as Minimum Unit Pricing (MUP) and interest in this approach, which supporters suggest makes an immediate impact in lowering alcohol consumption levels both across society and, specially, within groups of problem drinkers who generally consume low-cost yet high strength products such as spirits, ‘super strength’ beers and strong ‘white’ cider purchased from off-trade retailers such as off licences and supermarkets. In practice, alcoholic beverages in licensed venues generally exceed the MUP threshold so are unaffected. Whilst a UK wide initiative was mooted by at the time Prime Minister David Cameron in 2012, it was a specifically Scottish action that became the basis for the world’s first comprehensive Minimum Unit Price law. Having been passed into law with cross-party support in the Scottish parliament, the Alcohol (Minimum Pricing) (Scotland) Act 2012 was initially delayed by legal challenges headed by industry bodies, notably the Scottish Whisky Association. Since coming into effect on 1 May 2018, a minimum price of 50 British pence per unit of alcohol. There are several key criticisms of MUP. Such is the entrenched free market principles of consumer societies that government interventions on prices can be seen by businesses as an attack on trade and enterprise and by consumers as an attempt to curtail liberties and ‘nanny’ people into making decisions. For example, prominent in media coverage of the passing and implementation of the act was setting higher minimum prices punishes ‘responsible drinkers’ of modest incomes who rely on discounts and promotion to afford an occasional drink. Based on a logic that narrows alcohol consumption practices to rational economic decisions where higher costs result in equivalent lowers spending. Evaluations both before and after the implementation of MUP suggest that moderate drinkers are largely unaffected. Writing in the medical journal The Lancet, a team of scholars from University of Sheffield modelled an MUP threshold of 45 pence per unit to predict significant decreases in consumption, albeit with the most moderate drinkers being the least effected (Holmes et al., 2014). Evaluations have

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shown that both Scotland and Wales recorded decreases in alcohol sales following the implementation of MUP and that, critically, reduced spending came from households where the most was spent on alcohol, leaving low spending households largely unaffected (Anderson et al., 2021). Much has been made of Scotland’s MUP implementation being the first of its kind in the world and there is a general sense that policymakers in many other countries are watching the Scottish—and, since they followed suit in March 2020, Welsh—experiment to see if its heralded impacts play out in practice (Beeston et al., 2020). Public Health Scotland will lead evaluations of the impact of MUP, with a planned report to the Scottish Parliament in 2024 to inform a vote on if and how MUP should be continued beyond April 2024 (Beeston et al., 2019). Scotland presented a particular policy context and political climate which made a pricebased intervention suitable. Having a long-established burden of heavier alcohol harms than the other nations of the UK, yet relatively limited devolved powers (e.g. alcohol duties were set by the central UK government) (Katikireddi et al., 2014). Intoxication in Contrast 3

Between countries there are huge differences in levels of alcohol regulation and how strictly any laws are enforced. In Norway, Buvik and Baklien (2014) used ethnographic methods to observe public officials making inspections in pubs and bars in Oslo. They found that inspectors had to translate the abstract terms of alcohol legislations into ‘street-level’ decisions about managing the intoxication of individuals. However, identifying and punishing specific acts of deviance in a setting where the majority present are intoxicated proved difficult. In contrast, Emeka Dumbili (2014) examines the relative absence of alcohol regulation in Nigeria. He critiques the current preference for self-regulation by the alcohol industry as a failure to implement effective message to curtail problem drinking. For example, he notes that basic information about the strength of alcoholic beverages is generally absent from labelling, perhaps leaving consumers unaware of the possible harms of their drinking. Buvik, K., & Baklien, B. (2014). Street-level alcohol policy: Assessing intoxication at drinking venues in Oslo. Drugs: Education, Prevention and Policy, 21(5), 380–387. Dumbili, E. W. (2014). Can brewer-sponsored “drink responsibly” warning message be effective without alcohol policies in Nigeria? Drugs: Education, Prevention and Policy, 21(6), 434–439.

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Alcohol and Crime Whilst a link between alcohol and crime is so frequently made as to seem ‘self-evident’, the relationship between the two is ‘far more complicated than is assumed both in popular discourse and in the official response to offences committed after the offender had been drinking’ (Dingwall, 2015: 1). Evidence of a causal link between alcohol and crime is problematic. In the UK, the most cited data relating to what gets called ‘alcohol-related crime’ comes from the Crime Survey for England and Wales where victims are asked whether they think, at the time of an offence being committed, ‘the person/were any of the people who did it under the influence of drink?’. This, as with many other crime surveys, is problematic both as it relies on the subjective perceptions of victims and witnesses of crime and this means there is a risk of conflating spurious factors with direct causal power. Interesting questions are also raised about the implications of intoxication for criminal responsibility. Because mens rea, the specific mental intention to commit a criminal act, is required for the legal prosecution of many criminal offences, the intoxicated state of drunkenness is a potential justification for someone who can present their crime as committed when they were not of sounds mind. However, as Dingwall (2015) notes, cases where intoxication can be said to amount to an absence of mens rea are rare and limited to incidents of involuntary intoxication or extreme voluntary intoxication. In the great many cases, in short, being drunk does not absolve the offender of any element of criminal responsibility, especially when their drinking has been intentional as to forge the courage to commit crimes. In recent decades, disorder has been a recurring feature of policy debates. There has been an increased activity targeting the so-called ‘street drinking’ that falls outside the remit of licensed premises but takes place in public settings outside of the domestic home. Whilst such initiatives are now relatively common, in 1988, when the first byelaw banning street drinking was enacted in the English midlands city of Coventry, the specific banning of street drinking was considered an experimental intervention. The ‘Coventry City Centre Alcohol Related Crime Project’ was initially driven by the local Chamber of Commerce following increasing concerns about outbreaks of criminal damage attributed to alcohol to city centre shop fronts. Alongside other initiatives, such as public leafletting about the harms of alcohol and the local YMCA opening an alcohol-free disco, the consumption of alcohol would be outlawed, turning the city streets into an ‘alcohol-free Zone’. Although receiving considerable public support, particularly given the sensationalist media coverage of the middle and late 1980s decrying the rise of violent ‘lager louts’, the law was complicated to implement. The extent of

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the law’s remit had to be mapped with precision whilst public and private land had to be demarcated and, where private land fell within the restriction zone, the consent for its enforcement needed to be sought from landowners. Several hundred signs proclaiming the imposition of the ban in particular areas had to be erected by the council. Critically, however, it was not the drinking of alcohol in public space as much as the refusal to cease drinking in public, when asked to do so by a police officer, which was the offence to be addressed. This placed a burden on local resources and diluted the deterrent of a policy that would, in effect, allow public drinking up until the very moment a specific individual was asked to stop (see Ramsay, 1990). Whilst there was little evidence of a sudden reduction in crime figures following the implementation of the Coventry alcohol-free zone, the scheme received ongoing and enthusiastic backing both amongst local police and from residents. Despite concerns about the curtailment of civil liberties, such schemes would quickly become established in over a hundred towns and cities in the UK (Dixon et al., 2006) and are now commonplace (Fig. 3.1). In the application of such bans, what is often being targeted is not specific crimes such as assault and theft, which would already have associated criminal offences via which the police can initiate arrests, but a more general perception of disorder and disease with incivility. Pennay and Room (2012) reviewed several community evaluations of street drinking bans in locations across the UK, Australia and New Zealand and found no real evidence of their effectiveness beyond offering a perception of something being done to improve safety and protect local amenities. Additionally, recurring themes in the evaluations indicated that whilst public drinking bans tended to garner support from local traders, older residents and the police, they were also inconsistently enforced, with the likelihood that enforcement tended to impact negatively on marginalised groups. Alongside such measures tackling anti-social behaviour linked to alcohol in towns and cities eager for the golden touch of economic regeneration, a more immediate, on the ground and—in various ways—in your face form of regulation developed. The growth of the night-time economy generated a vast demand for ‘security’. In the 2000s in particular, a series of criminological studies sought to understand the work of bouncers and their role in regulating the night-time economy. In these studies, bouncers are shown to exert a form of social control pivotal to a leisure industry simultaneously selling transgressive excess whilst needing to curtail overt displays of disorder (Winlow & Hall, 2006). This was a period in which the government was pushing a previously informal sector to professionalise through mandatory registration and training. However, importantly, ‘working the door’ was shown to still very much rely on the bodily performance of working-class men for whom being tough, being able to administer and withstand acts

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Fig. 3.1   Alcohol-Free Zone Sign in Liverpool, UK

of violence, was leveraged into paid labour (Hobbs et al., 2003). Insights into the work that bouncers do in the night-time economy therefore foreground the surveillance of drunken behaviour and a constant vigilance of signs of disorder. Research commissioned by the alcohol industry funded Portman Group made specific reference to ‘lager louts’ in framing the problem of alcohol and public disorder as worthy of research and policy intervention. The resulting report (Marsh & Kibby, 1992: 22) showed some insight into why young men trying to ‘have a good night out’ were so ‘easily drawn into disorderly situations sim-

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ply because they were all milling around in the same place at the same time as “trouble” occurred’ and acknowledged various cultural and situational factors at play in drunken violence. Critically, the report would suggest that long-standing licensing restrictions forcing most venues to close at 11 p.m. precipitated a context in which crowds of revellers rushed through their final drinks before being discharged into congested spaces. In the reported data, violence peaked between 11 p.m. and midnight on Friday and Saturday nights, with incidents clustered around bottle necks such as venue exits, takeaway food venues and taxi ranks. Having made a case for the connection between alcohol consumption and violent crimes, the principal recommendation of the report was, somewhat counterintuitively, not for a tightening of regulation but for a relaxation of regulation. Staggered closing times, the recommendations suggested, would ease congestion and allow for a ‘drifting home’ involving the more gradual dissipation of drinkers. Issues around drunkenness and disorder were also the chief framing of debates leading up to the passing of the Licensing Act 2003, legislation which would significantly liberalise alcohol policy. Central to the act were plans to shift the granting of licences to sell and serve alcohol from Magistrates to local Licensing Committees and to offer flexibility in terms of opening hours and closing times. Underpinning this was the somewhat contradictory idea that alcohol was a driver of public disorder and therefore in need of regulation but, if done in this way, a more ‘continental’ style of drinking focused on bars, cafes and restaurants clustered around cultural venues could be fostered. However, the years between the passing of the act in 2003 and its implementation in 2005 were littered with alarmist media coverage which Yeomans (2009) describes as reviving Temperance era discourses about ‘out of control’ drinkers and the slippery slope into drunken violence which greater availability precipitates. Further still, Plant and Plant (2006) suggest that the alcohol industry lobbied in favour of licensing relaxation, alongside consumer information and education drives, all of which are known to have only limited impact. In practice a tiny number of venues applied for and implemented 24-hour licences, and amongst these most were atypical venues like airport bars. Although the intention of the act, and the imagery conjured up in debates around its implementation, was very much focused on urban areas, Foster (2008) notes the case of North Walsham in Norfolk. All the town’s seven pubs applied for and received 24-hour licences under the terms of the newly effected act, however, in practice they tended to close at midnight or 1am depending on the day of the week. It was reported that pub goers started their drinking later, pacing themselves more steadily and that assaults in the town had declined significantly.

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‘Please Drink Responsibly’?: The Problem of Moderation A clear strand in alcohol policy has been to deregulate and liberalise controls on the production and distribution of alcohol yet, at the same time, place increasing emphasis on the responsibility of the individual to restrict their consumption to certain levels. Whilst alcohol has become more available and more affordable than ever before, and arguably a substantial amount of stigma about heavy drinking has fallen by the wayside, pressures to control one’s behaviour have been strengthening. This is paradoxical until one considers the neoliberal ideologies that underpin this trend as prompting a laissez faire approach to the business of selling alcohol is paired with a fixation with individualised solutions that make an imperative of internalising messages about safe and unsafe drinking as the responsibility of individual drinkers. However, particularly where alcohol is concerned, it is worth examining the current trend for moderation which is, in many contexts, the intended outcome of public health campaigns relating to behavioural change. The thinking here stems from public health and its use of epidemiological data, combined with an admission that in a great many countries population-wide tee totalism is impossible. Population level health and illness trends are linked to alcohol consumption habits and guidelines about drinking rates are derived with the intention of reducing consumption rates for individuals but also for the population at large. Drinking guidelines which stipulate a certain amount of alcohol, typically as ‘units’, that can be drunk safely are increasingly common. However, they are frequently criticised for their apparent arbitrariness and how frequently they are changed, as they were in the UK in 2016 when the Chief Medical Officer equalised the recommendation for men and women not to exceed 14 units per week where previously men had been ‘allowed’ up to 21 units. Recently, Tassiane Paula and colleagues (2020) surveyed drinking guidelines across the globe, finding 58 of 194 countries to have low-risk guidance in place. Such guidelines were more common in high-income countries. Strikingly, both the definition of a standard drink and the suggested limit below which alcohol consumption could be said to carry a low-risk varied considerably. Depending on the country, then, guidelines could suggest a standard drink to be anywhere between 8 g—which is the basis of a ‘unit’ in the UK and roughly equates to a half pint glass of moderate strength beer or a single measure of standard spirits—and 20 g of pure alcohol. Guidance on weekly consumption also varied significantly, ranging from anything between 15 and 294 g depending on gender and age. Faced with such inconsistency, Paula et al. (2020: 226) conclude that ‘the lack of proper definitions and guidelines in relation to alcohol consumption is a challenge that needs to be addressed to improve the health of current and future generations’.

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Unit guidelines are also criticised for their lack of congruence with alcohol consumption practices and how they are embedded in everyday lives. On the one hand, guidelines are supported for offering consumers a clear message about moderate alcohol consumption and the associated risks of exceeding this, based on the notion that provided with the right information consumers will make their own informed choices. On the other hand, as noted, such guidelines often fail to map onto everyday drinking in practice; even when unit contents are displayed clearly on alcohol packaging it seems unlikely that more than a minority of people consult this and adapt their drinking accordingly, especially once inebriated. One issue with drinking guidelines is that they typically concern themselves with health-related risk and as such fail to account for the myriad other ways in which drinking is deemed safe or unsafe, acceptable or unacceptable, by the people who actually do the drinking. Unit guidelines do not, for instance, make any reference to comportment. One frequent criticism, then, of guidelines is that two people may drink 14 units in a week and thereby fall just within the threshold for being safe drinkers. However, if the first takes a daily small glass of wine alongside their evening meal whilst the second consumes their 14 units as five pints of beer and two double whiskies in the space of single evening, there are likely to be markedly different experiences and consequences. The variability of the meaning of moderate drinking is something that Thurnell-Read (2017) considers in his study of ‘real ale’ drinkers in the UK. Rather than quantifiable numbers of drinks or units of alcohol, he found that drinkers tended to describe their own drinking as ‘sociable’ and therefore safe, based on several factors relating to social context, conduct and motivation. Drinkers who consumed alcohol regularly but did so for the taste of the beer and the pleasure of regular social interaction in local pubs were contrasted with ‘other’, typically younger drinkers, who drank solely to achieve inebriation and who, once intoxicated, failed to conform to expected standards of comportment. Thus, the real ale drinker might drink far more, in unit terms, than a teenager or student. Yet, the former can see their drinking as moderate given it takes place in socially approved situations and patterns (sitting chatting over a pint in the local pub) in contrast to that of the inexperienced drinker whose conduct (downing shots, shouting, falling over, vomiting) is deemed impertinent and disruptive. The moderate drinker is, in part, an imaginary figure in the minds of drinkers eager to present their drinking as normal and unproblematic in contrast to that of ‘others’. Policymakers and the alcohol industry itself are also heavily invested in the idea of responsible drinkers who are, in a wider sense, model citizens engaged in the imperative to consumer and experience yet doing so with an internalised rhetoric of respectability. As we will see later, in both the chapters on representations of

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intoxication and addiction, treatment and recovery, various subtle—and some notso-subtle—cultural forces influence how alcohol and alcoholics are viewed by society, and this continues to play an important role in shaping policies regardless of evidence as to their efficacy.

Summary The chapter has explored the varied attempts made over centuries to grapple with the ‘drink question’, that is to say how does society respond to the reality that the consumption of alcohol is widespread and desired by many but, at the same time, a vehicle for some of the most pressing threats to the health of individuals and society. As we have seen, the historical approach has been an extended power game where, over the course of centuries, state actors and institutions have been handed the responsibility for governing if or, at least, where and when alcohol can be consumed. Examples of state-wide bans on alcohol, such as the US in the early twentieth century and Muslim majority states such as Saudi Arabia today, serve to illustrate the complexity of this task. In recent years, in keeping with wider trends towards neoliberal social and economic policies in many countries, alcohol is subject to competing and some might say contradictory forces often leaving the individual as the locus of control and (self-)regulation. A picture rife with tensions emerges. Alcohol is widely available and, both within licensed venues and within the home, getting drunk remains common even whilst its harms to health and well-being are revealed in greater detail and with increasing regularity. In the next chapter, we will consider the other side of the Great Regulatory Divide by examining the criminalisation of drugs. Points for Discussion

Is the complete prohibition of alcohol desirable or possible? Should alcohol be available for some people and not others? If so, how is it possible to enforce this? How strongly linked are alcohol and crime? What methods might be used to tackle this connection?

Read, Watch, Listen #3 Read: The Institute of Alcohol Studies (IAS) publishes a regular blog on alcohol policy issues with recent posts relating to topics such as alcohol

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labelling and marketing, Minimum Unit Pricing and the impact of the Covid Pandemic on alcohol policy implementation. Watch: DrinkWise Australia is an independent and not-for-profit organisation promoting safe and responsible drinking. Their YouTube channel includes videos and interviews discussing alcohol harms and drinking culture in Australia. Listen: The Alcohol ‘Problem’ Podcast is produced and hosted by the London based academic Dr James Morris. Each episode features an interview with an expert from the field of alcohol research and policy.

References Al-Ansari, B., Thow, A. M., Day, C. A., & Conigrave, K. M. (2016). Extent of alcohol prohibition in civil policy in Muslim majority countries: The impact of globalization. Addiction, 111(10), 1703–1713. Al Marri, T. S., & Oei, T. P. (2009). Alcohol and substance use in the Arabian Gulf region: A review. International Journal of Psychology, 44(3), 222–233. Anderson, P., O’Donnell, A., Kaner, E., Llopis, E. J., Manthey, J., & Rehm, J. (2021). Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: Controlled interrupted time series analyses. The Lancet Public Health, 6(8), e557–e565. Baumgartner, F. R., & Jones, B. D. (2010). Agendas and instability in American politics. University of Chicago Press. Beeston, C., Craig, N., Robinson, M., Burns, J., Dickie, E., Ford, J., Giles, L., Mellor, R., McAdams, R., Shipton, D., & Wraw, C. (2019). Protocol for the evaluation of alcohol minimum unit pricing in Scotland. NHS Health Scotland. Beeston, C., Robinson, M., Giles, L., Dickie, E., Ford, J., MacPherson, M., McAdams, R., Mellor, R., Shipton, D., & Craig, N. (2020). Evaluation of minimum unit pricing of alcohol: A mixed method natural experiment in Scotland. International Journal of Environmental Research and Public Health, 17(10), 3394. Berridge, V. (2013). Demons: Our changing attitudes to alcohol, tobacco, and drugs. Oxford University Press. Blocker, J. S., Jr. (2006). Did prohibition really work? Alcohol prohibition as a public health innovation. American Journal of Public Health, 96(2), 233–243. Decorte, T., Lenton, S., & Wilkins, C. (Eds.). (2020). Legalizing cannabis: Experiences, lessons and scenarios. Routledge. Dingwall, G. (2015). Alcohol and crime. Routledge. Dixon, J., Levine, M., & McAuley, R. (2006). Locating impropriety: Street drinking, moral order, and the ideological dilemma of public space. Political Psychology, 27(2), 187– 206. Foster, J. H. (2008). The Licensing Act 2003: Eighteen months down the road. Drugs: Education, Prevention and Policy, 15(1), 1–6.

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Gebhart, J. C. (1930). Prohibition: Statistical studies of enforcement and social effects. In S. A. Rice (Ed.), American statistical association committee on social statistics: Statistics in social studies (pp. 111–149). University of Pennsylvania Press. Greenaway, J. (2003). Drink and British politics since 1830: A study in policy making. Springer. Hall, W. (2010). What are the policy lessons of National Alcohol Prohibition in the United States, 1920–1933? Addiction, 105(7), 1164–1173. Hobbs, D., Hadfield, P., Lister, S., & Winlow, S. (2003). Bouncers: Violence and governance in the night-time economy. Oxford University Press on Demand. Holmes, J., Meng, Y., Meier, P. S., Brennan, A., Angus, C., Campbell-Burton, A., Hill-McManus, D., & Purshouse, R. C. (2014). Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: A modelling study. The Lancet, 383(9929), 1655–1664. Ingold, J., & Monaghan, M. (2016). Evidence translation: An exploration of policy makers’ use of evidence. Policy & Politics, 44(2), 171–190. Karlsson, D., Holmberg, S., & Weibull, L. (2020). Solidarity or self-interest? Public opinion in relation to alcohol policies in Sweden. Nordic Studies on Alcohol and Drugs, 37(2), 105–121. Katikireddi, S. V., Hilton, S., Bonell, C., & Bond, L. (2014). Understanding the development of minimum unit pricing of alcohol in Scotland: A qualitative study of the policy process. PLoS ONE, 9(3), e91185. Lindeman, M., Karlsson, T., & Österberg, E. (2013). Public opinions, alcohol consumption and policy changes in Finland, 1993–2013. Nordic Studies on Alcohol and Drugs, 30(6), 507–524. Marsh, P., & Kibby, K. F. (1992). Drinking and public disorder. Portman Group. Merton, R. K. (1938). Social structure and anomie. American Sociological Review, 3(5), 672–682. Michalak, L., & Trocki, K. (2006). Alcohol and Islam: An overview. Contemporary Drug Problems, 33(4), 523–562. Miron, J. A., & Zwiebel, J. (1991). (1991) Alcohol consumption during Prohibition. American Economic Review, 81, 242–247. Monaghan, M., & Yeomans, H. (2016). Mixing drink and drugs: ‘Underclass’ politics, the recovery agenda and the partial convergence of English alcohol and drugs policy. International Journal of Drug Policy, 37, 122–128. Nicholls, J. (2009). Young people, alcohol and the news: Preliminary findings. Alcohol Education and Research Council. Nicholls, J. (2013). The politics of alcohol: A history of the drink question in England. Manchester University Press. Örnberg, J. C., & Ólafsdóttir, H. (2008). How to sell alcohol? Nordic alcohol monopolies in a changing epoch. Nordic Studies on Alcohol and Drugs, 25(2), 129–153. Paula, T., Chagas, C., Martins, L. B., & Ferri, C. P. (2020). Low-risk drinking guidelines around the world: An overview of the current situation. Addictive Disorders & Their Treatment, 19(4), 218–227. Pennay, A., & Room, R. (2012). Prohibiting public drinking in urban public spaces: A review of the evidence. Drugs: Education, Prevention and Policy, 19(2), 91–101.

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Plant, M. A., Single, E., & Stockwell, T. (Eds.). (1997). Alcohol: Minimising the harm: What works? Free Assn Books. Plant, M., & Plant, M. (2006). Binge Britain: Alcohol and the national response. Oxford University Press. Powell, A. J. (2004). Only in paradise: Alcohol and Islam. In C. K. Robertson (Ed.), Religion & alcohol: Sobering thoughts. Peter Lang. Public Health Scotland. (2021). The evaluation of Minimum Unit Pricing (MUP) for alcohol: Summary. Public Health Scotland. Ramsay, M. (1990). Lagerland Lost?: An experiment in keeping drinkers off the streets in central Coventry and elsewhere (Crime Prevention Unit Series Paper 29). Home Office. Schrad, M. L. (2007). Constitutional blemishes: American alcohol prohibition and repeal as policy punctuation. Policy Studies Journal, 35(3), 437–463. Seddon, T. (2009). A history of drugs: Drugs and freedom in the liberal age. Routledge-Cavendish. Sournia, J. C., & Porter, R. (1990). A history of alcoholism. Blackwell. Stewart, K., & Sweedler, B. M. (1997). Driving under the influence of alcohol. Alcohol: Minimising the Harm, 126–142. Stockwell, T. (2006). Alcohol supply, demand, and harm reduction: What is the strongest cocktail? International Journal of Drug Policy, 17(4), 269–277. Thurnell-Read, T. (2017). ‘Did you ever hear of police being called to a beer festival?’ Discourses of merriment, moderation and ‘civilized’ drinking amongst real ale enthusiasts. The Sociological Review, 65(1), 83–99. Walton, S. (2001). Out of it: A cultural history of intoxication. Penguin. Warburton, C. (1934). Prohibition. In E. Seligman (Ed.), Encyclopaedia of the social sciences (pp. 499–510). Macmillan. Winlow, S., & Hall, S. (2006). Violent night: Urban leisure and contemporary culture. Berg. Yeomans, H. (2009). Revisiting a moral panic: Ascetic protestanism, attitudes to alcohol and the implementation of the Licensing Act 2003. Sociological Research Online, 14(2), 70–80. Yeomans, H. (2011). What did the British temperance movement accomplish? Attitudes to alcohol, the law and moral regulation. Sociology, 45(1), 38–53. Yeomans, H. (2014). Alcohol and moral regulation: Public attitudes, spirited measures and Victorian hangovers. Policy Press.

4

The Regulation and Control of Drugs

Introduction This chapter begins by exploring the origins of drug regulation before considering some of the most plausible explanations for why the global system of prohibition exists for substances or intoxicants we refer to as ‘drugs’ and alternative systems exist for substances such as alcohol and tobacco. Prohibition offers a particular version of prevention by trying to prohibit people from engaging in an activity by banning it and then putting in place the institutions and infrastructure to enforce such a ban through laws and their enforcement. In most cases we shall discuss, this is a move that places the consumption of said banned substances within the remit of criminal justice and law enforcement bodies, primarily the police. This is often thought to be based on a particular westernised, rational approach to control. However, Windle (2013) suggests that there is an alternative explanation suggesting that although prohibition was primarily an American strategy for global drug control, such measures were already in place in the East. For Windle, it is plausible that when Western missionaries visited China intent on converting the Chinese to Christianity, they may have been influenced by the prohibitionary zeal that was typical of many Eastern countries at the time based on the impact or destruction they felt opium, specifically, was causing. Globally the prohibitionist edifice was consolidated in the middle of the twentieth century, but prohibition has a longer history dating back to the 1900s and the Opium Conferences. Outlawing drugs, with some exceptions, is a mechanism that has been adopted for just over 100 years despite widespread evidence that drugs have been used for millennia across the planet and have been culturally accommodated. As a species, humans have a clear capacity to seek out substances that alter our states of consciousness, despite there being no known evolutionary advantage for doing © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_4

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so (Nutt, 2012). And whilst the emphasis throughout most of the twentieth century was on developing systems of control, prior to this there were wars of different kinds fought over the rights to expand rather than shrink the trade in ‘illicit’ drugs (Seddon, 2016).

The Origins of Drug Prohibition Heroin—derived from opium—is the drug that causes the most anxiety amongst policymakers in the present day and so the irony of history is that Britain went to war with China in the eighteenth century primarily for the right to trade opium in China and capitalise on the sizeable and, therefore, lucrative Chinese market. British opium was produced by the East India Company who wished to trade on the Chinese mainland despite resistance from the Qing dynasty authorities and pressure at home in the form of organisations such as The Anglo-Oriental Society for the Suppression of the Opium Trade. Early demands of the Anglo-Oriental Society were ‘for the abolition of the government monopoly of opium in India and the withdrawal of unfair pressure on the Chinese government to admit Indian opium’ (Berridge, 2013: 51; Feige & Miron, 2008). Berridge also notes how support for the Society came from the Church of England, consolidating the notion that prohibition of intoxication was linked to Protestant sensibilities, although as we have seen, prohibitive impulses were visible and prominent in the East prior to the arrival of Christian missionaries in that part of the world. According to Feige and Miron (2008: 912), the English presence in China dates to the 1630s, with the trade in opium, beginning in earnest around a hundred years later. Over the period 1729 to 1831, the Chinese government introduced a series of legislative edicts outlawing the sale of opium for smoking and subsequently outlawing the sale and importation of the drug. This forced the East India Company to stop direct exportation to China, but trade continued through various private merchants and traders. Feige and Miron also note how by the 1830s the Chinese economy was in recession and the balance of trade was against China. Opium became a scapegoat for this. In the 1830s Opium Debates in China focused on the relative merits of legalisation versus suppression of opium, with advocates of legalisation believing that this would impact on the profits of Organised Crime gangs and raise needed revenues for the State. These arguments were ultimately unsuccessful and the eradication of the Opium trade became a ‘major focus of the Ching dynasty’ (Feige & Miron, 2008: 912) although it did not lead to reduced use. Despite ongoing protestations on behalf of the Chinese to Queen Victoria, there was no ceasing of

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trade forcing the Chinese to take matters into their own hands by initially seizing and destroying British opium. A series of retaliatory strikes between the British and Chinese forces ensued over the following years culminating with the surrender of the Chinese to the British following and the signing of the Treaty of Nanjing in 1842. The treaty seceded Hong Kong to the British and opened new ports to British trade. The British pushed for the legalisation of opium, but the Chinese refused. The treaty didn’t end the hostilities, with war breaking out once again in 1856. The British again won the war easily. The Treaty of Tientsin, signed in June of 1858, contained no reference to the opium trade but further opened legal trade in favour of the British. After the peace, the British again supported legalization as the only way to control the trade. China finally succumbed, legalizing opium in 1858 with a tariff of about 8%.

It was at the turn of the twentieth century that the tide began to turn in favour of prohibition, but this was partly in response to the presence of the American missionaries in south Asia alongside increasing presence of anti-opium powers in Britain and China. By the early twentieth century…the USA had inherited its own colonial opium problem when it took over the Philippines at the end of the Spanish-American War; the previous Spanish rulers had used a government sanctioned scheme for the distribution of smoking opium. But this offended US missionary and temperance sensibilities and a policy of suppression except for medical purposes was introduced. In relations with China, the USA aimed to protect American trading, development and investment opportunities by every means possible; opium suppression fitted well into that approach and was supported also by US temperance interests. (Berridge, 2013: 124)

Britain belatedly ratified the Hague convention of 1912, which followed off the back of previous conferences held in Shanghai looking at international options for the suppression and control of the Opium trade. Although the early discussions were centred around opium, gradually other substances were subsumed in the discussions including cocaine and cannabis. Cannabis, in particular, was added almost by accident (Mills, 2003). There had been some concern raised in Egypt and India over its propensity to cause mental illness, but these concerns were not widespread and a major report by the Indian Hemp Drug Commission (1894) had earlier all but dismissed these concerns.

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Alongside developments on the international stage, there was struggle within the UK for how best to control drugs domestically. The medical profession—in its early guise with pharmacists in the primacy—was responsible for early restrictions placed around the sale of opium and opium tinctures such as Laudanum (see Berridge, 2013). Perhaps the first specific piece of legislation that attempted to restrict the sale of opium to the general public was the 1868 Pharmacy Act which restricted opium sales to licensed pharmacists, which in itself was implemented to overcome the limitations of the 1857 Sale of Poisons Bill. The 1868 Act was passed in relation to growing uneasiness about the prevalence of opium use in the general population as noted by newly established statistical outputs from the Government that were becoming established in the middle of the nineteenth century (Berridge, 1978a: 442). The 1868 Act put 15 selected ‘poisons’ into 2 schedules. Opium was in Schedule 2 and considered less harmful and thus less restricted and as Berridge (1978b: 50) notes, in reality the act served only to ensure that products were properly labelled. The Act, did however, establish the professional control of the pharmacists for opium sale. It was not until the second decade of the twentieth century that British drug control began to resemble that of the international stage as criminal justice responses began to gain traction. This was initially in response to concerns that drug use was undermining the war effort as soldiers were returning to the front line under the influence of cocaine. In Britain during the First World War, even as authorities were placing restrictions on pub opening hours, cocaine remained widely used. It was not a free-for-all, however. Harrods, for example, was prosecuted for selling cocaine without conducting due diligence (in this case checking the name and address of the purchaser and giving them proper instructions as to its use) and The Times carried adverts from the reputable West End pharmacy Savory and Moore describing packets of cocaine as ‘useful presents for friends at the front’ (Madge, 2001: 131). It was with the 1916 Defence of the Realm Act (DORA) and 1920s Dangerous Drugs Acts that controls became tighter, spurred on by the increasing prominence of drug-related stories in the media. Alongside opium, cocaine continued to be singled out as a particular menace as the press publicised links to immigrant Chinese and West Indian communities’ involvement in the supply and sale of drugs (Walton, 2001: 220). Blackman (2004) shows how around the turn of the century, British media reporting of drugs followed the same pattern as that in the US as they ‘increased their readership through fantasized depiction of ethnic men seducing young white women with drugs’. Kohn (2013) develops these themes analysing the high-profile deaths of various young female denizens of London’s

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West End who succumbed to drugs and met tragic deaths, often through their association with ‘foreign’ drug pushers. Writing of the early twentieth century, Kohn (2013: 6–7) notes The xenophobia of the war years persisted, and one of the ways it found expression was in the demonology of dope. Two individuals in particular, one Chinese and one black, were identified as ‘dope kings’, and invested with a highly sexualised menace. It was claimed that the main attraction of cocaine for men like Brilliant Chang, a Chinese restaurant proprietor, and Edgar Manning a jazz drummer from Jamaica, was as a means of seducing and enslaving white women. Along with women like the actress Billie Carlton and the nightclub dancer Freda Kempton, both of whom were killed by drugs, Chang and Manning became characters in rich dope folklore, which ranged from highly fictionalised journalism to novels and films.

The 1916 DORA was replaced by the Dangerous Drugs Acts of the 1920s (Stothard, 2021). This wrestled power for control of the drugs issue away from the medical professions towards criminal justice, whilst simultaneously recognising that addiction was the primary explanation for why people used drugs and that, therefore, responses should be health focused with criminal sanctions applied when necessary. These necessities were usually around non-compliance with the legislation determining who could legitimately be in possession of substances. Stothard (2021) also shows how the 1920 Dangerous Drugs Act did start to place restrictions on possession and the 1923 amendment also placed further controls around the importation of drugs. The passing of the Dangerous Drugs Act 1928 ramped up criminal justice controls. This imposed further restrictions on cannabis and in doing so further contradicted the findings of the 1893–1894 Indian Hemp Commission Report. Mills (2003: 216) notes how the Home Office had carefully monitored stories about cannabis use in the UK throughout the 1920s. Initially it was thought that there was little justification for its inclusion in the Dangerous Drugs Acts. Medical opinion on cannabis was divided and commonly ill informed. Significantly for Mills (2003: 217), those that could claim to have followed debates about drugs in general, and cannabis in particular were clear that it did not warrant the same level of control as opium. Indeed, cannabis was not on the radar of policymakers during the early part of the twentieth century and a ‘slippery slope’ narrative of softer ‘gateway’ drugs such as cannabis leading inevitably to harder and more dangerous substances had yet to take root. In the 1920s, cannabis use was not particularly prevalent but was ‘caught up in a web of concern spun out of little more than aspersions and inferences’ linking

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cannabis use with insanity (Mills, 2003: 202–203). These findings were based on studies carried out in Asylums. The portrayal of cannabis as a madness inducing drug would be seized upon by the authorities on both sides of the Atlantic. The move towards tighter control of drugs in the US had already started in the early part of the twentieth century with Harrison Narcotics Tax Act of 1914, which forced licensed official use and registration drastically limiting legal sale. But controls would ramp up more significantly over subsequent years driven primarily by Harry Anslinger and the newly created Federal Bureau of Narcotics (FBN). Anslinger (1892–1975) was appointed the first commissioner of the FBN in 1930 and wasted little time in making his mark in what would become a 32-year tenure as one of the most zealous characters in twentieth-century drug control. Focusing most of his energies on castigating cannabis and cannabis users, he did more than anyone to usher in the era known as Reefer Madness (Hari, 2015). This period cemented the view of cannabis as an ‘Eastern’ madness inducing drug, with portrayals of its destructive properties stoking the fears of suburban America becoming commonplace in the media in the US in the inter-war period. Like the stories emerging in the British media around unscrupulous ‘foreign’ drug dealers, under Anslinger the FBN view of drugs and their users was also characteristically racist. The various strategies employed by Anslinger and his allies in the right-wing media were to frame cannabis—or marijuana—as it was/ is known in the US as an orientalist ‘assassin of youth’. This narrative was to consolidate a link between the Arabic ‘hashish’ cult who were thought to be one of the earliest examples of a terrorist organisation and responsible for frequent and brutal murderous acts. As Blackman (2004: 14–15) notes, the consolidation of the link between youth, drugs and race was not originated by Anslinger although he no doubt consolidated it. He also pioneered the use of rapidly emerging forms of mass media communication to propagate and enflame moral fears. These connections had been prominent in the nineteenth-century newspaper reporting from William Randolph Hearst. Blackman shows how writers from Hearst’s newspapers such as Winifred Black published pieces supportive of the drug control measures of Mussolini and his contention that drugs spread contagiously in the same way as leprosy. But arguably the most pernicious example of the reach of the Hearst empire was the ‘alteration of language’ in renaming ‘marihuana’ to ‘marijuana’ in order to make the connection with the Mexican and Hispanic minority groups and to play on anti-Mexican sentiment. Blackman (2004) also notes how Anslinger and his ilk frequently portrayed drug use and drug users in racialised ways, as ethnic ‘others’ posing a sexual risk to ‘white virgin young women’. This justified, in their minds and the targeting of

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prominent African Americans especially those involved in the jazz music scene— which Anslinger also hated—for arrest, charge and prosecution. The persecution of the singer Billie Holiday—as portrayed by Hari (2015) is the best example of this. Hari demonstrates Anslinger’s sheer determination to pursue a case against Holiday for her drug use—in her case mainly heroin even arresting her on her deathbed. Anslinger’s attitude to Holiday stood in stark contrast to that of Judy Garland—a white actress and known heroin user whom he treated much more leniently. Holiday to Anslinger was ‘a black women who didn’t know her place’. There are several key pieces of legislation which were a direct outcome of the time. Blackman suggests that the ‘drug propagandists sought to use horror to demand harsh sentences and punishments’ (Blackman, 2004: 19). The Marijuana Tax Act of 1937, according to Musto (1972) was the Federal Government’s response to political pressure from enforcement agencies and other groups who feared the spread of marihuana through the population from the Mexican community. There are historians who see the passing of the Marijuana Tax act as more symbolic with the subsequent Boggs Act 1951 and the Narcotic Control Act 1956 the more serious pieces of legislation. Lindesmith (1963), one of the most forthright critics of Anslinger, pointed out how by the early 1960s the public attitudes towards the post-war emphasis on punishing ‘drug peddlers’ and ‘dope addicts’ was starting to change. This was not before the earlier impulses had been satiated via the Boggs Act 1951 and the Narcotic Control Act 1956. Both of these arguably represent the peak of Anslinger’s authority. The implementation and aftermath of these Acts provide a microcosm for discussions of drug policy across the globe ever since. They represent a tussle between those who favour strong punishment as a deterrence against those who equally vociferously argue against the futility of this. The 1951 and 1956 Acts introduced high mandatory prison sentences for repeat drug, (or ‘narcotic’ to use the language of the day) offenders and removed parole for first time drug offenders. For Lindesmith (1963), a contrast could be drawn between the unworkable nature of a law that accepted that people who were addicted to drugs had an illness but were punished for helping to spread this in the population. Lindesmith (1963) pointed out how by treating drug users and people addicted to drugs through the medical profession—as happened in Britain at the time (see Chapter 9)—created a much-reduced problem. Lindesmith also noted how in the 1950s Britain had ‘probably fewer than 1000 addicts at the time whereas the figure in the US was over 100,000’. For Lindesmith this was because Britain had a system of providing ‘low-cost, legal drugs from a family

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physician’ for those that needed them on a maintenance basis, whereas echoing alcohol prohibition, the drug market in the US was surrendered to the illicit producers and users had no safety net. Lindesmith offers a perhaps overly positive account of British policy at this time, but it is fair to say that Britain had not pursued the same tough punishment-based policies as the US. The tough approach, driven by Anslinger’s ideas and rhetoric would find their way into discussions around global drug control in the aftermath of the Second World War and were very much part of the debates in the passing of the 1961 Single Convention, which introduced a global system of drug control in the form of prohibition that has lasted to the present day.

UN Conventions On the global stage, drugs are regulated or controlled by three United Nations Conventions. The 1961 Geneva Convention is also known as the Single Convention on Narcotic Drugs. The Single Convention required all signatory states to introduce legislation prohibiting the possession, supply, importation, exportation and cultivation of substances listed in the Convention. The 1971 Convention on Psychotropic Drugs was implemented to close some of the loopholes of the 1961 Convention and address the emerging problem of hallucinogenic drugs that were entering the markets of many states at the time, perhaps best illustrated by the popularity of LSD amongst certain subcultures. The 1988 Convention was enacted to address the links between organised crime groups and drug traffickers and was designed to bolster interventions aimed at curbing drug supply across the planet. A defining feature of the Single Convention is the allocation of drugs to particular classes based on their perceived harm. In doing so, according to Bewley-Taylor and Jelsma (2012: 75), it retained many features of earlier attempts at control including the International Opium Conventions of 1912 and 1925 and the 1931 Convention for Limiting the Manufacture and Regulating the Distribution of Narcotic Drugs. It is worth pausing to consider the latter as it ‘marked the entry’ onto the international drug policy scene of Harry Anslinger. Bewley-Taylor and Jelsma (2012: 74) state how Anslinger’s ‘unswerving faith in prohibition, particularly the control of organic drugs at source, was to remain a prominent and increasingly contradictory aspect of the multilateral deliberations leading to the Single Convention’. The contradictions need not detain us here, but it is worth noting that Anslinger’s desire to control drugs through prohibition often based on misinformation has shaped drug policy ever since.

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The introduction of the 1971 Misuse of Drugs Act in the UK and the passing of the Controlled Substances Act 1970 in the US represent examples of how the Geneva Convention shaped domestic legislation. The US legislation placed controlled drugs into classes ‘depending on the potential for abuse and dependency and the accepted medical use of each drug’. Consequently, in the US, legislators took account of medical and therapeutic use, whereas the UK were less specific in this regard focusing more on levels of toxicity. Consequently, in the UK cocaine is classified as Class A and, therefore, of more potential risk and harms to users and society than cannabis. The same is not true in the US where cannabis is in Schedule I but cocaine is Schedule II.

The Misuse of Drugs Act The Misuse of Drugs Act (MDA) received the Royal Assent on 25 May 1971. A key feature of the 1971 MDA is the separation of drugs into three distinct classes, which supposedly reflect their relative harms. Legal penalties relating to possession, supply, cultivation, importation or exportation are based on these harms. The most harmful are Class A followed by Class B and Class C. Of the most widely used substances, in Class A there is heroin, cocaine, ecstasy, LSD and magic mushrooms. In Class B there is cannabis and ketamine with anabolic steroids in Class C. This system has been remarkably resilient. It has remained relatively unchanged for over 50 years but has been the subject of much criticism. One of the key criticisms is its lack of flexibility. Drugs rarely move down the system of harms and when they do, as with the case of cannabis in 2004, their reclassification is hugely controversial (see Drake & Walters, 2015) and in that case was reversible. Stevens and Measham (2014) refer to the MDA as a ratchet as controls tighten and rarely loosen. The intended outcome of the 1971 MDA was to reduce the demand for drugs by providing a framework for curtailing supply, but also by creating disincentives for drug use through punitive laws. It is essentially a prohibitionist approach to illegal drugs that attempted to consolidate earlier legislation, such as the Dangerous Drugs Acts of the 1960s. Importantly, as Stothard (2021) notes, the preceding Misuse of Drugs Bill provided for powers to amend the final Act using Regulations and Orders in Council; their extensive use has enabled the MDA to remain on the statute book and it has ‘enabled successive governments to avoid parliamentary scrutiny and consideration of the outcomes of the Act’. It has, furthermore, aided the growing evidence and examples of the Acts failings and the growing examples of alternative approaches to drugs to be neatly sidestepped, frequently on moral rather than technical grounds (Stevens, 2019).

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For the entirety of its existence, the MDA has been the subject of critique (Schofield, 1971; Young, 1971) and this has gained momentum over time. Walton (2001) says that because of the focus on the toxicity of substances, nobody is officially supposed to have knowledge of what these drugs do and feel like (Walton, 2001). For others, meanwhile, the prohibitionist philosophy means that the Act is unfit for purpose and that its stated preventative aims—using criminal sanctions as a deterrent—have not materialised (Rolles & McClure, 2009). Critically, the unintended consequence has been that the opposite has happened and that drug use has continued to multiply and drugs harms have become more conspicuous—nowhere is this more apparent than in the record levels of drug-related deaths across the UK—and that the supply-side of the market has: (a) developed ever more sophisticated and ingenious ways to supply the buoyant demand and (b) become subsequently so routine that drug supply is increasingly being viewed as being normalised (Coomber et al., 2016). Supply of drugs, under prohibition, is also surrendered to illicit producers meaning a distinct absence of official standards of quality control, unlike with alcohol or prescription medicines for instance. What this means, for critics, is that it might not be the substances themselves that are inherently harmful—indeed, many drugs controlled by the MDA are available in some form as medicines— it is the route to the market that makes prohibited drugs harmful. This could be down to the knock-on effects of the policy of prohibition making substances harmful by exposing users to irregular supplies of uncertain strength, provenance and toxicity and by requiring some form of contact, however fleeting, with criminal actors such as dealers and gangs. To put it more succinctly, the core criticism is that it is drug policy rather than drugs that cause harm. Other criticisms of the Act stem from the internal consistencies in the classification of drug harms. In other words, it is unclear why certain drugs are classified alongside others (MacDonald & Das, 2006; Nutt, King, et al., 2010; Nutt, King, Saulsbury, et al., 2007). In Class A for example are heroin and cocaine, but these sit alongside MDMA (ecstasy) and psilocybin (magic) mushrooms. In an analysis of drug harms—and bearing in mind the discussion earlier that policy may cause more harm than drugs—Nutt, King, Saulsbury, et al. (2007) and Nutt, King, et al. (2010) developed a scientific scale of measuring the harms of the 20 most widely used substances including alcohol and tobacco. Each substance was assessed against three main criteria (subdivided to include nine separate measures) of propensity to cause physical harm, psychological harm and social harm. An overall measure was then generated based on how much harm a substance causes a user and how much harm it generates for others. Based on these measures Nutt and

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colleagues concluded that alcohol is the most harmful substance followed by heroin. Ecstasy and magic mushrooms, meanwhile, were ranked as some of the least harmful. The key issue is that the Nutt matrix and its scientific scale of harm doesn’t map on very evenly to the Misuse of Drugs Act, but it’s not completely contradictory either. Heroin and crack cocaine and cocaine are all class A and in the top five most harmful substances, but then we start to see the anomalies with LSD, magic mushrooms and ecstasy, all in the bottom five in the harm index, but also Class A drugs under the Misuse of Drugs Act. A further criticism of the MDA classification system is that it is a blunt instrument in being able to respond to changing information and emerging evidence about the relative harms of substances. Alongside the Misuse of Drugs there are the Misuse of Drugs Regulations (2001) which determine the contexts in which drugs controlled by the Act can be lawfully possessed. There are five main schedules kind of determine the extent to which substances can be used as medicines. Schedule one substances are the most strictly controlled and these are thought to have no medicinal use. Until 2018, Cannabis has been in Schedule One alongside LSD. These are seen to have no medicinal purposes or properties, although there is increasing interest and awareness in both substances as part of the treatment for a range of conditions (see Chapter 6). In the case of cannabis most notably in the treatment of forms of epilepsy, particularly in young children (Monaghan et al., 2021) and with LSD and other hallucinogenic substances, in the treatment of PTSD and forms of depression. Schedules two to five can be used in medicine, with controls diminishing as the schedule increases. Over the last 20 years, there has been increasing interest in policy circles as to whether the classification system outlined by the Misuse of Drugs act is fit for purpose. The first ten years of the new millennium saw increasing activity with numerous reports looking at the system. The Police Foundation Report (Runciman, 2000), also known as the Runciman report, was the first significant inquiry into drug legislation since the Wootton Report of 1968. Like its predecessor the Police Foundation Report also made the case for the legal restrictions placed around cannabis to be loosened outlining the reasons that cannabis be moved from class B to class C on the grounds that cannabis better resembled other substances in that classification in terms of their harms and dangers. Similar findings were made by the House of Commons Home Affairs Committee in 2002 and in the same year by the Advisory Council on the Misuse of Drugs (2002) (Monaghan, 2014).

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In 2004, the then Minister David Blunkett reclassified cannabis from class B to C. This small but unusual step was justified on two main grounds. First, that this could free up police time to tackle more serious offending associated with heroin and cocaine markets. The second was that cannabis and its linked links to mental health were overstated. In 2005 the ACMD had another look at cannabis within the classification system and again recommended that cannabis should stay as class C (ACMD, 2005). Following on from this, the period 2006 to 2009 saw yet more activity in relation to the way that drugs are scheduled in legal frameworks (ACMD, 2008; Nutt, King, et al., 2010; Nutt, King, Saulsbury, et al., 2007; RSA, 2007). In 2008, the ACMD were again asked to review cannabis again, particularly focusing on the causal association between cannabis and mental health, considering suspected higher potency strains of cannabis in the market which, notably, were now receiving more prominent and sensationalist media coverage. Yet again the conclusion was reached that class C was appropriate, but this time the advice was ignored and the Government subsequently rescheduled cannabis back up to class B. Running alongside this was an ACMD review of ecstasy classification, which concluded that ecstasy be downgraded from class A to class B. Again this was ignored by the government. In 2009, Nutt also published a paper on the relative dangers of ecstasy use vis-à-vis high-end horse riding such as Eventing (Nutt, 2009). In this research and various talks delivered at the same time, Nutt indicated the numerous anomalies in the Misuse of Drugs Act classification system. This put him on a collision course with the Government of the time and he was subsequently dismissed from his role as Chair of ACMD. This provides a perfect case study of the challenging role of evidence in policy concerning intoxication. The idea behind the creation of the ACMD was to provide evidence for Ministers should they be considering making changes to the Misuse of Drugs Act, specifically, and policy more broadly. The unwritten rule was that this advice was usually implemented. It was implemented on the grounds that it came from diverse sources. The ACMD comprises of up to 25 experts with special knowledge around drugs, taking from a range of different disciplinary and occupational perspectives (UK Parliament Science and Technology Committee, 2005). What has become more apparent recently is that the unwritten rule has often been ignored and that Governments are increasingly becoming more pluralistic in where they look for evidence to shape drug policy (Monaghan et al., 2018). The impact of the Carol Black review (Black, 2020, 2021) on the 2021 Government drug strategy is indicative of this as is the creation of bespoke expert groupings to shape the deliberations of policy in the passing of the 2016 Psychoactive Substances Act (Monaghan et al., 2018). We return to this issue later, but for now it is

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important to consider how drug prohibition has evolved domestically and internationally since the passing of the 1971 Misuse of Drugs Act.

Prohibition as the ‘War on Drugs’ As indicated, around the same time the Misuse of Drugs Bill was passing through the UK Parliament, in the US in 1970 President Nixon signed the Comprehensive Drug Abuse Prevention and Control Act. This included the Controlled Substances Act (CSA). According to Caulkins and colleagues (2016), the CSA is widely thought to be the origin of the war on drugs. Over half a century, many commentators still view the war as raging making it, for some, America’s longest running war (Duke & Gross, 2014). In declaring war on drugs Nixon ushered in a new period of prohibition, but one with striking similarities to the one favoured earlier by Anslinger. Here drugs were seen to be ‘public enemy number one’ and increased funds were requested by Nixon from Congress to pursue an ‘all-out offensive’. Pryce (2012) suggests that there are four main explanations for why prohibition ratcheted up to all-out war in the latter half of the twentieth century. The first reason is ideological and the deeply held belief from Nixon and those like him such as his one-time running mate Nelson Rockefeller that drug (not alcohol) use is morally wrong. They believed that drug use is injurious to one’s character and leads to a loss of dignity. Furthermore, it leads to a neglect of all other responsibilities as drug users become enslaved to drugs. In this sense, addiction, is also a moral failure or relates to a weakness of one’s character. In the following chapter, we critically engage with some of these understandings of drug use and addition. The second argument is economic. Whilst there are economic gains to be made for states via the production, sale and taxation of substances, it is felt that this does not outweigh the potential costs of lost productivity. We can look to currently legal drugs such as alcohol here to provide evidence. A report by the Institute for Alcohol Studies (IAS) (Bhattacharya, 2019) looking at the costs of workplace hangovers to society concludes that based on a nationally representative survey, on an average working day, between 75,000 and 89,000 British workers are impaired by drinking. Furthermore, an estimated 42% of British workers have ever been to work hungover or under the influence of alcohol, and that 9% have done so in the last six months. The report suggests that this comes at a cost to the UK economy of between £1.2 and £1.4 billion a year. There are at least two caveats to translating these costs from alcohol to other drugs. The first is that should drug legalisation occur it may not take the same form as alcohol regula-

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tion and so drug use may not be as socially accommodated as alcohol currently is. It is also equally plausible, indeed there is good evidence from other regimes, that when laws concerning intoxicants and intoxication are liberalised, it does not automatically lead to increased use of those substances (Hughes & Stevens, 2010). There are also sociological explanations for prohibition. For Pryce (2012) these concentrate on the idea that drugs destabilise society and threaten its key social institutions. These ideas are, more precisely, associated with ideas of the New Right and their approach to understanding the heroin epidemics of the 1980s and 1990s (Pearson, 1987; Seddon, 2007). Buchanan and Young (2000) suggest that drug policy in the 1980s and 1990s was shaped by the politics of the underclass. Here, drug users were roughly split into two groups. On the one hand, were the young, mainly male working-class drug users, who lived on council estates and whose employment prospects had been seriously curtailed by deindustrialisation. These were framed as ‘social outcasts’ or deviants whose drug use was wreaking havoc on communities. On the other hand, were ‘respectable youths’ who risked being lured into heroin use from unscrupulous drug dealers. Prohibition is then a strategy of social control, which stops society descending into a Hobbesian war of all against all. Finally, for Pryce, there are recognisable political explanations for prohibition. These can be explained by drawing on Garland’s (2012) ideas around the culture of crime control in late modernity. For Garland, with the rise of the New Right and under the conditions of neoliberalism (which we can understand as policies linking so economic liberalism and social conservatism [Gamble, 1988]), there has been a significant change in how we understand criminal justice from the late twentieth century and into the twenty-first century. These changes revolve around several discrete strands but entail a notable hardening of rhetoric around crime and by association, drugs to the extent that strategies of rehabilitation and treatment that were prominent in the earlier part of the twentieth century had fallen out of favour with the electorate who preferred to see tough sentences applied to criminals and drug users. In other words, the public mood has turned away from understanding the plight of people who use drugs towards condemning them for doing so. This means that political discourse and rhetoric around drug use has become about posturing, or what Stevens (2010) describes as ‘totemic toughness’ and political point scoring. Under the politics of neoliberalism or the culture of control, drugs are a useful political ‘evil’ to rage against (often in spite of evidence). Of course, one way to punish drug users is to put them in prison. This requires more prison bed space. Various scholars have shown how the prison population rose throughout the US,

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in particular, in the latter half of the twentieth century and how many of these prison beds were taken up by those sentenced for drug offences and how these were also disproportionately members of the black or Hispanic communities (e.g. Wacquant, 2009). A final element of Garland’s culture of control thesis is that as more prison bed space is required, this creates opportunities for large corporations. The prison system in the US is partly privatised and prisons are more profitable and cost-effective when they are full. This situation then entrenches the power of elites who have a vested interest in drug prohibition through their profiteering of punishment. Another key point is that the stated aim of the war on drugs—repeated through various United Nations documents is to create a drug-free society. There are at least two reasons as to why this is unrealistic. Firstly, as we have shown in the earlier chapters of this book, intoxication is an almost permanent feature of all known and recorded human societies. Eradicating drug use then, at best, seems ambitious. Secondly, it is based on what Taylor and colleagues (2016) call drug apartheid, whereby war is declared on some substances (those we consider illicit) whilst socially and culturally accommodating others (i.e. alcohol) even though studies have shown that alcohol is quite conspicuously harmful to individuals and society (Nutt, King, et al., 2010; Nutt, King, Saulsbury, et al., 2007). It is probably no understatement to suggest that by its own measures the war on drugs has been a failure. Perhaps even more equivocally than alcohol prohibition was, overall, a failure. In what follows, we evaluate this through three key measures. The first measure is that drug use and prevalence has increased since the declaration of the war on drugs. The second is that drug harms have risen, including the levels of drug-related deaths as criminal justice shaped responses have been promoted at the expense of more welfarist, public health (harm reduction) approaches. Finally, we look at how attempts to tackle the global drug trade have become enmeshed with other elements of foreign policy, such as counter-terror to the detriment of both attempts to tackle drugs and terror. It is enormously difficult to get detailed measures on the global picture when looking at drug markets, but every year the United Nations produces a World Drug Report, which amongst other things, provides data on the size and nature of the market. The headline figures from the latest version (UNODC, 2022) state that in 2020 there were approximately 209 million worldwide cannabis users. The figures for opioids, cocaine and ecstasy were 61 million, 21 million and 20 million, respectively. So, in 2020, an estimated 284 million people worldwide aged 15–64, had used a drug in the past 12 months. The vast majority of whom were men. As report states, this corresponds ‘to approximately 1 in every 18 people in that age group, or 5.6 per cent, and represents a 26 per cent increase on 2010,

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when the estimated number of people who used drugs was 226 million and prevalence was 5 per cent’. Increases in the global population in part account for the rise, but not totally. The demand for drugs is more buoyant than it has ever been with drug users increasingly engaging in poly drug use—the use of multiple drugs as the norm. In terms of drug harms, the World Drug Report shows how of the 284 million drug users across the world, 11 million are injecting drug users. The review of drugs in the UK carried out by Dame Carol Black (Black, 2020) estimated that there were around 3 million drug users in the UK in 2020 (Black, 2020). The scale of the illicit drug trade in the UK has remained remarkably stable over time and the market is estimated to be worth £9.4 billion per year. This is just the trade. In the UK, when the costs and harms, such as those relating to health and crime, are considered the drugs issue is thought to cost as much as £19 billion annually. In terms of harms, drug-related deaths have continued to rise particularly throughout the last decade. In England and Wales, drug-related poisonings are at the highest level since records began in 1993 (ONS, 2022) Increases are reported for both males and females. In 2020, according to the ONS (2022), of the 4,561 registered drug poisoning deaths, 2,996 were related to drug misuse. The rate of death relating to drug misuse in 2020 was 52.3 deaths per million people. The male rate of drug misuse was 76.3 deaths per million in 2020 (2,165 registered deaths) and the female rate was 28.7 deaths per million (831 deaths). There are various suggested reasons for this, but it is likely to be down, in part, to the increased use via injection of opioids. This is without particularly highly potent varieties of opioids such as fentanyl entering UK markets with the devastatsing effect they have had in North America. In the UK drug deaths tend to be clustered around long-term heroin users who are in their 40s or 50s. These are often referred to as the ‘Trainspotting Generation’. Many explanations are often given as to why this group seems to be dying in disproportionate numbers, but the ageing cohort thesis is the most referenced. This suggests that long-term heroin use is driving mortality primarily because of the various co-morbidities associated with the drug, not least those stemming from injecting. According to Dennis (2021), referring to an ageing cohort is problematic and serves to naturalise these deaths, which in turn, serves to detract from the underlying causes of drug deaths such as growing health inequalities (Hamilton, 2020) magnified and exacerbated by austerity-driven cuts to essential services. It is extremely difficult to work out the level of divestment from treatment services in the UK over recent years although we can be sure there have been significant real-terms cuts. From 2015, central funding for drug treatment services declined.

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Conservative estimates suggest a 15% reduction since 2015, although in some localities the figure is thought to be closer to 50% (Hamilton & Stevens, 2019). There is currently a higher proportion of long-term heroin users with failing health who are, therefore, at greater risk of poisoning, but this only tells half the story. There is now the increased availability of higher purity heroin produced in Afghanistan (Black, 2020). Poverty is also an issue. Deaths are clustered in areas of high deprivation (ONS, 2022). Although there is an increasing number of deaths linked to a broader range of substances, opiates are most frequently cited on a death certificate. All of these trends sit within a policy context that over the previous decade has moved away from services delivered on the principles of maintenance and harm reduction to those that have championed abstinence-based recovery (Dennis et al., 2020; Duke, 2013; Monaghan, 2012), whilst drug supply networks have multiplied and remain buoyant (Black, 2020). Recent decades have seen a gradual removal of a safety net for drug users amidst buoyancy in drug supply. Whilst cannabis is the most widely used drug, it is more apt to look at the markets for the (illicit) drugs considered to be most harmful. The 2021 World Drug Report (UNODC, 2021) shows how over the past 20 years, global opium production has followed a long-term upward trend, reaching an estimated 7,930 tonnes in 2021. This increase was primarily the result of higher opium production in Afghanistan. This is significant in that post 9–11, part of the international strategy to tackle the financing of the war on terror was to address opium production. Efforts to eradicate opium crops in Afghanistan not only failed to make long-lasting dents in global supply, it also served to create issues in counter-terror policies. The main policies implemented to cut off drug supply are interdiction (intercepting drugs in transit) or crop eradication. Of the latter there are three main approaches. First, forced eradication where crops are manually destroyed or sprayed with weedkiller, second, compensated eradication where crops are destroyed, and compensation paid to the growers as a consequence and third, alternative livelihoods where farmers are paid to produce alternative crops such as coffee or bananas instead of harvesting drugs. Eradication programmes are notoriously ineffective and have often generated more problems than they have solved (Felbab-Brown, 2009). The links between the drugs trade and terror often are discussed under the term ‘narco-terrorism’. In a detailed account of the links between drug traffickers and belligerent groups (terrorists), Felbab-Brown (2009) demonstrates that the conventional narco-terrorism view which states that terror organisations are financed via the drug trade either in direct sales or taxation thereof has been mis-

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taken as these groups are not always one and the same. Counter-terror strategies rely on the intelligence provided by local populations. In places such as Afghanistan many of the poorest and most vulnerable members of society make a living from harvesting opium. If this crop is destroyed in the name of counter-terror it takes away a source of revenue from the very people who are needed to make counter-terror strategies work. In doing so, it can act as a recruiting programme into terror networks and/or can result in more political instability by forcing farmers to grow more opium to cover their initial losses. Björnehed (2004: 315–316) has also shown how attempts to eradicate drugs only succeed to introduce some scarcity into the market, making them more lucrative. Thus, a decreased supply of drugs may be seen as a victory in drug war terms, but potentially ‘increases the revenue made by terrorist organisations involved in the narcotics trade’ representing a strategic error on that front.

Prohibition 2.0 Drug law reform has a symbiotic relationship with the development of drug law. They exist side by side. Nowhere is this more apparent than with the development of the 1971 Misuse of Drugs Act. Despite being on the statute book for more than 50 years, it was the subject of critique since its inception (Schofield, 1971; Young, 1971). More recent commentaries (Taylor et al., 2016) show how the criminalising impulses on policy have been challenged by expert committees such as the ACMD over time. This can be seen most clearly in the case of cannabis. Yet it has not led to a wholesale rejection of prohibition in favour of other approaches. Instead what we are witnessing is, in many ways a doubling down of prohibition as a response to changes in drug markets in part caused by prohibition. The passing of the 2016 Psychoactive Substances Act demonstrates this. Around the year 2010, it was increasingly becoming apparent that there were new emerging substances that weren’t covered by the Misuse of Drugs Act, but which were being detected by early warning systems across Europe. These New Psychoactive Substances (NPS)—or Legal Highs—as they were known, were synthetic substances with chemical compositions designed to mimic the effect of illegal drugs such as cannabis or cocaine, but which did not contain compounds outlawed by the Misuse of Drugs Act. The production of the substances was thought to originate in China and India and distribution took place either over the Internet or through a network of ‘head shops’ that had sprung up on the high streets across the UK.

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Legal Highs entered the drug marketplace initially as substitutes for drugs scheduled by the UN Conventions or domestic policies such as the Misuse of Drugs Act. NPS were deliberately manufactured to circumnavigate existing drug legislation. Expert chemists were able to tweak the chemical composition of substances to keep them from falling within the remit of existing legislation. Some of the most popular NPS—synthetic cannabinoids—are supposed to mimic the effects of cannabis but bear little resemblance in terms of the effects experienced by users. NPS hit the headlines in the UK when ‘Spice’, a potent cannabis substitute and mephedrone, a synthetic stimulant continued to grow in popularity across Europe in 2009. At first these substances were unregulated, but a response was unavoidable when mephedrone—also known as Meow and one of the first widely used NPS was (wrongly) implicated in the deaths of two teenagers in Lincolnshire, UK in March 2010. Through their early warning system, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) detailed steady increases in the emergence of new substances from 24 in 2009, to 41 in 2010 to 49 in 2011. By 2012, there were 73 new substances that were officially notified for the first time in the European Union. By the time the EMCDDA and Europol issued their first report (EMCDDA, 2014) over 250 NPS were being developed. In May 2016 the Psychoactive Substances Act came into force across the UK. In passing the Psychoactive Substances Act, the UK Government followed the policy trajectory of Ireland who introduced similar legislation in 2010. This effectively introduced a ‘blanket ban’ on the production, distribution, sale and supply of Novel Psychoactive Substances (NPS). The Psychoactive Substances Act does not criminalise those who possess, for their own use, newly prohibited drugs unless they are within the prison estate. Those caught in possession (without intent to supply) will, therefore, not receive a criminal record. Despite these potential benefits, critics (Stevens et al., 2015) have pointed out some significant flaws with the legislation. There are problems with the notion of the psychoactive effect employed in the legislation. According to the Home Office: … a substance produces a psychoactive effect in a person if, by stimulating or depressing the person’s central nervous system, it affects the person’s mental functioning or emotional state; and references to a substance’s psychoactive effects are to be read accordingly. (http://www.legislation.gov.uk/ukpga/2016/2/section/2/ enacted)

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Falling within this definition could be any number of substances including flowers, air freshener and incense. Not only that the Government’s own scientific advisors the Advisory Council on the Misuse of Drugs (ACMD) (who had been marginalised throughout the entire legislative process) in favour of a bespoke advisory group heavily weighted towards law enforcement expertise (Monaghan et al., 2018) warned that without a revision, the law would be virtually un-enforceable as has been the case in Ireland. The Psychoactive Substances Act is a messy addition to the statute book. Ultimately, this has enshrined in law a twotier approach to drug possession where certain banned substances under the MDA are illegal to possess yet others under the PSA 2016 are not. Intoxication in Contrast 4

When evaluating the various policies put in place relating to drugs, it is important to understand the experiences and opinions of those effected. People who use drugs and the contexts in which drugs are used and regulated are diverse. Seeking to better understand drug user attitudes to regulatory policies in Australia, Lancaster, Sutherland and Ritter (2014) compared survey data relating to people who inject drugs, such as heroin and crystal meth, and those who take MDMA. They found that perceptions and experiences of drug policies were complex and heterogeneous. Even amongst drug users, there was strong opposition to the legalisation of certain drugs. The opinions and experiences of drug users was also the focus of a study by Gideon Lasco (2018). Focusing instead on a specific group of young men in the Philippines, where an increasingly militarised war on drug use has been waged, he found that his interviewees used tactics to evade law enforcement, who they saw as an enemy to be outsmarted. Despite draconian laws and their marginalised status, they were able to resist the imposition of drug policies by making ‘lay assessments of risk’ which meant that the very real possibility of arrest, imprisonment or of being killed were accepted aspects of their daily lives. Lancaster, K., Sutherland, R., & Ritter, A. (2014). Examining the opinions of people who use drugs towards drug policy in Australia. Drugs: E ducation, Prevention and Policy, 21(2), 93–101. Lasco, G. (2018). Kalaban: Young drug users’ engagements with law enforcement in the Philippines. International Journal of Drug Policy, 52, 39–44. ◄

Decriminalisation and Legalisation Debates

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Decriminalisation and Legalisation Debates Over recent years and in response to many of the issues we have discussed in the previous sections, alternatives to outright prohibition are being debated, implemented and evaluated. Some examples are widely known and discussed such as the Portuguese approach to decriminalising the possession of all drugs (see Hughes & Stevens, 2010). Others have received less commentary but are occurring nonetheless to the extent that some commentators have referred to a ‘quiet revolution’ in drug decriminalisation as over 25 countries across the world have some model of decriminalisation, although these can be widely variable (see Eastwood et al., 2016). Eastwood and colleagues make the distinction between de jure decriminalisation where decriminalisation is enshrined in law and de facto decriminalisation where drug possession offences are de-prioritised in policing. They also note that there is enormous geographical variance, with countries as disparate as Armenia, Belgium, Czech Republic, Ecuador, Estonia, Mexico, Portugal and parts of the US all adopting or extending some form of decriminalisation within their jurisdictions in the last 15 years or so. It is also not the case that reform to the control of substances listed in the 1961 UN Single Convention on Narcotic Drugs is restricted to decriminalisation of whatever hue. There has been significant cannabis reform taking place, particularly in the Americas (Pardo, 2014) as, at the time of writing over twenty states and territories in the US and the District of Colombia have introduced legalisation policies for cannabis for recreational use, developing previous policies that existed for the medicinal use of cannabis (see Caulkins et al., 2016; Decorte et al., 2020). Unlike decriminalisation, legalisation means that the supply of drugs could be state controlled or regulated in much the same way that alcohol and tobacco is. That is perhaps an over-simplification and there are various models that exist for how different substances could be legalised, not all involve the introduction of a retail sales market. Cannabis is, however, by far the substance that is furthest along its legalisation journey. It is also a good example of the kinds of issues that scholars and others should look at when discussing drug reform. In other words, drug reform is not really a case of yes or no, but how? Fig. 4.1 shows some of the options for reform for cannabis. As Caulkins and colleagues (2016) demonstrate there are strengths and weaknesses of each approach which involve a delicate balancing act between the potential for sales and taxation income versus the potential public health costs

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Fig. 4.1   Twelve Supply Alternatives to Status Quo Prohibition (Caulkins et al., 2015)

and consequences. Pricing is a key issue, setting the cost of legal cannabis too high means that the illicit market will remain buoyant and this will reduce the size of the licit market and the turnover it generates. Setting the price too low could serve as an incentive to use and encourage the production of higher potency strains to make products more cost-effective, which will have a knock-on effect for public health.

Summary The political reach of prohibition is on one-level astounding. Prohibitionist drug policies have been implemented across the globe, across time and across the political divide. Levine (2003: 147) sums this up: In the last 80 years, nearly every political persuasion and type of government has endorsed drug prohibition. Capitalist democracies took up drug prohibition, and so did authoritarian governments. German Nazis and Italian Fascists embraced drug prohibition, just as American politicians had. Various Soviet regimes enforced drug prohibition, as have their successors. In China, mandarins, militarists, capitalists, and communists all enforced drug prohibition regimes. Populist generals in Latin American and anti-colonialist intellectuals in Africa backed drug prohibition. Over the course of the 20th century, drug prohibition was supported by liberal prime min-

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isters, moderate monarchs, military strongmen, and Maoists. It was supported by prominent archbishops and radical priests, by nationalist heroes and imperialist puppets, by labour union leaders and sweatshop owners, by socialists, social workers, social scientists, and socialites - by all varieties of politicians, practicing all brands of politics, in all political systems. National drug prohibition was one of the most widely accepted, reputable, legitimate government policies of the entire 20th century.

Where the control of intoxicating substances, the history is a tale of unintended consequences and irony. For many substances, except for alcohol and tobacco, control is shaped by prohibition. The irony here is that prohibited substances are often not as harmful as those that are more readily available to buy and use. We only must look at the association between alcohol and liver disease and tobacco and lung cancer to see this. But prohibition itself is iatrogenic—or harm causing. The harms from prohibition are numerous but can be summed up by the way that under prohibition the control of the market is surrendered to illegal cultivators, producers and suppliers of intoxicants who have limited means and reasons to engage in quality assurance. Others see the harms of banning substances as being part of the ‘iron law’ of prohibition. This broadly states that regulating substances via the full force of criminal law, creates incentives in illicit markets where stronger substances are produced to make the risk for producers and distributors more worthwhile. It has been used frequently for a justification of legalising drugs. The iron law theory is, perhaps, too simplistic. Although data on cannabis potency does reveal increasing demand for higher potency strains which coincides, in the UK at least, with prohibition. At least it does on face value. The problem with potency is that it is furiously difficult to research and that research is often inconclusive and for some consumers higher strength does not necessarily mean higher quality. As we demonstrated in the introduction, however‚ for centuries, scholars have tried to get to grips with what we mean by ‘drugs’ and how they differ from medicines and other substances. Prohibition was meant to solve this issue. Drugs are substances that are illegal and medicines are legal. Yet the distinction is not this clear cut and as we will see later in the book, there are now increasingly blurry lines between ‘drugs’ and medicines which can be one and the same. It is the context of use that determines how intoxicants are understood. We have become accustomed to a degree of normalisation surrounding state sanctioned substance use (caffeine, tobacco, alcohol) in ways that have not been apparent for heroin and cocaine for instance. More recently, probably from around the 1990s onwards

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state prohibited substances such as cannabis, MDMA and others have also undergone, according to some thinkers a process of normalisation. In the next chapter we will look at how intoxication is explained. Points for Discussion

Do stricter drug laws lead to less drug use and fewer drug-related harms? What factors have driven the rise and continuation of the War on Drugs? Why have approaches to the regulation of alcohol and drugs diverged so remarkably? ◄

Read, Watch, Listen #4 Read: The United Nations (UN) produces an annual World Drug Report, which includes an overview of global drug supply and demand and features sections on specific drug markets and their regulation. Watch: The House I Live In is a 2012 documentary film by director Eugene Jarecki focusing on the human rights issues at the core of the War on Drugs in the USA. Listen: Prof Toby Seddon produces a Drug Talk podcast that includes an episode on Drugs, prohibition and harm reduction.

References Advisory Council on the Misuse of Drugs (ACMD). (2002). The classification of cannabis under the Misuse of Drugs Act 1971. Home Office. Advisory Council on the Misuse of Drugs (ACMD). (2005). Further consideration of the classification of can-nabis under the Misuse of Drugs Act 1971. Advisory Council on the Misuse of Drugs (ACMD). (2008). Cannabis: Classification and public health. Home Office. Berridge, V. (1978a). Victorian opium eating: Responses to opiate use in nineteenth-century England. Victorian Studies, 21(4), 437–461. Berridge, V. (1978b). Opium eating and the working class in the nineteenth century: The public and official reaction. British Journal of Addiction to Alcohol & Other Drugs, 73(1), 107–112. Berridge, V. (2013). Demons: Our changing attitudes to alcohol, tobacco, and drugs. Oxford University Press. Bewley-Taylor, D., & Jelsma, M. (2012). Regime change: Re-visiting the 1961 Single Convention on Narcotic Drugs. International Journal of Drug Policy, 23(1), 72–81.

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5

Theorising Intoxication

Introduction Devising a comprehensive theoretical overview of intoxication is a monumentally difficult task. There is an almost unending list of possible directions such a task could take. For instance, one could begin by looking at how the term ‘intoxication’—and related terms like ‘drunk’, ‘drug’, ‘stoned’ and ‘addict’—are socially constructed. There could be a separate focus on specific substances or a grouping together such as in the tried and tested distinction between alcohol and other drugs. There could be a review based on evidence stemming from specific methodological approaches, such as the copious (and often high-quality) ethnographic work into cultures of intoxication (see Hutton, 2020 for some excellent examples). One could analyse intoxication through the lens of masculinities and/or femininities, sexualities and ethnicities (see Hutton, 2020). Not least, there could be the task of explaining what motivates a person or group of people to drink or take drugs in certain ways, how intoxication is experienced by them particularly when their experiences might be at odds with the norms and values upheld by wider society or the rules put in place by governments and other authorities which are in turn enforced by the police and other criminal justice institutions. Before examining the various theories offered over the years to explain the role of drugs and alcohol in society, it is worth reflecting on what theories actually are, not least because for many students and some scholars the very term invokes something abstract and possibly convoluted. It therefore helps to see theories as ideas, or packages of ideas, offered to describe and explain why something happens in the way it does. Many theories are developed in response to an intriguing phenomenon or conundrum, such as why so many people continue to ingest mind-altering substances even when they are made illegal, their use linked to a number of possible © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_5

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harms and huge resources are spent enforcing their prohibition or reminding people how risky even occasional use might be. A theory is an argument that seeks to explain why this happens in the way it does. Many theories also have a predictive element in that they do not just describe what has happened or how things are but that they also anticipate the direction of travel and the way things are heading. If a theory is a good one it will describe, with some degree of reliability, an overarching pattern or trend. It is tempting to think of particular ‘Theories’, with a capital T, as something monolithic and unchanging. Theories emerge from and take root in distinct intellectual traditions and different academic disciplines think about and view topics from different stances. Theories provide different ways of viewing the same phenomenon. Biochemists, epidemiologists, sociologists, anthropologists and criminologists each have their own methods for examining, and language for talking about, different issues relating to drugs and alcohol. As such, in practice nearly all theories are multifaceted ideas that shift and adapt as they are tested by empirical data or simply by changing events. As new contexts emerge with the passing of time, theories must be critiqued, updated and even abandoned altogether. In this chapter, we undertake our analysis of intoxication by looking at how it has been understood primarily across the social sciences. Of course, to be able to do this we have to consider how the social sciences have departed from other (often earlier) attempts at explaining intoxication often stemming from the biological and psychological approaches and their descendants. To enable a coherent narrative to be developed, we have also considered these developments using the typology that runs throughout this book. With that in mind, we look at how intoxication has been understood from the point of view of self, state and society over time. Whilst it is unlikely that any one theory can hold in view all three scales of interest at once we argue that most social science approaches, and certainly the best and most widely applicable theories, strive to understand the complex interplay of individuals, institutions and wider social conditions. We begin this by considering what we might consider two opposites by addressing first physiological explanations of intoxication, that view things at the level of chemical reactions and processes within the body, and, at the other end of the scale, social and cultural accounts which tend to view intoxication as a constituent of the wider cultural fabric of society.

Physiological Explanations of Intoxication In the introduction chapter we set out why we feel a sociological, cultural and criminological approach to drugs and alcohol is necessary. It is not that the physiological processes involved in creating intoxication do not concern us. In fact, it

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is useful to address in an admittedly crude form a brief outline of what happens within the body, and to the body and mind, when intoxicants are ingested. These alterations to body and mind are the basis for so much rich social and cultural variety, they are part of the reason people seek out opportunities of intoxication and even the relatively inexperienced will be adept at reading the bodily and behavioural cues that signal an intoxicated body. As will be shown, this provides a useful starting point, but also a point of departure, from which the rich conceptual and theoretical terrain across which intoxication has been understood can be located. Within the body, a system of neurons (nerve cells) in our brains receive messages from neurotransmitters, a veritable cornucopia of chemicals that are ‘read’ by our body as signals for physical and mental processes. This system is the primary means by which our bodies and minds are regulated and how our behaviour is linked to environment cues. Neurotransmitters move through gaps between neurons (synapse) to other neurons (activate receptors) to create feelings such as hunger, pain or fear. Neurotransmitters then get reabsorbed when no longer needed. The chemical basis of many drugs is that the active elements of certain drugs target certain receptors to create specific effects (see Nutt [2012] for a good introductory summary of these processes). Opioids such as heroin target endorphin receptors—creating a sense of well-being and euphoria as well as surpressing the systems which create and perceive pain. Some drugs (e.g. cannabis, opioids) activate neurons because their chemical structure emulates that of a natural neurotransmitter. Other drugs (e.g. cocaine and crystal meth) simulate the nerve cells to over-produce huge amounts of natural neurotransmitters or prevent the usual reabsorption of these brain chemicals, either way resulting in the system being flooded, creating intensely amplified versions of otherwise ordinary emotions and sensations. Described at this basic level, intoxicants are wonderful things and demonstrate the human capacity for curiosity and ingenuity. Whilst various species of animals are observed to seek out and ingest certain substances and even seemingly understand and take pleasure in their effects, humans are alone in such a sustained quest to put naturally occurring intoxicants to use in adapting their perceptions of the world around them. Thus, the course of human history of intoxicants as told in Chapter 2 is one where bit by bit, humans have learnt which substances can be used to either heighten, suppress or simulate the effects of the likes of serotonin (which regulates mood, anxiety, appetite, body temp, sleep/wake cycle), dopamine (which regulates motivation and drive, enjoyment of food, pleasure) or endorphins (that create feelings of pleasure and reward, reduce pain). Certain drugs are more effective than our body’s natural chemicals—hence, the poten-

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tial for addiction. The question is why and how and when we would want to do this, to flood our body with a chemically induced feeling of euphoria. Why then, we might ask, does the ingestion of similar substances with identical physiological affects vary so vastly? How can one substance be a medical miracle yet, in another form and context, a pernicious evil blighting society? The answer to this and other questions lies in attempts to theorise and conceptualise drugs and alcohol and to better understand that upon those basic psychological processes are heaped layer upon layer of culture, morality and meaning.

Social and Cultural Explanations of Intoxication A useful contrast to purely psychological explanations of intoxication, that tell us a great deal about the biological basis of intoxicated states but far less about the context and meaning of alcohol and drug use, can be made with anthropological and sociological approaches that foreground the cultural and social aspects of intoxication. Here, the unit of analysis shifts from specific chemicals and physiological processes within individual bodies to the complex mixture of individual, group and institutional level realities and contexts. This places an emphasis on the learnt and shared ways of being intoxicated and on the collective experiences and meanings of states of intoxication. Indeed, many of the early proponents of such approaches, such as the Yale sociologist Sheldon Bacon, insisted that to understand intoxication and related questions of how and why people drink and achieve states of drunkenness, involved a concern with social functions. Thus, in 1943, Bacon asked: What are the societal functions served by the drinking of alcoholic beverages? What are the social rubs concerned with drinking? What are the pressures for and against this practice? How does this behavior pattern jibe with other institutions and folkways? (Bacon, 1943: 407)

Such an approach sees beyond the limited frame, at the time already entrenched within the medical and psychiatric communities, that ‘problem drinking’ stemmed solely from certain physical, psychological or even genetic weaknesses. However, as Freed (2010) observes, a ‘problem’ frame would remain dominant; it was simply that sociologists would instead see the causes of addiction to alcohol and drugs as social, rather than physical. Looking elsewhere, for now, it was anthropologists who were best placed to avoid seeing intoxication purely as a problem. Rather, alcohol was embedded

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in cultural contexts of consumption. Two such notable texts accounting for the centrality of alcohol in the social and cultural life of European society are worthy of note. Drunken Comportment: A social explanation is Craig MacAndrew and Robert Edgerton’s (1969) is notable for unpacking of the rules and rituals of alcohol, drinking and drunkenness in British society. Similarly, in 1987s Constructive Drinking: Perspectives on Drink from Anthropology, the anthropologist Mary Douglas brings together a collection of essays all suggesting that alcohol and intoxication do not exist simply as chemical processes in the body, abstracted from the cultures within which they occur. Rather, drinking is a central element of culture, not just a part of it but a constituent element. Writing in the introduction, Douglas says that: These essays treat drinking as a medium for constructing the actual world. The drinks are in the world. They are not a commentary upon it, nor a surface nor a deep structure module of its relations. They are the bricks and mortar. They are examples of things that constitute the world…Sampling a drink is sampling what is happening to a whole category of social life. (Douglas, 1987: 9)

The advantage of such approaches is that they help us think of drugs and alcohol not in a vacuum but in situ. Thus, drinking several pints of beer will result in some degree of intoxicant and the drinker feeling a certain way involving a change of mood, new bodily sensations and some change in bodily competencies. Now we pull back and note that the drinker is sat at a table with others, they’ve ceremonially bought a drink for each of their companions who, having timed their drinking that their glasses are drained in roughly similar time, then reciprocate by buying their ‘round’ of drinks. We might pull back again and observe the space in which they drink, maybe a traditional village pub or a hip city bar. Again, in either of these contexts we would then aim to appreciate how that setting shapes their drinking and their experiences of drunkenness. What does it mean to them and what purpose does it serve the group to meet and consumer beer in this way? Is their drinking doing something culturally expected, such as allowing them to perform ideals of manhood that expect men of a certain age to enjoy partaking in heavy drinking with peers? Whilst the legality and cultural visibility of alcohol perhaps make it easier to conceive of as being a central feature of everyday social life, rather than something external to and deviant from it, theorists of drug taking were also beginning to see the need for models of drug use that went beyond the purely physiological to include psychological, cultural and social aspects. A notable example of this is the American psychologist Norman Zinberg (1984) whose influential concep-

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tual framework involved three elements of the drugs experience: the ‘drug’, the mindset or ‘set’ and the ‘setting’. For Zinberg, any study of the first of these, the actual drug taken, needed the other two in order to properly understand the user’s experience where their ‘set’ involved understanding the user’s motivations, expectations and priorities and ‘setting’ meant acknowledging that the same drug taken in different social contexts and cultural milieu could be experienced in radically different ways.

From Deviance to Subcultures In Chapter 2 it was suggested that the emergence of drugs in the modern era was characterised by a dualism. On the one hand, European societies greeted a series of ‘discoveries’ and ‘inventions’ of new substances with enthusiasm, as panaceas for society’s many ills. Yet, on the other, many drugs soon became singled out as sources of disruption and degradation, as a problem or threat to the moral order of society. Moving into the twentieth century, however, a more measured approach, far less likely to swing between such extremes of positivity and negativity, prevailed. Thus, whilst a problematising framing continued into contemporary accounts of drug use, the middle decades of the twentieth century gave rise to accounts that theorised drug taking as something undertaken by a minority of individuals who, in both the marginal position of themselves and their activity as drug users, were positioned as deviating from the mainstream. Theories of this era were overwhelmingly sure that ‘illicit drug use, abuse, and addiction are normative violations—that is, a form of deviance’ (Goode, 2006: 418). Theories of deviance, therefore, represent the entrance of drugs into the social sciences. Framing drug use and alcoholism as ‘deviant’ was a way for social scientists to locate the study of drink and drugs within the remits of their research agendas. One of the earlier sociological accounts of drug taking, albeit one that framed the issue in terms of addiction, and the drug taker as the ‘addict’ was Merton’s (1938) version of anomie. Initially published in the American Sociological Review, the drug addict came to symbolise or was representative of one of the forms of deviance that Merton identified. To fully account for this, it is necessary to consider his scheme in more detail. Broadly speaking, for Merton, deviance and crime was best understood as a tension between the cultural goals of society (the desirable things in life) and legitimate means of obtaining them, through work or study for example. For Merton these are ‘elements of social and cultural structure’ which are ‘analytically separable although they merge imperceptibly in concrete situations’ (Merton, 1938: 672). Merton suggested that how people

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respond or adapt to the different aspects of the structure and whether this was in a positive (acceptance) or negative (rejection) way could account for the variations in levels of crime and deviance across society. Merton also points out how these categories are not fixed and people can and do move in and out of them at different times. In Merton’s account, those who accept the desirable things in life and the accepted, legitimate means of achieving them are the conformists. These are the non-deviant groups that follow the social script that says if you study, work hard and carry yourself in socially approved ways you will be rewarded with access to the trappings of a desirable life based on success, security and status. All other groups who deviate from this represent deviant populations in one way or another. The question, then‚ is how does this explain drug addiction? For Merton, the ‘addicts’ are found in the fourth adaptation—the retreatists. This group is, according to Merton, the least common. They are ‘in the society, but not of it’. He notes: Sociologically, these constitute the true “aliens.” Not sharing the common frame of orientation, they can be included within the societal population merely in a fictional sense. In this category are some of the activities of psychotics, psychoneurotics, chronic autists, pariahs, outcasts, vagrants, vagabonds, tramps, chronic drunkards and drug addicts. These have relinquished, in certain spheres of activity, the culturally defined goals, involving complete aim-inhibition in the polar case, and their adjustments are not in accord with institutional norms.

Merton explains how the retreatists once accepted the pursuit of cultural goals and legitimate means of obtaining them, but ‘institutionalised procedures’ which promise the potential of legitimately achieving desirable things are unattainable, meaning that they move away from striving for the cultural goals and develop a recognition that it is no longer feasible for them to abide by the official and social laws and norms of society, leading ultimately to ‘dropping out’ and the search for escape mechanisms—such as intoxication—to do this. Subsequent studies have attempted to use the ideas of Merton to show how drug use is best thought of as a version of retreatism (see Fazey, 1973). Merton’s theory was a key moment in the study of drug use in society. It influenced subsequent studies and others used it as a point of engagement. Albert Cohen, for instance, sought to move the debate by looking at elements that Merton had missed as ‘gaps in the theory as originally stated’ (Cohen, 1965: 5). Cohen adopts the stance celebrated by Merton himself as ‘standing on the shoulders of giants’ in the way he attempts to address some of the shortfalls of Merton’s account. For our purposes, Cohen identifies how the tendency in American

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deviancy theory at the time was to formulate theory ‘in terms of variables that describe initial states, on the one hand, and outcomes, on ‘the other, rather than in terms of processes whereby acts and complex structures of action are built, elaborated, and transformed’ (Cohen, 1965: 9). As Cohen notes, one of a few exceptions to this rule was Howard Becker and it was Becker as much as anyone at time who tried to ‘explore much more systematically ways of conceptualizing the inter-action between deviance and milieu’ (Cohen, 1965: 9). For Becker, the interaction between deviance and the milieu was explored through emerging himself in the jazz music scene of the 1940s. This was a deliberate choice. Becker was familiar with this as a musician himself, but the jazz scene had also been the subject of vilification from the perceived role of cannabis smoking within it. Being a visible expression of African American culture, the jazz scene had particularly felt the ire of Harry Anslinger, the erstwhile Director of the Federal Bureau of Narcotics. Anslinger had pursued leading figures in the scene such as Billie Holliday on the grounds he felt this was part of a wider process of the corruption of young people (Hari, 2015). A central concern of Becker (1953) was to understand why people persisted with their involvement in the jazz scene and why the same people accepted cannabis smoking as being integral to this, despite the probably strict sanction that would follow, on being apprehended smoking the drug. For Becker, the answer lay in the ritual of smoking, but also being able to recognise the effects of intoxication and in the latter most users were cognisant of the effects prior to becoming regular cannabis smokers. In effect, they were initiated into the scene by other users from whom they learnt the narrative of what it was to get high and how to enjoy this. So, for Becker, it was not so much that cannabis was addictive in the physical sense, it was the users learnt to enjoy the effects through interacting with significant others in their reference group. One ‘becomes’ a user through experimentation and learning. Becker, thus identified the three steps that needed to be taken in order to become a marijuana user: (1) Learn how to smoke in a way that produces real effects (2) Recognise the effects and connect them back to the drug’s use (3) Learn to enjoy these effects, and actively seek out recreating them. As has been widely documented from this starting point the culture spread across the US becoming a recognisable drug culture in the way we might understand the term today.

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According to Becker: In comparing this theory with those which ascribe marihuana use to motives or predispositions rooted deep in individual behaviour, the evidence makes it clear that marihuana use for pleasure can occur only when the process described above is undergone and cannot occur without it. This is apparently so without reference to the nature of the individual’s personality makeup or psychic problems. Such theories assume that people have stable modes of response which predetermine the way they will act in relation to any particular situation or object and that, when they come in contact with the given object or situation, they act in the way in which their makeup predisposes them. (Becker, 1953)

An important finding for Becker was that as more people learnt to understand the effects of the drug, it became possible for more people to use properly and, therefore, fewer people would have negative or unpleasant experiences. In subsequent work, Becker (1963, 1971) demonstrated how it is not so much the act or activity itself that constitutes deviance. It is more the reaction of significant others who applied the label of crime or deviance to these activities: The act of injecting heroin into a vein is not inherently deviant. If a nurse gives a patient drugs under a doctor’s orders, it is perfectly proper. It is when it is done in a way that is not publicly defined as proper that it becomes deviant. (Becker, 1971: 341)

Jock Young (1971) in his study The Drugtakers, picked up many of the themes developed by Becker. Of more concern for Young was the nature of the response and particularly how this constructed the drug taker as a ‘folk devil’. For Young, the nature of the drug itself was not an explanation for the nature of dependency. Instead, he claimed that the social reaction to the drugtaker which shape and is shaped by official responses all impact on patterns of addiction. As we have seen in earlier chapters, the social response to drug users in the UK in the run up to the passing of the 1971 Misuse of Drugs Act was very different from that of the US. In the UK emphasis was very much on controlling the issue of addiction through treatment, whereas in the US the emphasis was on punishment. Criminalising substances has the effect of increasing stigmatisation (Radcliffe & Stevens, 2008) and so is a pathway into more risky practice and often more chaotic use. Access to a legitimate supply, however, has been shown to allow the drug user to maintain a stable lifestyle. In Young’s later work he would become less concerned with the social reaction to drug use and more focused on how drug use linked to deprivation. In this sense, he was very much influenced by the emergence of Left Realist thinking in criminology in the UK, of which he was a key figure (Lea & Young, 1984).

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Reflecting on the public debate around drugs in the 1980s, MacGregor (1989: 5) says of Young that reported rises in drug use in the 1980s had been grossly overstated and, perhaps following a line of argument developed by Stuart Hall and colleagues some years earlier this focus on drug users was not out of a concern for them, but a fixation with how to diagnose the ‘sickness’ of society. Citing an article published by Young in the New Statesman in 1984, MacGregor (1989: 5) says that: The prevalent image of heroin was of an addictive drug of gothic proportions. A few snorts and you are hooked for the rest of your brief and unrelievedly wretched life. But in reality the smoker discovers that he is not immediately addicted and that heroin is pleasurable and exciting.

As many others have noted, since, drug control has never really come to terms with the fact that for some users the primary motivation is pleasure. It has even less been able to tolerate this when users come from particular socio-economic groups such as the working-class or the black, urban poor. This does not detract, however, also from the fact that drug use and particularly that linked to poor life chances and outcomes is clustered in the lower income groups in society (see Stevens, 2011). The rhetoric, in policy circles, has often been to blame such drug users for their own predicament, but also to blame them for other social problems such as drug-related crime and pressures on the social security system. In other words, drug users, according to Young (1971) were frequently scapegoated for deep-routed systemic problems in society. An important contribution of scholars like Young was to rebuild the connection between drugs, drug takers and society. These were not people undertaking deviant behaviour on the margins whilst ‘normal’ society went about its respectable business. Rather, drug use was, for many, a normal experience part of their lives and, in various ways, also a response to socio-economic conditions and therefore very much part of society. The meaning and practices of drug taking are not deviant, as such, but form around particular localised cultures. Just as Becker saw cannabis use as learnt behaviour situated within specific groups, such as jazz musicians, so too did subsequent academics who continued the important task of explaining how unique cultures formed around particular drugs. A good example of this is the studies of the rave scene carried out in the 1990s by Sarah Thornton (1996) and Ben Malbon (1999). The rise of ecstasy in the 1980s and its emergence from within a dance music scene that was integral to the leisure lives and social identities of ravers. Reacting to media-led moral panics, both Thornton and Malbon sought to show how

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ecstasy use makes sense to those who take it and is part of a value system with its own meanings, rituals and codes of behaviour. Importantly, ravers were not ‘dropping out’ of society to partake in drug taking, nor were they by any definition of the term ‘deviant’. For many, taking ecstasy and other drugs as part of their engagement with the rave scene allowed them temporary occasions of escapism and euphoria that did not derail their lives nor involve the relinquishing of the trappings of respectable life such as jobs, houses and relationships with families and friends. Ecstasy was integral to the clubber experience and both individual and collective identities. Ecstasy was part of the role of ‘clubber’ which could be inhabited for a weekend. It was a lifestyle and just as much part of being a real clubber with an authentic raver identity as appreciation of music and the creation or maintenance of social ties through time spent with friends. Another important point, worth noting, is that studies such as these marked an ongoing trend towards empirical research meaning grand theories of ‘deviance’ were increasingly being tested against data generated from talking to and spending time with ‘real’ people who happen to use drugs, which was also a key feature of what became known as drug normalisation.

The Normalisation Debate Although normalisation is now synonymous with changing drug scenes in the 1990s, there were discussions of the thesis taking place before this. Writing in the Druglink magazine in 1987, whilst making the case for harm reduction, Newcombe states: Though illicit drug use has not yet become typical among most British youths, it has become ‘normalised’ in the sense that the majority of 15 to 20 year olds in urban areas such as London, Edinburgh and Merseyside are likely to have one or more friends who take drugs such as cannabis and solvents on an experimental or recreational basis. A survey in Wirral in 1984-5 found that up to 1 in 10 unemployed male school leavers on some estates were known to be using heroin or similar drugs. (Newcombe, 1987: 10, cited in Berridge, 1989)

There is a lot to unpack in this paragraph. The first is the common misconception around the normalisation thesis, which equates it with normal, that is to say numerically common, behaviour more broadly. Parker and colleagues (1998: 152) note how ‘Normalisation in the context of recreational drug use cannot be reduced to the intuitive phrase “it’s normal for young people to take drugs”; that is both to over simplify and understate the case’ (Parker et al., 1998: 152). It is an

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over-simplification because, as commented by Newcombe it is not routine for all young people, it is just likely to be commonplace for some and their networks. It is understated for, as we shall see, a defining feature of normalisation relates to broader cultural trends that have gradually moved representations of drug use in music, cinema, fashion and advertising away from the margins and more into the mainstream of society. Continuing the longer historical look at normalisation, Parker et al. (2002) reflect on the evolution of the concept over time as it applies to drug use and how it had its origins in Danish studies of people with learning difficulties in the 1950s focusing on how this group could live a ‘normal life’ in the sense of creating ‘normal living conditions’ (Parker et al., 2002: 942). The adaptation of the term for understanding contemporary changes in drug policy drew more on sociological accounts of normalisation found in the work of Wolfensberger (1984). According to Parker and colleagues, Wolfensberger sought to apply learning from labelling theory to show how deviant or stigmatised groups (such as disabled people and people who use and inject drugs) suffer disruption to the rhythms of everyday life not solely down to their personal circumstances, but also as a product of societies reactions, responses and organisations. Many of these findings are closely linked to what subsequently became known as the social model of disability (see Barnes, 2012). As social attitudes vary over time and place, the normalisation idea is better thought of as an evolutionary rather than static one. Drawing on the work of Van Vliet (1990), Parker and colleagues also note how the very idea of normalisation can be simultaneously progressive and reactionary. It is reactionary to nations who maintain a firm line as regards the prohibition of substances buttressed by strict law enforcement because of the very fact that drugs are being accommodated into the lives of young people, whether or not they use them (key indicators of the theory as we shall see). This calls into question the preventative ideal of prohibition and the ‘loss of moral and social authority of the law’ (Parker et al., 2002: 943) and those who design and implement it. The normalisation of drug use then is both a quantitative and qualitative phenomenon. It refers to higher rates of drug experimentation, trying, use and availability of illicit substances particularly from the 1990s onwards. Furthermore, it explains the cultural and social accommodation of these things as otherwise unremarkable aspects of the lives of young people against a backdrop of increasing individualisation culminating in a more demanding journey out of adolescence and into adulthood. Yet this does not apply to all substances equally (nor in fact according to critics, does it apply to all young people as we shall see). As discus-

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sions of normalisation developed into the 1990s, the settled terminology was that it related to ‘sensible, recreational drug use’ (Parker et al., 2013). In this sense, recreational made a distinction between drugs associated with leisure and hedonism, for example cannabis, MDMA and other ‘club drugs’, as opposed to substances associated with more chaotic lifestyles such as heroin and crack cocaine. Sensible use was attitudinal in that this was how non-users often referred to the kinds of drug use they deemed acceptable (Parker et al., 2002). Although the normalisation thesis has a long history, it is the changes to the drug scene in the 1990s that were of significance. Throughout most of this period, Parker and colleagues were running the North West Longitudinal Study, which began in 1991 with over 700 14 year olds. The sample was then tracked for initially five years until they turned 18. The sample was drawn from two mixed metropolitan boroughs in the North West of England. As Parker et al. commented (1998) ‘it was initially representative of young people’ in these locales. The subjects attended eight secondary ‘high’ and grammar schools which were picked to represent evenly middle class and working class catchments. However there was substantial attrition at 16 (Year 3) when, fairly predictably, a proportion of primarily working class respondents, most of whom were male, were lost. A small number of respondents from Asian and Muslim backgrounds also withdrew.

This was the core of the sample that formed the initial findings of the thesis published in numerous articles and book chapters over the 1990s and into the 2000s and one monograph Illegal Leisure (Parker et al., 1998) that sought to elaborate on some of the key aspects of the thesis. The subjects have since been followed up through various different periods (see Aldridge et al., 2013). Longitudinal methods allow for the vicissitudes and rhythms of life to be explored in ways that one-off snapshot surveys perhaps don’t. From this study, a number of discernible quantitative measures on the contemporary drug situation were deduced. The sample reported that drugs were widely available and that drug ‘dealing’ was something of a misnomer in that most people obtained drugs through informal friendship networks rather than with street-level dealers. The authors refer to this as ‘sorting’ rather than dealing. Similar findings have been subsequently reported by other researchers (e.g. Coomber et al., 2016). Whereas subcultural theory placed significant emphasis on drug use often as an expression of resistance on behalf of primarily young working-class males to middle-class society, the normalisation thesis attempted to move beyond such accounts by demonstrating how drug use, on at least one occasion, cuts across socio-economic groupings. Where drug trying is concerned, the North West Lon-

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gitudinal Study showed how drug trying in the 1990s began earlier in the life course and lasted longer. It was not just the preserve of the young. It was also the case that drug use spanned social class, gender and ethnicity. Level of education was not a determining factor either, and so the ‘drop-outs’ of Merton’s study were not the only experimenters in the 1990s. Further key development in the 1990s was the evolution of dance culture and the centrality of drug use—particularly ecstasy—to that. Due to its empathogenic effects (see Bedi et al., 2010), ecstasy was seen to be a key part of the changing composition of the night-time economy in the 1990s with a perceived (if not real) reduction in violence and the threat of violence as part of a broader decline in the role of alcohol in socialising around the same time, although other accounts also show how such lucrative markets attracted gangland activity in the supply of the drug (e.g. Winlow, 2001; Hobbs et al., 2003). The centrality of ecstasy to dance culture can also be seen in (auto)ethnographic accounts from the time (e.g. Saunders, 1995). Moving beyond the focus on ecstasy, respondents to the North West Longitudinal Study reported that from 1991 around one quarter became regular drug users throughout the decade with cannabis being the main drug of choice, but ‘poly’ drug use commonplace as users increasingly adopted more consumerist ‘pick n mix’ approaches to drug use and identities were less shaped by the centrality of one substance to the group as in earlier studies on the mods and rockers subcultures (Cohen, 1972). The next criterion adopted in the normalisation thesis is the notion of being ‘drug wise’. This qualitative measure relates to the increasing knowledge that young people have in relation to drugs and their effects and that there was an increasing ‘matter of factness’ about the role of drugs in the lifestyles of young people that moved beyond the connotations with deviance more apparent in subcultural theory. Importantly for Parker and colleagues, this viewpoint extended to drug abstainers who not only had detailed knowledge of drugs, they didn’t condemn the drug taking of friends and acquaintances cannabis use, in particular was ‘condoned rather than condemned’ (Parker et al., 2002: 943). This pragmatism extended beyond the present as many respondents in the sample reported how even though they may be current abstainers, they might not always be. In this sense, the ‘future intentions’ of the sample showed how young people’s drug use, in the 1990s, would extend beyond the phase of adolescence, again critiquing the earlier psychological accounts of drug use and the more subcultural explanations that equated drug use with a rebellious phase in adolescence. Although some accounts view this as a separate feature, these sensibilities have to be put into the context of the time; the 1990s represented arguably the high point of thinking about risk and growing up in the risk society, in this sense, the increasing individ-

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ualism of the times created a more demanding journey into adulthood and set in this context, the decision or not whether to use recreational drugs in a ‘sensible way’ at weekends as part of the leisure-scape does not seem all that remarkable. A further proposition in the normalisation thesis was that into the 1990s there was an increasing cultural accommodation of the illicit. This was partly explained by an increasing blurring of the illicit (cocaine use) with the licit (alcohol use) in depictions of ‘going out’ as it was represented in television, film and celebrity culture in the closing decades of the 20th century. In effect, these previously deviant activities were becoming increasingly mainstream and the language and imagery of drug use were increasingly being incorporated into culture through fashion, music, tourism as well as being co-opted by the alcohol industry in its rebranding of products, particularly ice lagers in the 1990s. Ultimately, then, the normalisation thesis is an explanation that moves drug use beyond the focus on ‘respectable fears’ (Pearson, 1983) and moral panic (Cohen, 1972). It represents a challenge to policymakers as it is anathema to supporters of the drug war and even slightly diluted versions of the drug war. That said, it has not been without criticism. Blackman (2010) has suggested that there is and always have been times when drug use has been culturally accommodated into society and there is nothing necessarily novel about this recurring during the 1990s. Similarly, for Shildrick (2002), the normalisation thesis is ‘over-simplistic’. This conclusion is reached based on separate research on the role of drugs and young people in the Northeast of England. Shildrick’s (2002) critique focuses more on the heterogeneous nature of ‘youth’ than is acknowledged in the normalisation thesis. For Shildrick (2002) there are at least three different youth groups in her study—‘ordinary’—not having the outward appearance of belonging to a specific youth culture; ‘spectacular’ youths who were most obviously committed to a particular cultural style (e.g. goths) and ‘trackers’ were committed to a particular style, but more in terms of clothing and consumption. For Shildrick, the extent of drug trying, and use varied amongst the groups as did familiarity with drugs. She describes the trackers and spectacular youth as being more drug ‘aware’ rather than ‘drug wise’ with less knowledge apparent amongst the ordinary youth. Arguably, however, it is Shiner and Newburn (1997, 1999) who provide the most far ranging critique. For these thinkers the normalisation thesis over emphasises the amount of drug use amongst young people. As they state, across numerous surveys conducted at the time, the total of non-drug users outnumbers those who report as being drug users. Shiner and Newburn (1997) also question the methodology adopted by the normalisation researchers, suggesting that it amounts to a problematic scientific approach where the hypothesis that some

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form of normalisation has occurred is set out to be proven rather than falsified. In addition, the reliance on large-scale survey data, they claim, is incapable of capturing the nuances of the role of drugs in the lives of young people, particularly where associations between drug use and deviance are concerned. They conclude, based on the findings of their qualitative inquiry with 52 young people in the London Borough of Newham, that: The normalisation thesis pays inadequate attention to the normative context of behaviour. We have argued that, in general, young people do not view drug use as an ‘unproblematic’ activity. The young people who participated in our qualitative study and who had not used drugs commonly subscribed to a restrictive set of views, characteristic of the so-called ‘adult world’. This was clear in the associations they made between drug use, crimes and other forms of deviant behaviour. Surprisingly, perhaps, the attitudes of those who had used drugs were, in many respects, similar to those expressed by non-users. Users’ accounts of drug use highlighted the rule-governed nature of such activities. Their affiliation with consensus values was also evidence in their reaction to their siblings’ drug use, whether this usage was real or hypothesised. The principal difference, we have argued, between users and non-users lies in the generation, by the former, of neutralisation techniques, which allow them to engage in drug use while at the same time ascribing to consensus values. (Shiner & Newburn, 1997: 526)

The consensus values here refer to negative feelings towards drug use considered to be of a significant magnitude as to be ‘bad’. So, Shiner and Newburn’s respondents reported negative attitudes towards cocaine. There is a sense that this critique is somewhat in that cocaine was not part of the normalisation thesis as discussed in the 1990s although its use had become increasingly normalised in later tranches of the study (Aldridge et al., 2013). More recently a consensus has settled over the normalisation debate. This is best illustrated in the review of the thesis by Measham and Shiner (2009) hitherto on opposing sides of the discussion. For these thinkers normalisation should be seen as ‘a contingent process negotiated by distinct social groups operating in bounded situations’. A useful term for acknowledging this is ‘differentiated normalisation’ which accepts that drug use is ‘normal’ for certain groups in certain ways at certain times and with certain consequences. Differentiation by social class means that middle-class drug use is often less harmful to careers and reputations than it is for working-class individuals. Also, as Chapter 9 will explore, the normality of drug use is different for men and women, with men historically given more licence than women to pursue hedonistic pleasures through drug use and with female drug takers facing quite different pressures and pleasures, meaning ‘doing drugs’ involves ‘doing gender’ (Measham, 2002). Likewise, normalisa-

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tion is differentiated by race, ethnicity and religion. As Chapter 10 will examine, the very real risks and harms of drug use are often more pronounced for young black and Asian men whilst the cultural image of many drugs, and the treatment available for those struggling with substance dependency, is primarily white in a way that marginalises minority ethnic group experiences. It is now over 25 years since the normalisation thesis was developed. It has undoubtedly changed the way that we as researchers think about the role of drugs in the lives of young people, in particular, and society more broadly. Reflecting on its impact at 20, Pennay and Measham (2016) comment on how the ideas have been picked up across Europe, Australia, New Zealand and the US. Williams (2016), meanwhile, reflects on one of the many interesting developments to occur in normalisation discussions and one that could not have been predicted in the 1990s, despite the creators acknowledging that normalisation could be a ‘two-way street’ (Parker et al., 2002: 943, cited in Williams, 2016), which is the potential de-normalisation of intoxicants such as tobacco and possibly cannabis in light of the decreasing popularity of the substance according to various self-report surveys taken since the turn of the millennium. For Williams (2016) the main indicators of normalisation developed in earlier iterations now have contrary and contradictory data meaning the longevity of the thesis is difficult to determine. Focusing on the more quantitative measures of normalisation, Williams (2016) notes how one of the main features of the normalisation thesis was that many young people had been in drug offer situations in the 1990s. Parker (2002) explains this data thus: Across the last decade school surveys have also documented rises in accessibility and availability and have consistently shown that nowadays a majority of respondents can from around 15 years old access drugs, particularly cannabis, quite easily. A recent national survey of England found 61 percent of 15-year-olds had been offered at least one drug (Goddard and Higgins, 1999). A large longitudinal study in Northern England is finding incremental rises in drugs offers and availability, with 80 percent reporting being in offer situations by 16 years (Aldridge et al., 1999). Household surveys identify similar patterns with two thirds of 14–16 year olds being in offer situations, rising with age, whereby nearly 90 percent of 20–22 year olds report these situations. (HEA, 1999)

For Williams (2016) one of the paradoxes of the current situation is that in an age of social supply and when access has been facilitated through the use of cryptomarkets, meaning that drug users rarely, if ever, come into contact with either of the main enemies of the drug war (law enforcement or wholesale dealers) young

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people in contemporary society report being in fewer drug offer situations today than in the 1990s. Perhaps of more significance, however, is that Williams (2016) by analysing successive tranches of data from the Crime Survey for England and Wales notes that where drug trying and drug use are concerned there are potential signs of de-normalisation, which appears strongest in terms of drug trying and regular drug use for young people. As Williams (2016) points out, much of this downward trajectory in self-report data of drug trying can be explained by a consistent long-term decline in cannabis use amongst 16–24 year olds. This is supported by data from the HSCIC survey (HSCIC, 2014) which also showed the declining popularity of tobacco smoking over a similar period. As cannabis is mainly smoked with tobacco in the UK, this could explain the trend. HSCIC data reports that, in ‘2014, less than one in five 11–15 year olds (18%) said that they had smoked at least once. This was the lowest level recorded since the survey began in 1982, and continues the decline since 2003, when 42% of pupils had tried smoking’. Other explanations for the decline in cannabis use may be the increasing presence in the media of stories linking cannabis with mental illness such as psychotic disorder, often reporting on research findings in this space (e.g. Di Forti et al., 2009, 2019). The links between cannabis and mental illness are not new and are not well understood (Hamilton & Monaghan, 2019) but have been resurgent in line with evidence of the increasing potency of the drug in contemporary markets (Potter et al., 2016) and the rising numbers of people entering drug treatment services for cannabis-related issues (Hamilton et al., 2014). Although there may be signs of de-normalisation of drugs for young people, as Williams and Askew (2016) point out, the maturation thesis where young people cease drug use as they get older—on the grounds that it can be incompatible with the requirements of adulthood—might be taking longer and there is actually a cohort displacement effect occurring whereby ‘drug use is extending further into adulthood at higher rates of prevalence than has traditionally been the case’. They note that the CSEW has shown that reported recent drug use had increased for all adults aged 35 and over, whilst simultaneously decreasing for all adults aged under 35. What of the more qualitative measures, particularly the social and cultural accommodation of drug use in the lives of young people. According to the CSEW (although it does not routinely collect data on measures of attitudes to drug use), attitudes towards drug use have remained fairly stable. Williams (2016) shows how data from 2012 to 13 of the CSEW highlight the acceptability of occasional drunkenness of people of their own age more so than the occasional use of ille-

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gal drugs. This is despite the increasing prominence of research documenting the harms of alcohol vis-à-vis other substances (Nutt et al., 2010) and an increasing resemblance of alcohol policy to mirror drug policy without altering the great regulatory divide between the two where alcohol sales are legal for over 18s and other drugs are not (Monaghan & Yeomans, 2016). That said, when the tolerance of drugs is considered, occasional cannabis use is perceived as being the most acceptable, particularly amongst 16–59 year olds with around one-third reporting this. Williams (2016) also shows how measures of social accommodation can be assessed, by proxy, by considering the issue of how drugs should be regulated. Much has changed since Newcombe’s (2004) extensive review of the international literature on this matter, although as Newcombe noted, Britons ‘would appear to be the most pro-reform people in the world’, with well over a half of adults surveyed reporting a ‘relaxation of the general prohibition of cannabis’, although it can also be stressed that we must take the starting point of the law into consideration here. The key difference between then and now is the pace of change across the planet and that there is now a more developed evidence-base on what happens when jurisdictions do implement changes whether they be widespread decriminalisation as in Portugal or the introduction of regulated markets for both medicinal cannabis use and recreational use as in parts of North and South America. Recent data from opinion polls on legal change in relation to the drug laws in the UK shows that 76% of people surveyed (n = 1690) believe that the threat of criminal punishment is not a significant deterrent for individuals in deciding whether to use drugs and more than half felt that it was time to consider drug use as a health rather than criminal justice issue.1 As Williams (2016) notes these findings are consistent with others such as the British Social Attitudes Survey 2005 that found 41% of respondents believed cannabis should be legalised, up from 20% in 1993. As regards the cultural accommodation, this too is difficult to measure, although the level of scandal associated with drug use or ‘outing’ seems to be diminishing. Murji (2020) reflected how: The dominant, conventional approach has seen the media as a key force in the demonisation and marginalisation of drug users, as presenting lurid, hysterical images and as a provider of an un-critical platform from which politicians and other 1 https://www.cdprg.co.uk/press-releases/2019/7/16/yougov-poll-public-support-new-ap-

proach.

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moral entrepreneurs are able to launch and wage drug ‘wars’. The media is thus seen to comprehensively mis-represent drugs, their effects, typical users and sellers and indeed the whole nature of the drug market and the enforcement response to it.

The often cited reason for the misrepresentation of drug use in the media is that these stories ‘sell’, but as Taylor (2008) identifies, the news media and criminal justice policy ‘seeminly mirror each other’s beliefs’. Atkinson and Sumnall (2020) discuss substance misuse on reality TV suggesting that its depiction needs to be situated within neo-liberal discourse where drug misuse is seen as part of rational-choice behaviour and it is in the power of the drug user to cease if they want to. Such attitudes filter into public perceptions and can also explain failures in treatment of addiction. These victim blaming discourses are in contrast to the plethora of research that documents something like opiate addiction, for instance, as a chronically relapsing condition. Atkinson and Sumnall also highlight how substance misuse is framed alongside social security (welfare) dependence and, therefore, substance misusers were not considered to be productive citizens. These characterisations systematically downplay the structural determinants of drug use and its impacts, particularly the link with deprivation and inequality (Stevens, 2011). Although these tendencies remain, for Williams (2016) there are now more frequent episodes of drug scandals emerging in the media, but this does not necessarily result in a dismissal or loss of endorsements as it once did. Willams concludes that media portrayals will always vary, but since the 1990s, the ‘blurring of the licit and illict in the night-time economy, positive images of drugs and drug users on TV and in films and celebrities maintaining their status and careers after admitting to past drug use, all point towards continuing cultural accommodation’ and this is not to mention the lack of harm past drug use seems to have on the careers of politicians! Intoxication in Contrast 5

While consuming alcohol on holiday was a feature of the early days of mass package tourism in the 1960s, it is from the 1990s onwards that resorts like the Spanish island of Ibiza and, on the Black Sea, the Bulgarian report of Sunny Beach have become infamous destinations associated with heavy drinking and drug-taking for young Europeans. A number of scholars have used ethnographic methods to explore these settings. They also make use of particular theories to explain the risky and disorderly behaviour they witnessed during their fieldwork. The Danish criminologist Sébastien Tutenges’ (2013), for example, used Durkheim’s concept of ‘effervescence’ to theorise how the

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club’s in Sunny Beach used a range of strategies to ‘stir up’ hedonistic behaviour amongst crowds of young tourists from Scandinavia. He showed that music and lighting were used strategically to cause excitement and, also, that club ‘reps’ continuously prompted revellers to drink more and engage in disinhibited behaviour. Similar themes were addressed by Tim Turner (2018) in his research in Ibiza. However, he used the concept of ‘Disneyization’ to show how the experience offered in places such as Ibiza is deliberately manufactured by conglomerates to blur the boundaries of licit and illicit intoxication and to make illicit drug use seem like a normal feature of these spaces. Further still, Disneyization helped explain how this corporate staging of illicit behaviour served to sanitise the hedonistic experience. Tutenges, S. (2013). Stirring up effervescence: An ethnographic study of youth at a nightlife resort. Leisure studies, 32(3), 233–248. Turner, T. (2018). Disneyization: A framework for understanding illicit drug use in bounded play spaces. International Journal of Drug Policy, 58, 37–45.

Intoxication for Pleasure, Profit and Identity A theme spanning many, if not all, of the theories discussed so far has been the need to explain the line between normal and abnormal intoxication. Theories concerned with deviance tend to explain under what conditions a particular intoxicant and the people that use it are subject to social disapproval, accounting for how their use results in stigma or the loss of social status. They may also seek to understand, with varying degrees of sympathy, how such stigmatised individuals and groups negotiate their marginal status and, at times, resist and reframe their identities. The thrust of many anthropological accounts may be to directly or indirectly condone intoxication as something embedded in the social arrangements and cultural systems. Here, intoxication may involve certain transgressions but these are often explained by conformity to cultural expectations. Getting drunk can serve a social function in line with the wider rules of society. Subcultural accounts, on the other hand, theorise intoxication as a separate world into which people enter and become part of through ritualistic social interactions and shared expressions of value. To rave going youths dropping ecstasy and dancing the weekend away ‘makes sense’ for them and their peers even if it horrifies their parents and others whose main understanding of such behaviour is gleaned through tabloid sensationalism.

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In these accounts, partaking in drinking or drug use can be both pleasurable and beneficial, in that beyond the individual bodily sensations intoxication can enhance friendships and improve social status and feelings of belonging (Thurnell-Read, 2016). For so long, not just policy and media but also several branches of academia have viewed drug use through the lens of ‘deviance’ which means it can be a struggle to acknowledge the pleasure involved. As Hunt and Evans (2008: 32) observe: Although legal and illegal drugs have throughout history given pleasure to those who consume them, research in the drug field has ignored this central and fundamental feature…Pleasure is still missing within much of this drug discourse. Research has failed to explore a significant and integral feature of drug use, primarily the reasons why people use and the benefits they receive.

Put like this, both alcohol and drugs can be theorised not as deviant but as experiences desired by many. Advances in theorising intoxication mean that we are now more likely to accept it as meaningful and, as the remainder of this final section will suggest, also profitable for a wider economy of social and economic participants. A trend in recent scholarship on drugs and alcohol has been part of a wider turn in the social sciences towards identity. Numerous contemporary studies of alcohol and drug use study in detail the ways in which getting drunk, or high, gives a person a sense of who they are and where they belong. In the years straddling the turn of the millennium, sociologists like Anthony Giddens (1991), Zygmunt Bauman (2000) Ulrich Beck and Elisabeth Beck-Gernsheim (2001) all suggested that as we moved into a stage of ‘late’ or ‘liquid’ modernity, old certainties and traditions have been replaced by increased freedom for people to shape their identities as individuals. Intoxication is a reflection of an individual identity and is bound up with freedom of choice and freedom of expression. As part of this, the bodily sensations and social vibrancy offered by many intoxicants and the contexts of their use become desirable commodities in a consumer society fascinated with youth, geared towards offering hedonism and self-expression in varied forms, albeit channelled into a specific range of activities. ‘In the modern consumerist world’ as Chrzan (2013: 8) observes, ‘alcohol use – much like language, clothing and other purchased displayed goods – becomes a semiotic text manipulated to convey social meaning’. The idea that there is a right to pleasure or, further still, an imperative to seek out and experiment with pleasurable experiences, has its roots in the romantic era and received periodic boosts such as the 1960s counterculture and the 1990s era of

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intoxication. Intoxication has long been a lucrative business. However, in the latter part of the twentieth century it has been firmly integrated into the economic structure of society but also the psychological logic of the age. Intoxication is encouraged both directly (e.g. advertising, freshers fairs, cultural veneration of drug taking celebrities) and indirectly by an ethos of hedonism and the pursuit of individual expression. From the 1980s onwards, facilitated not least by increasingly liberalised licencing legislation, a rush of money and investment was ploughed into providing places for people to drink and play. The night-time economy encourages intoxication and excess through ‘aesthetic processes aimed at encouraging alcohol-related excitement and excess’ (Hayward & Hobbs, 2007: 438). The packaging of intoxication as a pleasure and escape for consumers is at the heart of what has become known as the night-time economy where urban areas in post-industrial cities became ‘reimagined’ as spaces of play, consumption, hedonism and excess (Chatterton & Hollands, 2002). What emerged was the urban night-time as a ‘contested’ landscape involving hedonistic release and pleasure for drinkers and profits for bar and club operators but also issues about power and control for both local and central government (Hadfield, 2006). So entrenched has this become to the economies of many Western societies, it is quite easy to overlook quite how pervasive and consistent the messaging an imperative to express oneself through intoxication is in advertising and in other cultural forms such as music, television and cinema. Indeed, here certainly alcohol but increasingly also drugs are lifestyle choices which are, far from being the concern of deviant outsiders, offered up for pleasure and enjoyment in a way quite congruent with the values of individual self-expression and the pursuit of self-actualisation integral to consumer society.

Summary In this chapter, we have outlined some of the main ways in which intoxication has been theorised by academics, particularly those in the social sciences. Taking a purely physiological approach as a point of departure, all the theories covered involve elements of social and cultural understanding as to why intoxication is experienced by some and responded to by others in certain ways. If an overarching trend can be observed, it’s perhaps that from the dramatic polarisation that placed the earliest years of drugs as either miracle cures or scourge of society, the twentieth century became focused on theorising intoxicant, particularly alcoholism and any form of drug use, as deviant. From the 1960s onwards, a gradual push to appreciate and understand the pleasurable social and cultural aspects can

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be observed, ending in the closing years of the twentieth century and the start of twenty-first with intoxication being not just big business but very much in keeping with the spirit of the age. A review such as this gives some idea of how, cutting across the varied approaches and priorities of different theories that have come and gone, there are common themes or tensions. One important tension is central to the position of this book, the balancing of self, state and society. Taking a drug results in a person feeling a certain way. That same drug is deemed illegal by the state where this person lives. Becker focused on Jazz musicians, but subsequent subcultural theories could explain how drugs were integral to the practice and values of distinct groupings of people whilst at the same time being demonised from the outside by the state and the media. Recent decades have been marked by a general shift towards understanding the lived experiences of intoxication and how it relates to identity, for some, and profits, for others. Importantly, rather than being something aberrant from society, intoxication has become increasingly understood as entrenched within the very values of individualism, expression and consumerism that underpin modern economies and inform social values and codes of conduct. Subsequent chapters will examine, that whilst the news media has long sustained narratives of deviance and propagated new discourses with which to cause moral panics, hedonistic drinking and drug taking are also frequently accepted, encouraged and even celebrated in a wider cultural trend. Before we do this, we discuss the issue of what happens when drug use moves beyond pleasure towards harm and how this impacts on individuals, but also how society reacts and the state responds. Points for Discussion

Why do theories relating to alcohol and drugs change over time? How useful is it to view drug use as deviant? Under what conditions might it appear ‘normal’ to take illegal drugs?

Read, Watch, Listen #5 Read: There are lots of generalist introductions to understanding drugs and the drug trade and many journalistic accounts. There are also lots of blogs too. The Global Drug Survey overseen by Dr Adam Winstock, an addiction specialist, is a fabulous resource for those interested in researching and exploring drugs issues.

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Watch: Can You Feel It? How Dance Culture Conquered the World is a documentary that charts the origins of dance culture and its proliferation in the 1980s and 1990s. It also discusses the role of ecstasy/MDMA in this context. Listen: The Drug Science Podcast—is hosted by Professor David Nutt erstwhile chair of the Government’s Advisory Council on the Misuse of Drugs and now chair of Drug Science—an independent organisation seeking to provide an evidence base around drugs free of political and commercial interests. Professor Nutt has a regular podcast with different experts invited each time to discuss a pressing drug issues and problems.

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Addiction, Treatment and Recovery

Introduction It has become common to speak of the ‘disease’ of addiction. Yet, at the same time, there is widespread understanding that addiction to alcohol or drugs is a ‘social problem’. The term ‘disease’ brings to mind a defect or abnormality in the brain or body, as an individualistic and medicalised term that can, at times, seem distinct from wider social issues. Untangling the biological, psychological and social is a difficult task. Consider the case of returning soldiers from the Vietnam War, where opium and heroin addiction had been prevalent amongst American GIs. On coming home to the US, however, only a minority of veterans continued their opioid use. Removed from a context in which drugs were easily accessed and the horrors of combat drove many to the numbing effects of opioid use, many soldiers simply stopped using or, at least, reverted to dependency on the far more readily available alcohol. Not only does this question the framing of addiction as solely a medical matter, but it also alludes to the complex interplay of conditions and contexts in which substance dependency might develop and, equally, be overcome. In this chapter, we will explore both the concept of addiction and its critiques as well as the numerous approaches to treating substance misuse both for individuals and within society. Addiction, and alternative terms coined to describe the compulsive and often destructive use of alcohol and/or other drugs that are intended to be less stigmatising, is a contested term and, further still, how individuals and societies should respond to it are equally contentious. There are many who might feel that the responsibility to ‘sober up’ or ‘get clean’ rest solely on the individual. These depictions are commonplace in reality television for example. Yet, particularly for those without a network of support and, not least, access © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_6

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to treatment services and other resources vital to rebuilding lives derailed by addiction, recovery can seem impossible. If addiction is a moral failing, then particularly when it results in harm to others and to society, should the response not be one of punishment and regulation? If addiction results from a physical or mental anomaly, perhaps inherited, then should the response be solely medical, with treatments administered in a medical setting by trained medical experts? If the occurrence of addiction varies between different groups in society and between different areas and times indicating a possible social or cultural underpinning, then societal level responses are required that go beyond either the punishment or treatment of single individuals. It is also important to ask what is the desired outcome of treatment? Should the individual be able to continue to consume alcohol or drugs but do so in a regulated and moderate fashion or, as is often the case, is total abstinence the one and only desired outcome? There are, of course, no conclusive answers to these questions. Indeed, one aim of this chapter is to show that addiction can be seen as being socially constructed and that, even with its acceptance into common sense language, it is a contested and critiqued term. As Keane (2017: 367) observes: ‘addiction’ and ‘the addict’ are created and culture-bound categories rather than natural types and the medical and scientific project of identifying the universal truth of addiction is in fact part of the process by which the phenomenon itself is brought into being.

What is defined as addiction and who is defined as an addict has varied greatly over time with the ebb and flow of cultural and political sentiments. As we progress through this chapter we will explore some of the most widely followed responses to what we call ‘addiction’ or what gets called, in other contexts, substance misuse. To say that something is socially constructed does not mean it doesn’t have very tangible manifestations and consequences in the real world. At the outset, however, it is worth remembering that drug and alcohol use can and do ruin lives and kill people. Based on recent trends, this happens with increasing regularity. The latest available data show that in England and Wales in 2021, there were 4,859 deaths relating to drug poisoning. This was the highest number since records began in 1993. Those from Generation X and born in the 1970s— often, but problematically, referred to as an ageing cohort of opiate users have the highest rates of deaths and over half of all drug poisonings involve opiates (ONS, 2022). Indeed, the persistence of drug-related deaths, particularly amongst the so-called ‘Trainspotting generation’—named in reference to Irvin Welsh’s 1993 novel depicting the lives of a group of Edinburgh heroin addicted people and the

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1996 movie of the same name—has been linked to the impact of austerity and the retrenchment services (Marmot, 2017). Although an inquiry by Public Health England (PHE, 2016) suggested that it was not possible to draw a conclusive link between treatment policy and drug-related deaths, it has been suggested that increasing social deprivation and cuts to public sector services, drug treatments amongst them, has impacted upon this group disproportionately (ACMD, 2016: 4). In its contemporary use, addiction is very much still a difficult concept to grasp. In many ways it is an archetypal ‘wicked problem’ (Rittel & Webber, 1974). There is little agreement on its nature and, therefore, little consensus about the most efficacious responses. According to Day (2021) addiction is best understood on a long spectrum and it varies from substance to substance. Nicotine, the active ingredient of tobacco is thought to have a high addiction threshold whereas others, such as MDMA, are less addictive even whilst being more readily accepted as illicit and in need of prohibition. Added to this is the apparent incongruity that, in many countries, one of the most addictive and harmful intoxicants, alcohol, is widely available and culturally accepted, if not celebrated. Although many people use psychoactive substances, relatively few people experience significant harm in terms of dependency and addiction. Even the drugs that are considered to have the most deleterious outcomes for users, such as heroin, can and have been shown to be used in controlled ways (McSweeney & Turnbull, 2007; Shewan & Dalgarno, 2005). When harms do arise, however, these often multiply quickly and rapidly become self-perpetuating. Broadly speaking these are the products of drug dependency. Although there is no neat explanation for this term, it is widely thought to describe a chronic recurring condition that has physical, psychological and social dimensions (Day, 2021). Dependence is characterised by loss of control of the ability to regulate one's own substance use and is usually associated with unsuccessful attempts or repeated attempts to cut down or at least control the use of substances and to avoid this impacting over long periods on other social activities and functions such as maintaining meaningful relationships or steady employment. We need also mention terms like ‘functioning alcoholic’ and ‘hidden addiction’ as qualifiers for those whose dependency on alcohol or drugs hides behind a façade of respectability, for instance in holding onto a wellpaid job and fulfilling family commitments. What this demonstrates is that there are various policies and interventions that fall under the umbrella of substance misuse treatment. To understand the drug and alcohol treatment landscape in any jurisdiction very much requires an analysis of how the issue of addiction is framed in the specific policy context and the form of wider perceptions of those who experience addiction or attempting recovery from it. In policy terms ‘framing’ relates to the way that issues are categorised

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or the ‘images’ that are used to discuss them (Cairney, 2019). As we have seen, in Britain there has been a long-standing debate over whether drug use should be seen as a criminal issue, on the one hand, or a medical or health issue, on the other. These debates inevitably shape the way addiction is responded to.

The Invention of Addiction The terms ‘alcoholic’ and ‘addict’ are commonplace in contemporary usage. Indeed, the latter gets freely used to the point of triviality when we joke about being ‘addicted’ to a new favourite series or reach for one more cookie that tastes too good to leave on the plate. In both everyday and clinical settings, it is now common to talk of addictions to, amongst other things, sex, work, shopping, gambling and the internet (Savelle-Rocklin & Akhtar, 2019). Yet, this ‘common sense’ usage hides a complicated history. Sociohistorical analysis shows that the modern understanding of addiction emerged from specific social, economic and political contexts. Notably, in the nineteenth century, with the rise of a middle-class who came to value individual self-control, ‘alcoholism’ become a means of describing alcohol consumption that threatens ‘modern’ values of rationality and productivity (Levine, 1978). It is not that people did not drink to excess prior to this nor did people not struggle with an inability to control their drinking even when its devastating impacts on mind and body were all too apparent. Rather, the ‘evils’ of drinking immoderately were personal failings. Up until this point, being a compulsive drinker lacked a clinical definition and the judgements levelled against such compulsive drinkers were largely issues of morality policed by the community and the church. The coining of terms such as alcoholism and addiction is part of a longer term trend that saw complex issues relating to the place of intoxication in society increasingly corralled by a burgeoning medical profession. From the late nineteenth century, the medical profession increasingly defined, identified and treated habitual drunkenness as an illness within a medical remit and has, then and since, played the leading role in the evolving terminology used to describe issues such as addiction, abuse, dependency, withdrawal and recovery. Across the nineteenth and twentieth centuries, compulsive drunkenness was gradually turned into a medical ‘fact’. It was the Swedish Physician Magnus Huss (1807–1890) who would first use the term ‘alcoholism’ and, by placing the excessive drinking of alcohol on the same footing as other diseases, opened an ongoing project of the medicalisation of the compulsive use of intoxicants. Another key development to occur was the founding of the Society for the Study and Cure of Inebriation still operating today as The Society for the Study of Addiction (SSA),

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under the guidance and leadership of the Scottish physicist and temperance advocate Dr Norman Kerr. As Parssinen and Kerner observe (1980: 280), many of the society’s earlier publications were founded on the idea that the inebriate, previously condemned ‘as a sinner’ or punished as ‘a criminal’, was in fact ‘a sick man’ suffering from ‘a physical defect over which the sick person has no control’. On the face of it, this might seem like a more sympathetic approach which would pave the way for medical care and treatment, as opposed to moral condemnation, persecution and imprisonment. However, to establish scientific credibility for these theories, Kerr and colleagues sought to demonstrate how the disease of inebriety was hereditary. Berridge (1984: 27) observes, the new definitions of inebriety as a disease that emerged in the late nineteenth and early twentieth century targeted almost exclusively the working-class drunkard and responded to a general sense of uneasiness over the ‘physical inferiority of large sections of the population’, tied to Eugenicist understandings of the role of alcohol in ‘racial decline’, by pinning drunkenness as a form of insanity legitimising medical intervention and leading to confinement for treatment. Such arguments cannot be considered without also thinking about the attempts of the medical profession, close to something that we now recognise, as trying to gain some legitimacy in the regulation of social affairs. Berridge (2013: 132) notes that models of addiction as they were developed and consolidated early in the twentieth century were very much shaped by who it was who was addicted, particularly their socio-economic characteristics. This in turn shaped responses and, notably, provided the rationale for interventionist approaches that linked the predicament of individuals with the moral and physical health of society more generally. A similar process to the medicalisation of compulsive drunkenness as alcoholism can be observed in the protracted emergence of what is often referred to as the disease model of addiction. In the nineteenth century, opium was thought to be invaluable to medical practice on the grounds that at the time physicians did not really attempt to ‘cure’ diseases as ‘much as manage their symptoms’ (Parssinen & Kerner, 1980: 276). As a naturally occurring and easily administered pain killer, opium was accepted as an invaluable item in the physician’s repertoire. Two events in the late nineteenth to early twentieth century started to change the way opioid ‘addiction’, as it was yet to be known, was understood. The first was the isolation of morphine from opium and the second was the more widespread use of the hypodermic syringe as a mode of delivery. Whilst the first of these made a clearer distinction between morphine as an effective pain killer, legitimised by medical expertise and opium as a problematic substance ‘used’ for hedonistic reasons alone, the second made the administration of the drug both more controlled, in medicinal contexts, and the risk of misuse heightened, in non-medical contexts and especially so in ‘street’ use. Then, in 1878, the German

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physician Eduard Levinstein published Die Morphiumsucht [The Morbid Craving for Morphia]. This influential work moved beyond seeing opium derived morphine as a medicine. Instead it considered how person’s desire to use morphine could become uncontrollable. As treatment, Levinstein advocated for a period of abstinence which, after around four weeks, would leave the patient drug-free and ready to return to the community. Viewed in light of contemporary understandings of addition and treatment, which we will examine in greater depth below, such explanations seem limited and we have become accustomed to viewing addiction, particularly to the opiates, as chronically relapsing conditions that often take several attempts at treatment before abstinence is achieved. It must be stressed also that contra to Levinstein, abstinence has not and is not always the desired outcome of treatment. Indeed, there was in Levinstein’s work a prejudice that remains strongly today relating to how some people simply can’t be trusted to moderate their substance use making total abstinence the only option. Another key moment in the evolution of a clinical framing of addiction as a disease was the meeting of the 1924 Departmental Committee on Morphine and Heroin Addiction. Known more widely as the Rolleston Committee, after its Chairperson Sir Humphrey Rolleston, the resulting publication of the 1926 Rolleston Report defined drug addiction in terms of illness as opposed to crime or moral failing. As an illness heroin addiction could (and should) be treated by doctors and this could take the form of the maintenance prescribing of opioid drugs to ‘addicts’ (Berridge, 1980). This had occurred in private practice, but it would be sanctioned officially by Rolleston. In many ways this was the ultimate triumph of the disease model and allowed medical practitioners the freedom to exercise ‘compassion towards addicts’ who were being criminalised elsewhere, such as in the US. Seeing addiction as a disease made equivalencies easier; a person with a disease, just like any other, requires sympathy and treatment not shame and stigma. Moving forwards and closer to the contemporary period, addiction is firmly entrenched within the remit of various of medical professionals, each with their own stance on the biological, psychological and social elements of addiction. Whilst insights into addiction and pathways to recovery emerged from lay understandings, such as those from the early participants in Alcoholics Anonymous (which we discuss in more detail below) it was psychiatry that gained the ascendency during the second half of the twentieth century. During this time, the increased influence of institutions such as the World Health Organization (WHO) came to dominate the defining of alcoholism, its diagnosis and treatment. An example of this is the influential (and controversial!) American bioscientist

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E. Morton Jellinek (1890–1963). As the author of The Disease Concept of Alcoholism (1960), he made a considerable contribution to the formalisation of medical framing of alcohol addiction as a chronic disease which could be codified by ‘types’ and ‘stages’. As the disease progressed from Pre-Alcoholic to Early Alcoholic stages, the individual in question began a steady loss of control of their drinking. A further decent, through the Middle and Late Alcoholic stages meant a succession of devastating harms impacting the life of the alcoholic. A fifth and final stage, however, involved both the intervention of medical experts and a changing of ways by the individual which would then lead them on an upward path to recovery. Elaborated since as the ‘Jellinek Curve’, this idea of both addiction and recovery being a process involving moving through various stages is one of the central tenants of the disease model of addiction which, as we see below, informs several of the most widespread treatment and recovery approaches. Conceptualisations such as Jellinek’s have proved influential, not least in how they present addiction as something that can, with the right medical expertise, be diagnosed and treatments proscribed. In more recent decades, this is best seen in the psychiatric classifications of addiction, now termed Substance Use Disorder (SUD), based on diagnosis by observable and measurable indications of harmful relationship with substances. The American Psychiatric Association (APA)’s Diagnostic and Statistical Manual of Mental Disorders establishes the problematic relationship with alcohol, and other substances, as a mental illness, with the publication of its fourth iteration (DSM IV) in 1994 describing two distinct disorders, alcohol abuse and alcohol dependence, with specific criteria for each. In reference to a set of 11 symptoms occurring in the past year (see Table 6.1) alcohol disorders could be ranged from ‘mild’ (2–3 symptoms) to ‘moderate’ (4–5 symptoms) and ‘severe’ (6 or more symptoms) present. In the 2013 fifth edition, the disorders of abuse and dependency would be combined into a single disorder called alcohol use disorder (AUD) with mild, moderate and severe sub-classifications. Similar criteria exist under the broader umbrella of substance use disorder (SUD) which now covers cannabis and caffeine along with alcohol, stimulants, opioids, sedatives, tobacco and others. Whilst the critiques of the DSM, particularly its fifth edition, are far ranging— including the trend towards medicalising as mental illness ‘conditions’ such basic human experiences as shyness and bereavement—the principal defence of such diagnostics is that it places the medical identification of alcoholism (or other substance use disorders), and, therefore, treatment, as an objective classification. Yet, as Keane (2017: 378) observes, in its application the diagnostic frame still has plenty of subjective, perception-based and culturally specific ‘judgements about what a meaningful and productive life looks like’ (Keane, 2017: 378).

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Table 6.1   Diagnosis of Alcohol Use Disorder (AUD) in the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) In the past year, have you Had times when you ended up drinking more, or longer, than you intended?

The presence of at least 2 of these symptoms indicates Alcohol Use Disorder (AUD)

More than once wanted to cut down or stop drinking, or tried to, but couldn’t? Spent a lot of time drinking? Or being sick or getting over other aftereffects?

The severity of the AUD is defined as:

Wanted a drink so badly you couldn’t think of anything else? Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?

Mild: The presence of 2–3 symptoms

Continued to drink even though it was causing trouble with your family or friends? Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?

Moderate: The presence of 4–5 symptoms

More than once gotten into situations whilst or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area or having unsafe sex)? Continued to drink even though it was mak- Severe: The presence of 6 or more symping you feel depressed or anxious or adding toms to another health problem? Or after having had a memory blackout? Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before? Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

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The Criminalisation of Addiction The disease theories prominent in the nineteenth and twentieth centuries were engaged in a prolonged struggle for legitimacy against those understandings that did view inebriation and intoxication as criminal activities and, therefore, worthy of punishment. Successive pieces of legislation passed through the early twentieth century effectively provided a countervailing force to the increased power of the medical profession to claim the use and misuse of drugs and alcohol as their territory. In the US, the Harrison Act of 1914 effectively outlawed the prescribing of opiates and, in the UK, the Dangerous Drugs Act 1920 preserved some conditions in which opioids could be prescribed but also, in effect ratcheting up the legislative basis for the control of drugs being a criminal justice issue rather than a purely medical matter (Stothard, 2021). Working counter to the Rolleston Committee’s recommendations of the 1920s, the steady accretion of drug control laws steadily consolidated drug policy in the hands of the Home Office. The Dangerous Drugs and Poisons (Amendment) Act 1923 added powers to prohibit the importation of drugs and the Dangerous Drugs Act 1928 imposed controls on cannabis. In part fed by newspaper scandals recounting the irresponsible distribution of drugs such as morphine and amphetamines by a small number of rogue pharmacists, a sequence of acts in the 1950s and 1960s placed further restrictions on the medical profession. In a ratification of the 1961 UN Single Convention, the Drugs (Prevention of Misuse) Act 1964 made it a criminal offence to import or possess any substances listed in a Schedule to the Act without a Home Office licence. In effect, as Stothard (2021) shows, this raft of prohibitive legislation impacted the medical profession, in the UK at least, by making both the prescription of restricted drugs as part of treatment for addiction either illegal or exceptionally impractical and by dramatically curtailing the potential for the medical profession to research the therapeutic benefits of certain substances. The 1960s and 1970s were pivotal periods in UK drug policy. Whilst the 1961 Brain Report of the Interdepartmental Committee on Drug Addiction upheld many of the principles of the 1926 Rolleston Report by reiterating the case for the medical profession to intervene in the problem of heroin addiction and dependence, it did remove from GPs of the power to prescribe heroin. As Berridge (2013: 193) states, Brain represents a period in which ‘medical expertise was established but within the framework of criminal justice’. The Brain Committee recommended that the remit for control of illicit drugs be transferred to the Home Office and an increasingly socio-economic framing of the ‘addict’ as being

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of a certain social class in need of tighter regulatory surveillance began to take hold. The pervading sense of crisis in the run up to the 1971 Misuse of Drugs Act emphasised that restrictions were needed tightening controls after the irresponsible prescription of opiates by a small number of rogue GPs had been presented in parliament and in the media as typical of the entire profession. Far from being a purely medical issue, addiction and its various impacts on the individual and on wider society would increasingly be seen as necessitating the ‘law and order’ approaches which, as we saw in Chapter 4, came to define global drug policy in the closing decades of the twentieth century. The admittedly brief overview offered in the opening sections of this chapter sets out how viewing addiction as a disease emerged as a dominate means of thinking about problematic alcohol and drug use during the twentieth century. Whilst clinical approaches, particularly those rooted in psychiatry, have become dominant there is a greater complexity to the realities of treatment. The following section enters this complex and often controversial terrain by summarising a number of the key approaches to treatment.

Types of Treatment The ebb and flow of how addiction is defined and understood leads inevitably to great variations in the proposed responses. Broadly speaking, drug and alcohol treatment programmes can be categorised by different underlying philosophies of what they were trying to achieve. The desired outcome of treatment can be abstinence involving a complete cessation of use. Or, in other approaches, recovery can involve maintenance of a moderated intake where risks are reduced and harms minimised, which is often equated with harm reduction. Treatments vary by how much the onus of recovery is placed solely on the addicted individual and, further, by the remit of other actors and institutions, from the medical profession to criminal justice institutions such as the police, courts and prisons. These different ideals underpin the modalities and the kinds of interventions available. In what follows, we look at how these tensions have played out at the level of policy and practice. Anglin and Hser (1990) note how it is the opiates that have been the primary drug targeted by treatment regimes, primarily in the form of opiate substitution therapies involving methadone and buprenorphine. More recently, there has been increasing recognition of the need to treat stimulant use and, in the UK and elsewhere, cannabis is emerging as an issue for treatment organisations particularly where young people and women are concerned (Hamilton et al., 2014, 2019). In terms of implementation of policies, treatments

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do not just need to be effective. Treatments also need to be affordable to society and palatable to the population of society who might be averse to non-punitive approaches given the persistence of equating addiction with criminality and immorality. We close the chapter considering a possible trend towards destigmatising addiction, led by celebrities and other public figures willingness to disclose struggles with alcohol and drugs which may be fostering a more nuanced and compassionate view of people who use drugs or struggle with alcohol dependency.

Abstinence Approaches (12 Step, Self Help) One of the most significant and yet almost paradoxical developments in the history of treatment for addiction is that whilst knowledge has developed over time looking at the role of the brain in addiction treatment, the treatment modality with the most significant longevity, and greatest cultural visibility, is the twelve-step programme first introduced as Alcoholics Anonymous. Alcoholics Anonymous was founded in 1935 and set out its core tenants in what has become known as the ‘Big Book’. Alcoholism was framed as a bodily condition, akin to an allergy, which certain people carried with them causing them to have great difficulty in controlling their intake of alcohol. Treatment, however, was on a non-medical basis involving a personal journey supported by a group of fellow members. It is based on a 12-step programme of character and spiritual development enlisting the support of a God (however understood) to move away from alcohol dependence towards a sober and alcohol-free lifestyle. The small ‘tokens’ or ‘chips’ awarded to mark specific periods of abstinence, from 24 hours to multiple decades, are an important and now iconic feature of the AA process (Image 6.1). According to the UK website, the heart of the suggested programme of personal recovery is contained in the Twelve Steps outlined in Table 6.2. In terms of the evidence for effectiveness, Day and colleagues (Day et al., 2019) conducted a review of attendance at AA or NA groups using a cross-sectional survey of 200 consecutive attendees at a specialist treatment service in the West Midlands of England between January and April 2018. Cross-sectional surveys are used to make inferences about a population of interest or concern— in the case of drug treatment attendees—at a single point of time. They therefore provide a snapshot of the universe with which they are concerned. In this research, a measure of past attendance and affiliation with AA/NA (AAAS) and a scale designed to quantify future readiness to attend (SYRAAP) were administered and anonymously linked to data supplied to the National Drug Treatment

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Image 6.1   AA chips showing duration of abstinence (6 months) and AA motto ‘To Thy Own Self Be True’ (Photo Jonn Leffmann) Table 6.2   The twelve steps of AA 1

We admitted we were powerless over alcohol—that our lives had become unmanageable

2

Came to believe that a Power greater than ourselves could restore us to sanity

3

Made a decision to turn our will and our lives over to the care of God as we understood Him

4

Made a searching and fearless moral inventory of ourselves

5

Admitted to God, to ourselves and to another human being the exact nature of our wrongs

6

Were entirely ready to have God remove all these defects of character

7

Humbly asked Him to remove our shortcomings

8

Made a list of all persons we had harmed, and became willing to make amends to them all

9

Made direct amends to such people wherever possible, except when to do so would injure them or others

10

Continued to take personal inventory and when we were wrong promptly admitted it

11

Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out

12

Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs

Source https://www.alcoholics-anonymous.org.uk/About-AA/The-12-Steps-of-AA

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Monitoring Service (NDTMS). They found that only a minority of the sample n = 59 (31%) had ever attended an AA meeting with only 14% (n = 27) having done so in the past year. Where NA was concerned, 41% (n = 79) had ever attended a meeting with 24% (n = 45) having done so in the past year. These numbers are situated against the backdrop of positive outcomes for these types of interventions where abstinence is seen to be the primary outcome. There is evidence that enrolment in fellowship style groups such as the twelve steps groups can reduce healthcare costs (e.g. Humphreys & Moos, 2001). Furthermore, updated evidence published in the Cochrane Library concludes that when delivered by clinicians, but following AA fellowship principles, there is: High certainty evidence that clinically delivered and manualized TSF programs designed to increase AA participation can lead to higher rates of continuous abstinence over months and years, when compared to other active treatment approaches such as cognitive behavioural therapy. The evidence suggests that 42% of participants participating in AA would remain completely abstinent one year later, compared to 35% of participants receiving other treatments including CBT. This effect is achieved largely by fostering increased AA participation beyond the end of the TSF program. (Kelly et al., 2020)

The question, then, is why are these Twelve-Step Fellowship (TSF) programmes not more widely taken up, particularly in the UK? Laudet et al. (2000) and colleagues have noted how the spiritual emphasis of twelve-step fellowships and associated notions of self-surrender contrast with the increasingly secularism of the West and the cultural norm of ‘self-reliance’ which, we might add, also counters dominant masculine ideal for many men who are taught to equate surrender with weakness. In a Norwegian treatment sample, Vederhus et al. (2011) meanwhile concentrated on issues of self-identity and managing potentially ‘spoiled identities’ as a barrier, these identities realising themselves as an embarrassment. Meanwhile, Day et al. (2015) suggest that the barriers to participation stem more from the treatment sector with staff unlikely to refer to these groups on the grounds of potential diminishing participation in the delivery of their own services, which have increasingly been secured through a competitive tendering process and, therefore, need to emphasise value for money through retaining people in treatment and delivering successful outcomes. The AA framing of alcoholism as a spiritual journey, as a Manichean struggle of good and evil, is possibly at odds with biomedical models of addiction in addressing not just the mind and body but the soul. The focus of AA on the personal journey through which participants must undertake frank and deep-reaching examinations of themselves and their behaviours informs the American sociolo-

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gist Norman Denzin’s conceptualisation of the ‘alcoholic self’. In his 1987 book The Alcoholic Self, Denzin drew on extensive research with AA groups, alongside his own personal experiences of alcoholism, to propose a conception of alcohol addiction and recovery which foregrounded lived experiences and emotional conflicts involved. According to Denzin, whilst alcoholism is a disease, its most destructive impact is on the identity of the alcoholic who experiences an identity ‘divided’ between ‘sober’ and ‘intoxicated’ selves which in turn lead to emotional and physical violence of different forms. Recovery, at least as it presents itself in the groups that Denzin studied, is the process of reconciling the fragments of selfhood and of reconstituting a single identity free of alcohol. Thus, ‘becoming sober’ involves a dialogue between two self-structures, with the alcoholic self relegated to the past and the new sober self in the present ‘transformed into a recovering alcoholic who is a storyteller, the member learns how to talk about the self of the past from the standpoint of humor and dramatic irony’ (Denzin, 1987: 191).

Therapeutic Communities Therapeutic communities are a modality used to address other kinds of psychiatric disorders inside and outside secure settings. Although rare in the UK, Anglin and Hser (1990) note how Therapeutic Communities have typically been used for treating heroin addiction, but not solely. They are ‘noncontroversial and low in cost’ and when delivered in outpatient settings they are increasing in number, particularly when they provide drug-free programmes, drug education and counselling. Like TSFs, TCs for addictions are also ‘overtly recovery oriented’ and focus on the principles of self-help and mutual support. Being recovery-oriented means that they engage participants to work towards abstinence rather than maintenance. In doing so, they can be seen to contrast with the philosophy of harm reduction. Vanderplasschen and colleagues (2014) summarise Therapeutic Communities as being ‘linked to a range of treatment traditions and approaches’ that coalesce around the idea that ‘relationships and activities of a purposefully designed social environment or residential treatment setting can promote social and psychological change’. They are underpinned by the theory that people with addictive and other problems can live together in a structured way to promote change (in themselves and others). In this sense they are shaped by the ‘community as method’ approach, which includes the use of a range of structured activities undertaken by both staff and residents. In addition, peers as role models are important in the setting of positive examples of how to live, in accordance with the values and philosophy of the TC.

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According to De Leon and Unterrainer (2020), the TC is shaped by interconnected views of; substance use disorders, views of the person and the nature of healthy living, which all shape the process of recovery. The view of substance disorder in TCs is best contrasted with that derived from statistical manuals of diagnoses, such as the International Classification of Diseases or the Diagnostic and Statistical Manual of Psychiatric Disorders. As shown, these are ‘symptom-oriented’ diagnostic systems and take addictive properties of substances as the starting point for explanations as to why substance use or misuse, in this case, occurs. TCs meanwhile view substance use as part of a personality disorder, with addiction just one symptom of broader individual issues which may relate to cognition, behavioural, moral or spiritual failings. As this is the case, the TC aims to direct the patient towards reparation with the community and the rebuilding of social bonds. It also acknowledges that far from being a purely physiological disease or a lifestyle ‘choice’, addictions often stem from deep-rooted trauma that refracts through a person’s life in numerous interconnected ways. The Community as Method approach is used as a partial defence from critics of TCs who question the clinical effectiveness of the approach, primarily due to the absence of clinical trial data on the effect size of the approach. As Vanderplasschen et al. (2014) show, the community is the primary change agent, making this a difficult intervention to evaluate due to the myriad of activities that take place in the community setting. Nonetheless, TCs have increasingly been subject to evaluation. Indeed, Vanderplasschen and colleagues (2014), drawing on the findings of their systematic review state that in the US context, retention in TCs varies significantly and TCs tend to be less effective than other interventions in retention, which is significant as retention is positively correlated with positive treatment outcomes. On the flip side, there is ‘added value’ in shorter or less intensive TC interventions, so that shorter stays can yield significant benefits. When clients are retained in treatment, TCs achieved ‘gains in terms of reduced drug use and abstinence and experienced longer periods of drug-free functioning post treatment than those given “treatment as usual”, no treatment or “modified” TCs’. In Europe limitations in the data make it more difficult to draw conclusions. Vanderplasschen et al. (2014) do note that the European studies also report positive treatment outcomes, associated with a longer duration of treatment, especially so when treatment is seen through to completion. Furthermore, ‘almost all observational studies report that TC residents show reductions in drug use and offending and improved quality of life (social and health domains)’. A common feature of both the US and European context is that TCs are an effective way of reducing the rates of re-incarceration up to 12 months post-release.

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Closely linked to TCs are residential rehabilitation facilities, which are often seen to be beneficial to those who have a significant co-morbidities alongside acute housing needs. Access to residential services in the UK is lower than for other modalities delivered in the community setting, such as methadone maintenance treatment (see below). Like TSFs and TCs, residential rehabilitation tends to be abstinence focused and provides intensive support for clients. Residential rehabilitation, in the UK, has gained prominence through the endorsement of high-profile celebrities such as Russel Brand. They were also seen as being a key cog in the Coalition Government’s (2010–2015) approach to drug policy as they were consistent with the move away from what were perceived to be ‘failed policies’ of community-based methadone treatment programmes (see below) and facilitative in helping people with substance use disorders achieve abstinence. As in the case with many treatment regimes, however, that promise some level of effectiveness proportionate to costs, the provision of expensive residential services has declined in line with austerity era funding cuts from 2010 onwards.

Opiate Substitution Therapy Whereas the TSFs and TCs address a range of addiction types—in terms of the substances used—drug treatment across many parts of the world has become synonymous with substitute prescribing to address the deleterious effects of opiates such as heroin on people who use drugs and to society. A mainstay of the approach to addressing heroin addiction has been to replace heroin with alternative drugs that are similar in terms of chemical composition to the drug that has produced addiction or dependence. The principles of substitute prescribing for Opioid Dependency date back to around the 1920s as heroin was first used to wean dependent users off Morphine (Davenport-Hines, 2004). Since then, pharmaceutical-grade heroin (Diamorphine or Diacetylmorphine) has been sporadically used in some areas of the UK as a treatment for heroin addiction (we return to this point later). More commonly, substitute prescribing for opioid dependency has consolidated around the oral use of Methadone or the sublingual (under the tongue) use of high-dose Buprenorphine. The idea behind substitute prescribing is that it can reduce the often physically and psychologically unpleasant withdrawal symptoms of heroin use and also reduce cravings for the drug. It is both pre-emptive and reactive. Importantly OST is not simply a medical intervention. Whilst it can help reduce the cravings for and withdrawal effects of heroin, it can also create an opportunity to make

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changes in people’s wider lives, generating stability (e.g. through addressing offending behaviour, resolving housing situations, engaging in talking therapy). Although first manufactured in the 1930s, Vincent Dole and Marie Nyswander from Rockerfeller University in New York were early pioneers of methadone in the 1960s as a means to treat heroin dependence. In the UK methadone has assumed the status of the dominant OST and it is also used in over 80 countries across the world (Wodak, 2015). Methadone is soluble in fat and so it is fast-acting and long-lasting, but does not offer users the same ‘high’ as heroin. It attaches to the opioid receptors in the brain so this means that users of heroin will not experience the effects of heroin after using required doses of methadone over a two-week period (Wodak, 2015). As dependent users of heroin often experience significant co-morbidities including physical and mental health problems, methadone is often used alongside other psychosocial interventions, although it can also be prescribed without these. Even whilst methadone as a treatment for opioid dependency has been approved by the World Health Organization, in the UK it has become the subject of some controversy. Although a mainstay of drug policy since the 1980s, from around 2008 onwards, certainly after 2010, its use became increasingly questioned (see Monaghan & Wincup, 2013). To add more nuance, methadone became more of a political issue during the austerity policies introduced by the UK Coalition Government from 2010 to 2015. In this sense, when used as a maintenance treatment as opposed to starting the pathway to abstinence (and recovery) it was thought by critics to be trapping people in, rather than ‘curing’, addiction and also extending the burden on the social security system (Gyngell, 2007). In this sense, methadone was caught up in broader debates in drug policy over the competing philosophies of harm reduction and abstinence-based recovery which, as the next section will examine, goes to show that a treatment being effective is not enough to ensure its acceptance either in policy from the general public.

Public Health and Harm Reduction Approaches With its focus on abstinence, the twelve-step fellowship programmes and TCs are often seen to be at odds with harm reduction approaches that emerged in the 1980s in UK drugs policy. Although there had been a long history of treatment operating on the principles of the harm reduction in the context of the British system, this had slowly begun to dissipate. Since the 1970s, under the rhetoric

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of the war on drugs, drugs had assumed the position of ‘public enemy number one’ and zero-tolerance responses were the favoured policy response (Single, 1995). However, in the 1980s, the outbreak of HIV/AIDS amongst communities of intravenous drug users in many parts of the deindustrialised north of England and in Scotland was a decisive moment in the history of drug policy. It was given renewed emphasis in 1984 as the ACMD (1984) reported that HIV/AIDS represented a bigger threat to health than drugs themselves. Localised responses to this threat began to change both the discourse and practice from an acceptance of drugs as a ‘menace’ to be prevented through prohibition, to one that could be ‘managed’ through more pragmatic policy and practice. This principle that, whilst complete eradication was impossible, resources could be redirected from enforcement of prohibition into pragmatic solutions to reducing risks and harms of drug use, became the foundation stone of what harm reduction was to become. Its key elements are outlined in Table 6.3.

Table 6.3   Key elements of harm reduction approach •

Acceptance, for better or worse, that licit and illicit drug use is part of our world and working to minimise harmful effects is better than simply ignoring or condemning the behaviour

•

Understands drug use as a complex, multifaceted phenomenon that encompasses a continuum of behaviours from severe abuse to total abstinence and acknowledges that some ways of using drugs are clearly safer than others

•

Establishes quality of individual and community life and well-being—not necessarily cessation of all drug use—as the criteria for successful interventions and policies

•

Calls for the non-judgemental, non-coercive provision of services and resources to people who use drugs and the communities in which they live to assist them in reducing attendant harm

•

Ensures that people who use drug and those with a history of drug use routinely have a real voice in the creation of programmes and policies designed to serve them

•

Affirms people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeks to empower these people to share information and support each other in strategies which meet their actual conditions of use

•

Recognises that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

•

Does not attempt to minimise or ignore the real and tragic harm and danger associated with licit and illicit drug use

Source Harm Reduction Coalition (n.d.)

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Notably, as the United Kingdom Harm Reduction Alliance asserts (www.ukhra. org) harm reduction involves an acceptance that drug use is somewhat inevitable but safer drug use is possible given pragmatic and non-judgemental approaches that are sensitive to the lived realities of users and understanding that drug dependency can involve causes far beyond the individual, to include socio-economic uncertainty and community decline. Importantly, the approach seeks to maximise the availability of interventions rather than more abstract and unfeasible one-size-fitsall approaches. Many of these principles are enshrined in what is perhaps a definitive moment in the genesis of harm reduction in the UK. Where harm reduction is concerned, the drug at the forefront of changing practice was heroin that had begun to ravage communities in many post-industrial cities of the North of England and Scotland (see Pearson, 1987). Like many cities in the once industrial north, Liverpool was experiencing significant changes to the local economy as heavy industry declined to leave widespread unemployment amongst mainly young, working-class men who would otherwise have had a job for life in sectors such as ship building and manufacturing. Inserted into this environment was the supply of cheap ‘brown’ heroin from Afghanistan (Seddon, 2007) creating a situation where increased supply met high demand. Various strategies were implemented over the course of the 1980s to try and stall and reverse the rapidly rising rates of HIV/AIDS amongst the injecting drug user population. Methadone maintenance treatment played a part here, as did other significant interventions such as needle and syringe exchange schemes, which were championed as part of a Public Health response developed in Merseyside‚ UK to address the issues of heroin use in the region at the time. In the UK, Harm Reduction is best traced back to the 1980s and the Mersey Harm Reduction Model. Research at the time estimated that there were approximately 20,000 drug users in the region—which included the city of Liverpool and a catchment of smaller towns many in areas blighted by deindustrialisation and social decline—out of a population of around 2 million (Parker et al., 1987). Recognising the scale of the issue of HIV/AIDS in the community, key figures from the time including John Ashton, an academic from the University of Liverpool, and Howard Seymour, Head of Health Promotion in the Merseyside Regional Health Authority (MHRA), highlighted the need to learn from elsewhere for solutions. Ashton and Seymour attended various international conferences and at one met Glen Margo, an activist who had pioneered public health approaches to HIV transmission in San Francisco. A principle outcome of the meeting, Ashton and Seymour (2010) recall, was a heightened understanding of the importance of both on-the-ground coordination and consensus building, the direct involvement of those most at risk and, critically, the urgent implementation of practical solutions. The provision of clean injecting equipment to drug users being chief amongst

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these. According to O’Hare (2007), it took a specific combination of factors to enable Merseyside to introduce its pioneering approach to drug policy including finding powerful sponsors from the healthcare sector who could argue the case with reticent local politicians. The main goal in Merseyside was to engage the main target groups and to discuss the hierarchy of objectives with the group. The primary objective at this time was to reduce the preponderance of drug users sharing injecting equipment. HIV is a blood-borne virus and, as Glen Margo had stressed, this was one of the main routes of transmission. The objectives were ‘to reduce sharing of injection equipment, to reduce injecting drug use, to reduce street drug use, to reduce drug use and if possible increase abstinence’ (O’Hare, 2007: 143). Thus, whilst cessation of drug use was an objective, this was tempered by the frank admission that in the immediate term urgency meant any form of safer drug use must be encouraged and where possible provided for. Such was the impact of the strategy that it became the cornerstone of the Advisory Council on the Misuse of Drugs in their landmark report of 1988 on AIDS and Drug Misuse. Of course, the strategy in Merseyside would not have worked without the input of law enforcement. In Merseyside at the time, there was a pervading feeling that law enforcement approaches were not fruitful in terms of police time and that drug users presented something of a revolving door of arrestees. With this in mind, a pragmatic stance was chosen where police under the leadership of the Drug Squad chose not to enforce the law in the vicinity of drug services. The change in emphasis did not quite go as far to engage the police in the delivery of harm reduction services, as in places such as Amsterdam, but it was, nonetheless, a defining moment in the history of drug policing which had, hitherto, been more influence by drug war practice. The turn to harm reduction in the 1980s was a pivotal moment in the history of UK drug policy and practice. The lessons from the initiative rippled out across the world as civil society organisations and NGOs picked up the mantle. Norman Fowler, the Health Secretary under Margaret Thatcher, recognised the seriousness of the threat of HIV/AIDS and became an advocate for the approach pioneered in Merseyside. Needle and Syringe Exchange programmes have since been rolled out widely. It is interesting to note, then, that despite such as seismic impact, in policy the popularity of harm reduction has ebbed and flowed. Since the 1990s, various policies and strategies have served to dilute the legacy of the Merseyside case in the decades since. Whereas the philosophy of harm reduction was about engagement, a steady erosion of this manifestation of drug policy can be witnessed from the late 1990s onwards, particularly with successive drug strategies passed by New Labour (Duke, 2013; Monaghan, 2012).

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Despite the shaky evidence base for the connection between drug use and offending, over time reducing harm shifted from being about the protection of specific (drug-using) communities from the ravages of infection to the protection of wider community from the scourge of drug-related crime (Stevens, 2007, 2010). Monaghan (2012) notes how the passing of the 1998 Crime and Disorder Act which introduced the flagship New Labour Policy, the Drug Treatment and Testing Order (DTTO), was a pivotal moment in UK drug control again in theory if not practice. The DTTO was central to the 1998 Drug Strategy and brought into focus in UK drug policy the move towards quasi-compulsory treatment. A defining feature of the strategy was to double the number of drug users entering treatment from the decade running from 1998 to 2008. The direction of policy at this time was to be treatment-lead crime reduction. Hunt and Stevens (2004) refer to drug policy at this time as a shift to coercion and away from voluntarism. Whilst voluntarism was at the heart of the harm reduction responses to drug use that emerged in the aftermath of the AIDS crisis of the 1980s, the shift to coercion, by contrast, entailed the state utilising various means to ‘track down drug users’ and to give them an option of a custodial sentence (if warranted) or enrolment in drug treatment as an alternative. If treatment was declined, then custody was the only option. The theory here was underpinned by a particular view of the drug-crime link which Goldstein and colleagues (1985) had developed in the 1980s which viewed drug-related crime on the grounds of economic compulsion where often economically marginalised and socially excluded drug users maintained their ‘habit’ through acquisitive offending. The principles of coercive, quasi-compulsory treatment have been widely critiqued. Seddon (2007) questioned the ethics of coercing people into treatment, particularly if these services are delivered in part by the National Health Service (NHS). This process distorts the fundamental principles of patient consent and confidentiality and is therefore ethically dubious. Others meanwhile questioned the validity of assuming that most offending was somehow drug-related. In a devastating critique, Stevens (2007) labels it an example of ‘voodoo criminology’. In other words, Stevens questioned the numbers on the grounds that because of prohibition the total number of drug takers is unknown and the best we have are estimates. Combined with the fact that the total amount of crimes are also unknown, a product of the fact that most crimes go undetected, we are left with a ‘collision of dark figures which are rendered almost meaningless’. The other side of this argument is that the system was pragmatic and that accepting the rhetoric that drug use led to crime was a lever for public health professionals to pull to establish more secure funding for the profession. These debates, like many others relating to intoxication are ongoing.

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Intoxication in Contrast 6

Treatment programmes are an important resource for those seeking to overcome substance misuse. Conducting exploratory research in Spain, Carballo and colleagues (2008) interviewed substance abusers who recovered with treatment or on their own. They found that those with more extensive substance dependency had pursued treatments whilst those with less of a history had sought to overcome their dependency on their own. In both cases, having support from friends or family was associated with maintaining abstinence. Studies of substance misuse treatment are extensive in North America and across Europe, they are less established in much of the Global South. To address the dearth of knowledge about treatment of substance misuse in West Africa, Ahmed Kabore and colleagues (2019) recruited participants in recovery from substance abuse in Accra, the capital of Ghana. They gave participants cameras and asked them to capture and narrate images within their communities that helped explain the factors influencing substance misuse and recovery. This revealed complex issues relating to both the onset of addiction and the availability of treatment, including peer pressure from family and friends, the effects of urbanisation and the relative lack of regulation and its enforcement. Carballo, J. L., Fernández-Hermida, J. R., Sobell, L. C., Dum, M., Secades-Villa, R., García-Rodríguez, O.,.. & AlHalabí-Diaz, S. (2008). Differences among substance abusers in Spain who recovered with treatment or on their own. Addictive Behaviors, 33(1), 94–105. Kabore, A., Afriyie-Gyawu, E., Awuah, J., Hansen, A., Walker, A., Hester, M., … & Meda, N. (2019). Social ecological factors affecting substance abuse in Ghana (West Africa) using photovoice. The Pan African Medical Journal, 34.

Behaviour Change Approaches More recently, we have been witnessing a later dimension in control, which in some ways involves regulation without the state. Taking guidance from behavioural economics, often colloquially referred to as ‘nudge theory’ (Thaler & Sunstein, 2021) a focus on interventions that do not radically alter a person’s ‘choice architecture’ or restrict their choices over what to consume, but how in this case, has been taken up in campaigns and initiatives that, at least in principle, aim to encourage moderate drinking (less so drug use, which is still officially condemned in policy). Examples of this include, in the UK Dry January, where participants

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pledge to abstain from alcohol for the entirety of the month of January and, in Australia, Hello Sunday Morning, where participants share experiences of a period of non-drinking with an online community of fellow abstainers. As opposed to the strict health focus of unit guidelines, both these campaigns encourage a more holistic reassessment of the place of alcohol in participants’ lives. As Yeomans (2019) and Pennay et al. (2016) suggest, respectively, about Dry January and Hello Sunday Morning, their value appears to be in how they provided a framework within which to reflect on and possibly change the relationship between the self and drinking. In both cases, finding new ways of socialising is bound up feelings of self-actualisation. More contentious are the various responsible drinking campaigns run by the alcohol industry or their representatives. A prominent example of this is the Drinkaware Trust, founded in the UK in 2006 by the trade body the Portman Group with the aim of encouraging responsible drinking. What this amounts to, and what criticism takes aim at, is the ease with which initiatives such as adding ‘Please Drink Responsibly’ caveats to alcohol advertising shifts culpability away from the drinks industry onto individual drinkers. Alcohol harms are made the outcome solely of individuals making irresponsible choices and, by implication, if the companies making and profiting from alcohol can provide enough information it is once again the fault of the consumer for not following this through into moderate and socially approved drinking. Understandably, nudges are less prominent where other drugs are concerned as this would require authorities to make a tacit acceptance that current prevention strategies and policies are not working. Indeed, the popularity of nudge interventions in recent years perhaps stems from them being relatively free of value-laden and potentially stigmatising terminology, where ‘addicts’ struggle against ‘dependency’ and seek out ‘treatment’, fearing a ‘relapse’. The above examples each present ways to reassess one’s relationship with alcohol with a view to achieving either temporary or longer term abstention. As Morris et al. (2022: 5) assert, when it comes to addiction ‘language and the stories we hear matter’. They argue that the narratives available to the diversity of people with some form of alcohol use disorder have narrowed given the dominance of now long-established disease models of alcoholism or, more recently, of new sobriety stories of self-transformation, both of which present total abstinence as the sole desired outcome of treatment and recovery.

Summary The themes of addiction, treatment and recovery are complex and contested, not least because they encompass such broad areas of thinking spanning medicine, psychiatry, criminal justice and personal and public health, not to mention the

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deeply personal ‘selfhood’. As we have seen, the struggles with alcohol or drugs faced by some are deeply personal and high-stakes, for addiction can derail and end lives. Both the progression of addiction and of recovery have been, in different ways, presented as journeys, as troubled paths that individuals must walk in search of redemption. Equally, the medicalisation of alcohol and drug use as ‘alcoholism’, ‘addiction’ or ‘dependency’ and, more recently, Substance Use Disorder is part of a lengthy process by which the predicament of individuals struggling with alcohol and drugs fell increasingly within the remit of medical expertise and clinical intervention. Yet, a recurring theme in the chapter has been the periodic return to a criminalisation of addiction meaning the medical profession’s land grab for substance misuse has never been total. Indeed, both the global dispersal of Alcoholics Anonymous and other mutual support and self-help groups, with the more recent addition of both public health and behavioural lifestyle change approaches, ultimately presents an unavoidably congested picture. Terms like ‘addict’ are fiercely contested because the basis on which they are attached to people sets in train processes by which individuals are treated. Treatments offered are varied and they each have at their foundation some revealing assumptions about the nature of alcohol and drugs and those who use them to excess. Approaches vary according to how much or how little they hold onto a punitive element that at least implicitly casts addicts as failed individuals. Acceptance, support, sympathy or stigma and shame impact greatly on the provision of services and the pathways to recovery. Points for Discussion

What factors explain the popularity of Alcoholics Anonymous and similar approaches to the treatment of addiction? Is the term ‘addict’ stigmatising? If so, what alternative terms might be used in its place? Are there any situations where coercive treatment for substance use can be justified?

Read, Watch, Listen #6 Read: The Hungarian-Canadian physician and author Gabor Maté’s book In The Realm of Hungry Ghosts: Close Encounters With Addiction combines personal reflections and case studies drawn from the author’s work with substance users in Vancouver’s Downtown Eastside and includes a discussion of the meaning and scope of addiction in modern society.

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Watch: In Drinkers Like Me – Adrian Chiles, the British TV presenter Adrian Chiles uses his own relationship with alcohol to discuss how and why alcohol has become so central to the daily lives of many people who, despite this, do not consider themselves to be ‘problem drinkers’. Listen: In a 2018 interview for BBC Radio 4’s Don’t Tell Me The Score series titled ‘Addiction: Tony Adams’, the former Arsenal and England footballer Tony Adams discusses his battles with alcoholism and his recovery journey. Adams also discusses Sporting Chance Clinic, which he founded in 2000 to provide treatment for sportsmen and women suffering from drink, drug or gambling addictions.

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Vederhus, J. K., Timko, C., Kristensen, Ø., & Clausen, T. (2011). The courage to change: Patient perceptions of 12-Step fellowships. BMC Health Services Research, 11(1), 1–8. Wodak, A. (2015). The failure of drug prohibition and the future of drug law reform in Australia. Australian Prescriber, 38(5), 148. Yeomans, H. (2019). New Year, New You: A qualitative study of Dry January, self-formation and positive regulation. Drugs: education, prevention and policy, 26(6), 460–468.

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Representing Intoxication

Introduction In the previous chapters, we have considered in some detail the historical emergence of intoxication as part of the cultural fabric of many societies. We have looked at the divergent ways in which intoxicants are controlled and regulated and we have explored the ways in which we can try and explain, using different theories and concepts, the presence of intoxicants in society. In this chapter, we give more detailed attention to how alcohol and drugs are represented in the media and in cultural forms such as music. Across history, representations of intoxication have said as much about the fears and prejudices of the society producing them as they have about the actual experience of getting drunk or getting high. Intoxication is debated in the public sphere precisely because it is complicated; discussions allow for other things to be fiercely debated. We will see here, and in subsequent chapters, how representations of intoxication often reveal deeper concerns about issues relating to gender and race, amongst other things. When public debates about intoxication take place, they are nearly always about more than the intoxicant or act of intoxication itself. They are about who can drink or take drugs and what is at stake for them in terms of how they are depicted and viewed by society. What emerges is a clear suggestion that representations of intoxication can be read as being illustrative of the wider cultural and political values prevalent in a society at any time. Media representations of intoxication require scrutiny and critical awareness. Many contemporary representations are part of a long legacy that shapes our understanding of alcohol and drugs and their use in society. In this chapter, we develop our analysis, by focusing on why it is important to consider the ways intoxicants and intoxications are represented in mainstream media. We first discuss this in the his© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_7

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torical context, moving on to consider representations in the twentieth century and beyond. Following this, the chapter discusses how intoxication has been portrayed in popular culture and advertising. The final sections look at media representations of particular concerns or panics. We conclude with discussions about how intoxication is depicted in lifestyle media and the faux shock that exists around it.

Why Representations of Intoxication Matter? For most people, their first awareness of drugs will not be direct with the drug itself nor with the effects that drugs have on another person. Rather, it will be some form of representation of the drug: in soap operas, in news stories and magazine features, in advertising or in the lyrics of popular songs. Depictions of drugs, their effects, the people who use them and the places in which they use them pervade contemporary culture in many societies. Alcohol and drunkenness are also long-time features of television series and movies, often allowing for situations of humour or tragedy to drive plot lines forward but also, we should note, just being present in the background of the lives of those depicted. Perhaps stemming from the Great Regulatory Divide, often advertising links alcohol to ideas of leisure, fun, friendship and adulthood, whereas depictions of drug taking are often linked to crime, trauma and suffering. That said, those representations are not static and depictions of drugs in the media that are intended to be negative often have the unintended effect of glamourising drug use. For example, heroin is most associated with deprivation and morbidity, but in the late 90s the ‘look’ of the compulsive heroin user was transformed into ‘heroin chic’—the epitome of style and fashion at the time (Hickman, 2002). Both alcohol and drugs are remarkably mainstream cultural topics. It is difficult to maintain the idea that drug use is deviant when we have had 60 or more years of cultural visibility of drug use and of issues to do with alcohol and drugs. Yet, the normalisation of recreational drug use at this time hasn’t eased the fascination with drug media. Far from it. Series such as Breaking Bad deploy drug stories as dramatic narrative devices to explore human qualities and failings whilst recent years have seen a wealth of drug-related content across popular media platforms. Drug references, images, language and symbolism have proven profitable and, as such, are a widely accepted in mainstream culture (Blackman, 2004). It is certainly first worth considering why media and cultural depictions are significant. Do they merely reflect, mirror-like, the society or do they shape attitudes and, worse still, encourage viewers to engage in risky behaviour? Such representations directly and indirectly both reflect and shape attitudes and con-

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nections to wider issues, although where drugs are concerned there is a tendency to downplay the social causes of drug use in favour of moral outrage. Media representations are cumulative in that they build up over time and must be understood not as offering a single causative message but as an aggregated affect over time. In other words, how intoxicants are depicted in the media shape perceptions of them, their effects and the attitudes towards people who do or don’t use them. Representations work in maintaining particular ‘common sense’ and taken-forgranted understandings. As Manning (2006: 4) argues, the representation of drugs and drug use in cultural forms such as television, newspapers, cinema and popular music matters because they illuminate the ‘symbolic frameworks within which patterns of drug consumption are framed or understood’ and that these ‘symbolic frameworks construct particular substances in particular ways, which associates such substances with certain social groups or identities rather than others, and by mobilising particular forms of language and symbolism’. Critical analysis of representations often shows particular people or groups as stigmatised and marginalised (Atkinson & Sumnall, 2021). We should also be aware of those who are primarily absent from media attention such as the affluent middle-classes; when they do appear intoxication is often celebratory and associated with success and glamour. Battles over what elements of the experience of drinking alcohol or taking drugs can or cannot be represented in popular culture have a long history. Representation is a political issue. The censorship of the benefits and pleasures of drugs juxtaposed to drug war propaganda are recurring features of representations of drug use. Over various periods, public service films have attempted to demonise and dissuade, with the anti-drunk driving campaigns of the 1970 to the 1990s being a good example of media representations being used to tackle an important issue to reduce harm. However, we must question any move to attribute direct and sole causative power to representations of alcohol and drug use because these representations can and often do have unintended consequences. Also, the majority of representations are not related to a public good goal, such as reducing injuries and deaths caused by driving whilst intoxicated.

Historical Representations Before looking at contemporary representations of intoxication, a brief overview of historical representations is useful, not least because it helps us to identify recurring themes or issues that have long animated debates about alcohol and drugs. Whilst we might think of media representation as a modern phenomenon, the evolution of mass media from the printing press to modern newspapers,

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cinema, the internet and social media is part of a 400-year process. Each new medium of communication brings with it new cultural forms and conditions under which ideas are expressed and contested. The British historian Mark Hailwood (2013) studied seventeenth-century broadside ballads, single sheets of inexpensive paper printed with typically playful and bawdy rhymes and songs, to examine how ideas about the nature of alcohol and its impact on the mind and bodies of drinkers were understood in early modern England. For Hailwood (2013:44) ‘the language of both pro- and anti-drink ballads implies a perception that alcohol-induced stimulation of the brain could be hard to control once set in motion, and that a “quickening” of the mind was hard to halt or reverse’. In such ballads, alcohol was seen as being transformative; drink could improve mood and quicken the whit of drinkers, but once unleashed was difficult to control. Similar themes can be witnessed in Hogarth’s Gin Lane print from the eighteenth century, which provided a caricature of society's fears about drunkenness in the urban working poor. A famous example of the power of printed media to shape social attitudes to intoxication can be found in The Bottle, an 1847 sequence of eight images by English satirical illustrator George Cruikshank. Commissioned as a pro-temperance cautionary tale by Manchester reformer Joseph Adshead‚ The Bottle was widely circulated in the UK, was reproduced in the US, and has since become regarded as an exemplar of the fierce anti-alcohol attitudes of the time. Across eight scenes, Cruikshank’s cautionary series charts the brutal demise of a seemingly respectable family, narrating a tale of unemployment, destitution, violence and, eventually, death and incarceration all attributed to ‘the bottle’. After the first bottle purchased in the opening scene, and as the husband implores his wife ‘Just to take a drop’, things quickly deteriorate as the man loses his job and they pawn their clothes. Then, after the bailiffs descend to seize their furniture, they are made homeless and driven into the streets to beg. In the latter scenes, their youngest child dies of ‘cold, misery and want’ before ‘fearful quarrels and brutal violence’, stated as a ‘the natural consequences of the bottle’, lead to first the murder of the wife by the husband with the eponymous bottle, ‘the instrument of all their misery’, then the prostitution of the daughter and incarceration of the now insane father. A similar cycle is rendered in The Drunkards Progress, an 1846 lithograph by American illustrator and Temperance Movement advocate Nathaniel Currier (See Image 7.1). An arc of steps charts the journey from ‘A glass with a Friend’, to ‘A glass too much’ and, following becoming ‘A confirmed Drunkard’ in Step 5, a rapid decline through first ‘Poverty and Disease’, social ostracism once ‘Forsaken by Friends’ before ‘Desperation and crime’ then, in the ninth and final step, ‘Death by suicide’. Images of this period not only cautioned against the destruc-

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Image 7.1   The Drunkards Progress by Nathaniel Currier (1846)

tive forces of alcohol, but they also presented alternatives. In an advertisement in the 1880s for the Nottingham-based confectioner Allen and Sons depict in stark juxtaposition the ‘Temperance & prosperity’ of a respectable cocoa drinking family against the ‘Intemperance & poverty’ of a second family, the husband hunched in a sparse room whilst his gaunt children huddle around their mother. The choice between the wholesomeness of cocoa and the intemperance of drink positions the family as either respectable or failed consumers in line with an ideology of self-improvement which had become prevalent in Victorian society. As we shall see, this is a strand of thinking that still prevails in contemporary depictions of addiction as a moral failure for those addicted. Several points are relevant in drawing a line between these and contemporary representations. It is possible to see in these select examples recurring tensions relating to how society, via various media forms, discusses alcohol, drugs and intoxication. The tension is between individual choice and moral responsibility in that it frames intoxication as an expression of freedom and personal autonomy but also a relinquishing of respectable duties and moral strictures. There is a focus on the family and the different impacts of alcohol on husband, wife and children which has been a

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consistent theme in depictions of alcohol and alcoholism ever since. There are constant depictions of alcohol as a creeping menace removing agency and debasing its users. Those who submit to it are seen as having failed or as being weak. Alcohol is also seen as being agentic, that is in having its own wilful force to enact transformations and wreak tragedy on those who submit themselves to its hold. A connection is made between alcohol and poverty and an emergent Victorian image of respectability and morality manifest in the domestic home and trappings of consumerism as seen in the depicitions of family essentials such as food, clothes and furniture. In many of these examples, it was the widespread distribution afforded by new printmaking techniques that underpins their cultural importance, allowing an association between alcohol and the moral concerns of the time to be established and strengthened in the public mind. Techniques such as the glyphography process, which allowed fast and cheap reproductions of Cruickshank’s series to be sold for a shilling, were the popular media of their day and resulted in an opening up of, and subsequent battle for, ideas about understanding and ideas about the effects of alcohol on individuals, families and society.

Representing Drugs in the Twentieth Century As we have already alluded to in the introduction to this chapter, the proliferation of drug-related content across mass media means that a critical awareness of how drugs and drug taking have been represented is essential to understanding intoxication and how its position of contemporary society is depicted. Tracing the development of media representations of drugs and drug taking across the twentieth century is a useful exercise. Across this period, drugs have fascinated audiences and provided writers and directors of movies and TV dramas with plot devices and some of film and television’s most memorable characters. Drugs and drug taking have featured in even the earliest films of the silent movie era. The 1920s saw movie star overdoses and drug possession arrests in the same way that the tabloid newspapers saw profits in the public readiness to read about these events. Many of these stories were based on racial stereotypes and prejudices, such as the figure of the Chinese opium dealer. Blackman (2004: 53) notes that: By the 1920s there were set character types such as the drug fiend and drug addict who used intoxicants to control people’s minds or achieve personality transformation. Subsequently prostitution, suicide, crime, Satanism and murder became long-running drug themes for the film industry.

Such stereotypes are a core component of the sensationalist depictions of drugs that typified the early decades of the twentieth century, particularly in the US. We

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Image 7.2   Reefer Madness (1936)

have seen how in the 1920s and 1930s Harry Anslinger’s directorship of the Federal Bureau of Narcotics weaponised racist images to whip up fears about drugs as a threat to the respectable American way of life. Defining output at this time were the 1936 public information—or, as some might suggest, propaganda— films Reefer Madness and 1937’s Assassin of Youth (See Image 7.2). Both films looked at foreign drug empires overseen by evil oriental masters using drugs to enslave women into prostitution. Drugs, sex and ethnic minority immigrants were mixed in a cocktail to incite visceral responses from viewers. It was commonplace at the time for anti-drug films to use sexualised imagery to entice viewers (Blackman, 2004). Drugs were depicted as being used by ‘wicked women’ or used by evil men to lure ‘good girls’ into sexual situations.

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A pivotal moment for the representation of drugs in popular culture relates to the period from 1930s onwards when successive steps were taken to restrict content depicting drug taking, especially when heavily associated with crime, violence and sexual expression or exploitation. First proposed in 1930, and implemented in 1934, with the backing of the head of Motion Picture Producers and Distributors of America Will H. Hays, a Republican politician and Presbyterian elder, the Motion Picture Production Code (MPPC) was more commonly referred to as the Hays Code. Acknowledging the influential power of cinema on American society, the Hays Code aimed to prevent a perceived lowering of moral standards by ensuring that ‘correct standards of life’ were depicted and that, where vice and illegality were depicted, no sympathy for such violations would be felt by audiences. For example, according to the code, illegal drug trafficking must never be presented. The Hays Code laid down guidelines which studios had to apply or risk fines and refusal of approval for public distribution. The list of content prohibited reads like a manifesto of the fears of conservative America. Unsurprisingly, robbery, violence and murder are heavily sanctioned, with brutal killings and methods likely to inspire imitation singled out as being of particular concern. Obscene and blasphemous languages were forbidden, as were depictions or discussions of Venereal disease, miscegenation and childbirth were also forbidden. Some leeway, however, was granted. For instance adultery and excessive liquor were deemed permissible topics providing they appeared morally contextualised by the plot. Thus, crimes could be depicted if the perpetrators of such legal violations were suitably punished, and empathies and allegiance of the audience were directed to the figures of the establishment such as the police or judiciary. Although, by definition, a voluntary code, all major Hollywood film studios agreed to abide by the guidance of the Hays Code and submitted films due for release for prior clearance. Importantly, a distribution licence could be rejected if films depicted drug use. The Code would shape the content of American films for over three decades but was occasionally challenged. Notably, in 1955 Preminger’s The Man with the Golden Arm showed Frank Sinatra as a heroin addicted poker player and, despite being refused a MPPC approved distribution, achieved critical and commercial success, with Sinatra receiving a Best Actor Oscar nomination in 1955 from the very Hollywood establishment upholding strict rules restricting the release of his cinematic portrayal of drug addiction. Reflecting how drug use norms and acceptability differ across space and cultural contexts, for the British release, cuts were requested to remove shots detailing Sinatra’s face following a heroin injection, presumably for fear of depicting the euphoria caused, and sev-

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eral violent scenes depicting multiple blows to the face and body were cut. The Code was amended in 1956 to allow for the treatment of narcotics as a theme, and eventually replaced with an age-based classification system in 1966. The 1960s was a watershed decade in terms of the increasingly common role of drugs in Western societies. As we have seen in earlier chapters, this was the decade when subcultural explanations of drug use came to prominence off the back of noticeable changes in the increasingly common role of drugs in the leisure time of certain groups in society. Where representation is concerned, in the 1960s and beyond we get a culture emerging where musicians, film stars and celebrities often became more overt in their drug use. These kinds of attitudes were of note and ushered in what Newburn (1991) referred to as the ‘permissive society’ characterised by liberalising impulses in legislation around gambling, homosexuality, abortion and pornography that were not extended to drug use. The overt expressions of drug consumption in the 1960s can, therefore, be seen as counter cultural in that they were in many ways a rejection of the norms and values of (middle-class) society. The expression of drugs as rebellion can be seen in films such as Easy Rider (Hopper, 1969). The film depicts a road trip undertaken by the main characters, played by Peter Fonda and Dennis Hopper, from Los Angeles to New Orleans. With the cash from a drug deal stashed inside their stars and stripes-painted motorbike fuel tank, they undertake a journey both physical and symbolic, rejecting all lifestyles ranging from conformists in suburbia to the ritualists living in communes. Merton’s typology of adaptations in Chapter 4 can be used to explain how in this film drug use is counter cultural. In pursuing the journey for the sake of freedom, the main characters can be seen as retreatists, rejecting the cultural goals and legitimate means of society, without replacing them with anything of substance apart from the immediacy of movement and experience, of which drugs are a powerfully symbolic component. Cinema has proved a powerful media for the representation of drug-related themes and films like Easy Rider are now accepted in the cultural canon. Another cultural sphere where there is a long tradition of depicting drug use is in music. According to Shapiro (1988) there is a long association between drugs and music, but it certainly reached a pivotal point in the 1960s. Cannabis and heroin were associated with jazz in the first half of the twentieth century, LSD and again cannabis with rock and psychedelia in the hippy counterculture emanating from California of the 1960s and 70s. Indeed, drugs were central to the creative lives, tragic deaths and subsequent mythologising of musicians such as Jimi Hendrix, Janis Joplin and Jim Morrison (Blake, 2007). Then, in subsequent decades MDMA and ecstasy became synonymous with dance and electronic music from the 1980s

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onwards. As Blake (2007) notes, even the brief ascendency of what became termed Britpop in the 1990s had notable associations with cocaine and alcohol, with band members making no attempt to hide their drug and alcohol-fuelled binges. There is a long history of drug lyrics causing concern alongside the way that from the 1970s onwards drug humour gives a more sympathetic treatment of, drugs and their effects. References to drugs have been immortalised in various song lyrics and titles across decades and genres: I’m Waiting for the Man by Velvet Underground (1967); Golden Brown by The Stranglers (1982); Mr. Brownstone by Guns N’ Roses (1987) to name just a few heroin-themed songs. There are countless others. Whilst these examples are somewhat coded, others are not such as those that directly reference the drug in the song title such as Cocaine by J.J. Cale (1976). Some songs directly depict the experience of drug use often in a humorous way for example Afroman’s Because I Got High (2000). Blackman (2004: 93–94) notes that it was widely reported drug-related deaths of musicians and musicians publicly speaking about their addictions at the time and since that has furthered the connection between drugs and music. Herd (2009), for example, analysed the lyrical content of rap songs in the US by comparing the period from 1979 to 1989 and that from 1990 to 1997, showing references to alcohol and drugs increasing from 0 to 13% and from 6 to 30%, respectively. In Diamond et al.’s (2006) analysis of references to ecstasy in rap a sample of 69 rap songs, the drug is depicted as a luxury or designer drug with associations of status, its positive effects are linked to enhancing the pleasure of dancing and sex whilst negative effects related to sentimentality, depression or loss of control. They add that ‘enough ambiguity can be found in many rap songs to allow youth to interpret the messages about ecstasy in a variety of ways’ (Diamond et al., 2006: 292 original emphasis). Drug references in the lyrics of rap songs were also more likely to be associated with violence whereas alcohol reference appeared not to increase the likely association with violence. Since the turn of the century, there has been something of a renaissance in media coverage of drugs and related issues. Iannicelli (2001: 142) observes recurring themes in the cinematic representation of drug taking in the early twentieth century and, further, that these trends speak to wider social concerns where drug-related stories became used ‘as narrative tools to amplify these fears, and thus become a focal point for attempts to control or reverse those broader trends’. Drugs were a means to incite and enrage audiences by stoking racism and xenophobia, fears about sexuality and the threat of wild and rebellious youth. He identified five recurring themes:

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1. Racism and xenophobia, or ‘blame the other’ 2. Urban/rural dichotomy: nostalgia for an agrarian past 3. The road to ruin: drugs lead to an uncontrollable downward spiral 4. Drugs are intertwined with unbridled and dangerous sexuality 5. Drugs are an indication of a wild and threatening younger generation In the third of these, Iannicelli (2001) notes a recurring narrative that would be familiar to any nineteenth-century fan of Cruickshank’s The Bottle, the ‘The Inevitable Downward Spiral’ where even a fleeting dalliance with drugs like cannabis precipitate an inescapable degeneration into a life of poverty, crime, desperation and eventual death or imprisonment. A particular theme in cinematic and televisual depictions of the War on Drugs era is, as Boyd (2002: 398) observes, that drug traffickers are depicted as: ...evil, sadistic, immoral, greedy corrupt outsiders, who lure innocent youth, and draw moral women into drug addiction and crime. The media constructs them as guilty in the eyes of law enforcement and society, and therefore, deserving of the brutal treatment handed out to them by criminal justice vigilantes, family members of the victim, and justice seeking police officers. Drug sellers are routinely shot, and killed, in movies and TV shows before they can be arrested, or brought to court. In Hollywood, the drug trafficker is most often portrayed as a black or Hispanic man living in the inner-city in the US, and the ‘king pin’ who has even higher status, thus more evil intentions, is usually represented as a Hispanic man from Mexico, or South America.

However, there are also notable efforts to cover drug-related social issues with more criticality. Prominent amongst these is the documentary The House I Live In (Jarecki, 2012), which on its release received widespread praise for its criticism of the War on Drugs and the intersection of issues of race, class and criminal justice in America. There appears to be a renewed interest in gritty exposés of the lived experiences of alcohol and drug harms. Vice Media rose from relative obscurity to become a global media corporation based on self-styled edgy content with depictions of drug taking, dealing and trafficking prominent amongst them. Meanwhile, the British-American broadcaster and filmmaker Louis Theroux, noted for his reportage style and focus on the human stories at the heart of many law and order issues, is also notable for his coverage of drugs with 2009’s The City Addicted to Crystal Meth and 2019’s Heroin Town. Running for five seasons between 2002 and 2008, the HBO series The Wire is widely venerated for being one of the best television series ever made but also, specifically, for being an at the time uncharacteristically complex representation of drugs, drug dealing and its social impacts. The series follows both the

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Barksdale crew dealing drugs on the streets of Baltimore and the police officers charged with catching them. Many of the moral certainties beloved by the War on Drugs rhetoric of good versus evil are dispelled. Instead, ‘grey’ characters whose moralities are uncertain or who can do bad things in the pursuit of what they see as a just cause proliferate. An initial close focus on the use of telecommunication surveillance equipment, the titular ‘wire’, gives way to a spiralling patchwork of characters and narratives taking in politicians, trade unionists, journalists and the cities crumbling education system. Drugs, and their devastating circulation through the lives of Baltimore residents, are examined with rare nuance. The logics and rationales of gang machinations are laid out in stark detail, as are the vexed attempts of authorities to outmaneuver them. However, we also see the ravages of addiction, notably in the character of Reginald ‘Bubbles’ Cousins whose struggles run throughout the series and include intermittent attempts at ‘getting clean’ with the support of family and Narcotics Anonymous meetings. Notably, a storyline in the fourth series follows the efforts of police Major Howard ‘Bunny’ Colvin as he experiments with a form of quasi-decriminalisation, concentrating drug sales and use to a single district promptly dubbed ‘Hamsterdam’ by the denizens of Baltimore’s street drug community. The Hamsterdam storyline is just one of many used across the five series of the show to, as creator David Simon has explained, make ‘statements about the American City and even the American experiment’ by tracing the personal stories at play within the vast ‘interconnectedness of various urban macrostructures’ (Nitschke, 2016: 109). The British criminologist Stephen Wakeman (2014: 236) suggests that The Wire is an important cultural work and ‘a cultural paradigm of the drug policy problematic, one that provides an important visual representation of the many tensions and antagonisms inherent in systems of drug control’. Given its knack for representing complex social issues in nuanced ways and, in so doing, generating discussion, some have gone as far as to describe The Wire as a work of ‘social science fiction’ (Penfold-Mounce et al., 2011). Intoxication in Contrast 7

Media coverage of drug policy is an important factor in how changes are made to regulation and control. Pardal and Tieberghien (2017) studied media depictions of Cannabis Social Clubs in Belgium. By analysing media coverage and interviewing directors of these clubs, set up to cultivate and distribute cannabis for personal use to club members, they were able to highlight the role of local media in contributing to understandings about the legality of recreational cannabis use. While it might be assumed that the media would present a hostile framing of such initiatives, coverage addressed both legal issues and the prac-

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ticalities of running Cannabis Social Clubs. How news media represented new developments in drug policy was also the focus of Gunning and Illes’s (2021) study where they analysed media items published before and after the legalisation of cannabis in Canada in 2018. Focusing on medical cannabis, their data showed that media coverage focused on the therapeutic applications of cannabis. While half of these stories also referred in some way to how access to medical cannabis could be coordinated, they noted there was little content addressing the ethical dimensions of legalisation. Overall, then, they concluded that the media plays a role in shaping public opinion about the latest changes to drugs policy. Pardal, M., & Tieberghien, J. (2017). An analysis of media framing of and by Cannabis Social Clubs in Belgium: making the news? Drugs: Education, Prevention and Policy, 24(4), 348–358. Gunning, M., & Illes, J. (2021). Coverage of medical cannabis by Canadian news media: Ethics, access, and policy. International Journal of Drug Policy, 97, 103361.

Celebrities and Addiction Particular drug stories generate and sustain media attention more than others and specific drugs, usually those associated with glamour or youthful lifestyles such as cocaine and ecstasy, receive far greater and more detailed coverage than less glamorous substances (Manning, 2006). Famous people who struggle with drink and drugs are of particular interest and there is a long history of such people, whether we call them celebrities or not, being fodder for sensational media coverage. Talented but troubled footballers like George Best, Diago Maradona and Paul Gascoigne were subject to as many tabloid news stories about their hedonism as they were for their skills on the pitch. Indeed, Best needed two liver transplants in a life blighted by alcohol dependency, yet his iconic image and, importantly, his association with heavy drinking are still celebrated with greetings cards and posters carrying his much-quoted aphorism ‘I spent a lot of money on booze, birds and fast cars. The rest I just squandered’. That such an unapologetic attitude to the harms of alcoholism now seems somewhat dated has something to do with how celebrities of more recent times are engaging in more reflexive discussions about alcoholism and drug dependency. In recent years, as we see in Chapter 9, figures such as the cricketer Andrew ‘Fredie’ Flintoff, boxers Ricky Hatton and Tyson Fury have, amongst others, given candid interviews and taken to social media to reflect on their struggles. It is significant that many of these examples are retired sportsmen, meaning their prior

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exploits as sporting champions gives them the kudos to speak openly only once their playing careers have run their course. Celebrities, and the increasingly numerous spaces in which their lives are deconstructed, are a significant arena for information and norms about substance misuse to circulate. It has also become increasingly common for celebrities to speak out about addiction on social media platforms where their visibility to millions of followers positions them as important and influential shapers of opinion. Several studies have posited the potential for celebrities and their addiction to improve understanding of substance use and treatment. Dwyer and Fraser (2019), for example, suggest that celebrities who speak out about their addiction on Twitter such as the American singer Demi Lovato and British comedian and presenter Russel Brand, do so in ways that ultimately perpetuate stigmatising and individualised framings of addiciton. In their analysis of media coverage of celebrities being caught driving whilst under the influence of alcohol, Smith and colleagues (2009) suggest that such events are ‘teachable moments’, where important lessons about the harms of drunken behaviour might be imparted on a youthful celebrity-focused audience. In practice, however, such coverage contains little in the way of educational content and, perhaps worse, tends to emphasise the glamourous lifestyles of the celebrities featured. Tiger (2015), similarly, notes the advent of celebrity gossip blogs as an unlikely but potentially influential space in which ideas about addiction are negotiated. She observes that: Celebrity gossip bloggers such as Perez Hilton espouse their views of addiction as a moral failing and sickness, as a disorder of choice even when they are sympathetic to the idea that addiction is a disease. Celebrity becomes the vehicle through which readers debate with each other about the nature of addiction on new media sites that facilitate high levels of interaction. However, even in their moments of divergence about what addiction is, they reinforce a hybrid and dominant construction of regular drug use as a medico-moral disorder . (Tiger, 2015: 353)

Overall, then, whilst such new openness about alcohol and drug addiction should be applauded, it may be that the promise of such revelations remains unfulfilled given the restrictions of platforms such as Twitter and, in no small part, given that such exposure is still dwarfed by the vastness of global alcohol advertising.

Advertising, Alcohol and Drugs Advertising and marketing of intoxicants has a long history. As we saw in Chapter 2 in the late nineteenth century and early twentieth century, cocaine and opium were widely available and often marketed as miracle cures, and as the

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l­atest medicinal innovations. Perhaps the most common form of representation we encounter in our daily lives is the advertising, branding and product placement of alcoholic beverages such as beer, wine and whisky. Indeed, such is the prevalence of alcohol advertising in many countries that the promotion of an intoxicant with known harmful effects is taken for granted. Global alcohol corporations have historically spent huge amounts on advertising with the hope of increasing their market share for established or new products (Dade, 2008). Indeed, we should assume that advertising and branding does ‘work’, in the sense of persuading some people to drink or to keep drinking a particular brand of beer or vodka not least because if it didn’t then the collective US$ 6–7 billion spent annually on alcohol advertising would be laughably wasteful. There are three primary reasons as to why companies engage in significant expenditure in relation to branding (Da Silva Lopes, 2007). Firstly, to increase market share and to launch and establish new products as recognised brands. Secondly, to remind consumers of existing brands already on the market, often with a long history and, thirdly, to encourage brand loyalty amongst consumers in a competitive market. Branding has been a key feature of the process of global expansion. Before 1960s, each country consumed predominantly one type of drink, produced domestically. After 1960s, family-owned brands such as Guinness underwent internationalisation, emerging as multinational brands with global reach. As a result of decades of growth, mergers and acquisitions, the global alcohol market is now dominated by a small number of global corporations, such as Diageo. AB InBev is another good example. Formed from companies with roots in Belgium, it has since become truly globalised with regional offices in the US, Brazil, South Africa, Mexico and the UK. Given the extensive portfolio of brands over which they preside, it is estimated that around one in four beers consumed globally are made and distributed by AB InBev or one of its subsidiaries. Advertising works by building symbolic linkages between largely inanimate objects and wider meanings and social values. Dade (2008) identifies recurring themes in an analysis of over 100 years of alcohol branding and advertising, which include: • Health and physical benefits, particularly those relating to leisure and relaxation • Taste and distinction, where drinking of particular brands are depicted as having higher social status than others

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• Relationships relating to social interactions with gender roles being particularly prevalent • Adapting to changing socio-economic and cultural contexts such as wartime or the advent of mass international travel Over time, advertising has tended to move from the literal to the symbolic and from fixed, bounded, explanations of the product’s value to far more abstract, aspirational symbolic narratives. An example of this is Guinness, the globally recognised Irish stout. Earlier in its history, it was promoted using the iconic— and now, given changing attitudes to alcohol and its health impacts, ironic—slogans ‘Guinness for Strength’ and ‘Guinness is Good for You’. From the 1970s onwards, however, Guinness advertising shifted first to something akin to a lifestyle, then to something more transformative, a feeling or atmosphere. Most strikingly, the 1999 television campaign Surfer featured evocative monochrome visuals of surfers and horses cascading through breaking waves accompanied by a pulsating soundtrack supplied by British electronic dance music pioneers Leftfield. That there is little connection to the drink itself—save for the opening narration of ‘He waits. That’s what the does’ alluding to the contrived requirement for a slight pause during the pouring of a pint of Guinness—did not prevent the advertisement from generating huge visibility for the brand. Another, somewhat problematic trend in alcohol advertising has been its adoption of drug-like imagery from the 1990s onwards in response to the popularity of ecstasy amongst young people (Measham, 2008). This is to be expected. Indeed, Blackman (2004) notes the widespread use of drug imagery in advertising, connoting youth, rebellion and transformation to sell everything from shampoo to chewing gum. Around the same time, also apparently motivated by the industry’s fear of losing a generation of potential new customers, many drinks producers launched products to secure the custom of a younger demographic of new consumers. These so-called alcopops appealed to the tastes and preferences of adolescents, with flavours and branding to imitate soft drinks and sodas. Concerns about the impact of marketing until recently have focused on children and young people, but recently there have been more population level studies, and calls for more focusing on those with Alcohol Use Disorder and in ‘recovery’. Underage drinking has received more attention in the context of the global burden of disease in relation to alcohol (Rehm et al., 2003), where alcohol was thought to be a risk factor in the global disease burden to the extent that 3.2% of the global deaths and 4.0% of the global Disability Adjusted Life Years (DALYs) in the year 2000 could be attributed to alcohol exposure (Rehm et al.,

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2003). These results are stratified by sex and region for both outcomes, and we explore similar issues in the subsequent chapters. Perhaps in relation to these developments, alongside findings such as those related to the Global burden of disease, the Advertising Standards Authority (ASA) has tightened its code around advertising alcohol. Section 19 is about alcohol and now places greater restrictions on the association of alcohol as being linked to individual popularity, as enhancing performance in any way, or as being an aid to social success‚ or as an aid in sexual seduction. Prohibited too are any references to the therapeutic nature of alcohol. Furthermore, the regulations also prohibit the promotion of irresponsible consumption such as repeat purchasing of rounds of drinks. There has been much written on the efficacy of codes of practice in shaping and regulating behaviours, particularly in relation to powerful, globalised industries like alcohol. Social media campaigns such as #DontPinkMyDrink and #BoozeCalendar which link alcohol to the rhythms of everyday life are powerful marketing tools. Supermarkets advertising discounted beer to coincide with national vacations and holidays is likewise now a common and worrying trend. Alcohol advertising on the internet is a problem also facing regulators. Of course, no matter how much is spent on advertising and regulation, one must not underestimate the power of celebrity in shaping attitudes towards consumption. The image of the footballer Cristiano Ronaldo replacing a bottle of Heineken beer with a bottle of water during a press conference for the Euro 2020 football tournament was as powerful an anti-drinking statement as those contained in any regulatory document.

‘Binge Drinking’ and UK Media Representations of Intoxication The issue of the emergence of alcopops discussed in the previous section is also tied into a further pattern of the representation of intoxication in the mainstream media and the ongoing issue of scare stories or panic around alcohol and other drug consumption. This is of significance when set against the backdrop of the normalisation of representation of alcohol in the mainstream media in the UK. In soap operas such as Eastenders, Coronation Street and Emmerdale, some of the most watched television programmes in the UK, references to alcohol are frequent and a great deal of action takes place in pubs (Furnham et al., 1997). This is however, contrasted with periodic outbreaks of concern over excessive drinking of young people in society.

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‘Binge drinking’ has become the latest label for drinking practices that society, or at least the media and government, perceive to be problematic drinking. The definition of ‘binge drinking’ has changed over time, having initially been used to describe a sustained period of several days of drinking before being focused on exceeding a set threshold of drinks in each drinking session (Plant & Plant, 2006). The phrase, however, is used in the media as shorthand for a specific kind of heavy drinking with the intention of achieving intoxication. The notoriety of the term was heightened by the popularity of TV shows Booze Britain 2: Binge Nation that depicts ‘the spectacle of binge drinking’ (Hayward & Hobbs, 2007). During this time, ‘a visual language began to emerge in mass media depictions of “binge drinking”: photographs and CCTV footage seemed to reveal a nocturnal pandemonium of violent young men, sexually vulnerable (or promiscuous) young women and harassed police in luminous jackets struggling to cope with the disorder that explored on the streets as young binge drinkers staggered from one garish venue to the next’ (Nicholls, 2013: 236). Such representations present intoxication as the cause, rather than a symptom, of societal harm and specific groups such as students and working-class young people are depicted by the media as ‘flawed’ and ‘irresponsible’ consumers, not to be trusted and in need of surveillance and control (Ayres & Taylor, 2020). There are several factors that may have influenced the rise in media content depicting binge drinking and associated anti-social behaviour during the 2000s. Importantly, whilst drinking habits were changing so too was the media landscape through which depictions of hedonistic excess emerged. The growth of the nighttime economy in many cities created ‘hot spots’ notorious for drunkenness and disorder. This was spatial and temporal change in drinking habits, with drinking becoming focused on these ‘hot spots’ in which licensed venues clustered and involving the concentration of drinking on Friday and Saturday nights. At the same time, changes in the media industry made sensationalist and visual content appealing to a tabloid market for images of intoxication and a growth of TV channels looking for original but cheap content, produced in reality TV or ‘fly on the wall’ style documentary formats. Growth of news websites that hosting more images (for example, the Daily Mail website) needing to fill screen space, a single photographer could provide dozens of images from a few hours standing on a corner of Broad Street in Birmingham or the Bigg Market in Newcastle. Technological advances that allowed broadcast quality media production at a far lower entry level amongst independent production companies combined with deregulation and the first wide uptake of satellite and ‘freeview’ television, followed by internet media platforms like YouTube, continued these trends.

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The peak of media reports on binge drinking can also be linked to the legal changes around the 2003 Licencing Act, with the number of newspaper reports mentioning binge drinking in England quadrupling between 2003 and 2004. As we saw in Chapter 3, the Licensing Act 2003 proposed a liberalisation of licensing but the media instead focused on a narrow narrative of the anticipated impact of ‘24-hour drinking’ on law and order (Plant & Plant, 2006) and amounted to what we might describe as a ‘moral panic’ (Critcher, 2008). Such media representations are also heavily gendered, with male drinkers becoming violent to themselves and others, whilst female drinkers harm their health and put themselves at risk of assault (Critcher, 2008). Day et al. (2004) analysed UK newspapers to see how gender plays a role in the framing of the ‘binge drinking’ representations and found that a recurring theme was the harms and dangers caused to the female body by heavy drinking. Female binge drinkers are therefore seen as less feminine and more masculine, with visual and textual representations of the coarse drunken behaviour of so-called ‘laddettes’ emphasising the effects of alcohol on the female body, making them fatter, harming reproductive health and rendering them sexually vulnerable yet morally culpable. Newspapers like The Daily Mail coverage of rape cases involving alcohol are shown as unsympathetic to victims (Meyer, 2010). Whilst the moral panic has somewhat abated, the appeal of an easy story full of images or videos of young drunk people falling over is present. Indeed, stories depicting out of control drinkers now follow a well-worn script and include annual coverage of university fresher’s initiations involving new students and the outbreak of alcohol and cocaine fuelled violence from the ‘wrong sort’ of attendee at otherwise up-market events like the Royal Ascot horse races. Most recently, a new inflection was offered with tabloids rushing to run stories of drunken youths and their failure to social distance during the early days of the Covid-19 pandemic. While the tabloid news media and various channels of lower production value television give us the most prominent examples of media depictions of intoxication and excess, so-called lifestyle media or magazines and, more recently, social media content, has also frequently portrayed alcohol in problematic ways. Lifestyle magazines analysed by Lyons et al. (2006) showed drinks such as cocktails, wine and champagne depicted as feminine and glamourous and seen as desirable when associated with success, popularity and status. Similarly, Atkinson et al. (2012) analysed magazines aimed at teenagers and young adults to find content linked certain kinds of drinks and drinking to notions of glamour and celebrity style, and that such alcohol-related stories made such connections even when the readership is under 18. In the years since these studies, the focus on young people has shifted to social media. Niland et al. (2017) asked young adults in

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New Zealand to give them a ‘tour’ of their Facebook activities whilst participants answered questions about their exposure to alcohol marketing online and their use of social media to share content involving alcohol and drunkenness. Their findings show that social media marketing has been used by the alcohol industry to embed their brands within the online friendship activities of young adults. Treading the fine line of what is permissible, alcohol branding and advertising seeks to situate itself within young people’s friendship groups and social identities. In a UK Study by Ross-Houle et al. (2016) on alcohol advertising online found that following and liking brands used to signal and negotiate gendered and classed identities online. These likes were enthusiastically adopted by alcohol industry due to a) difficulties in regulation compared to ‘traditional’ media and b) interactivity and user-generated content being more effective, targeted and ‘authentic’.

Media and Morality: Shock and Disgust The seemingly contradictory, or even hypocritical, way in which the media demonises some forms of intoxication whilst promoting others as desirable and glamourous, either directly in lifestyle content or indirectly through the prominence given to advertising and placement of brands, in fact speaks to the consumerist logics of neoliberal society. Intoxicants, both legal and illegal, are chosen from amongst a range of commodities and those who drink or get high are buying into experiences which offer not just gratification or escape but personal meaning and identity. Thus, media discourses and public culture tend to pathologise individuals and groups who consume in the ‘wrong’ way as being failed consumers who have made the wrong choices and proven themselves unable to manage the competing demands of self and society. Neoliberalism reduces complicated and multifaceted social problems to the poor life choices and moral failings of individuals, and media narratives about addiction readily cast drug users as failed individuals without sufficient personal qualities. Recovered users can seek redemption by performing recovery and a rehabilitated self. Drug stories have lent themselves well to moral fables about socially desirable and whilst some critique communities and failed social policy (e.g. The Wire), far more common are media tropes that place individuals as subjects of derision and revulsion. Atkinson and Sumnall (2020) argue that televised depictions of drug users uphold a neoliberal discourse through an emphasis on individual responsibility and choice, with drug use the outcome only of user’s moral failings and poor choices. Drug users are caricatured and associated with negative characteristics

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such as unemployment (and its implied laziness), selfishness and untrustworthiness whilst structural factors, such as deprivation and community breakdown, and public policy are ignored or side-lined. In such depictions, the treatment of addiction is framed purely as an individual effort to ‘recover’ the ‘lost self’ through the residential treatment, with stories of recovery often involving an obligatory confessional style where the person featured must renounce their past sins and perform a new, morally acceptable, identity. Addiction (the AA version in particular) is a regular trope and dramatic device, often less about drugs and their use and more about a dramatical device to present a protagonist with a barrier to overcome. Many stories about addiction take the form of modern morality tales. Characters are cast as deserving or undeserving. Typically, recovery comes from personal will and strength of character (rarely is the provision, or lack of, treatment included). This trend can be seen in David Sheff’s memoir of his relationship with his son Nic, and Nic’s battles with methamphetamine addiction, an account which places the impacts of addiction on families, and parents specifically, at its centre. Sheff’s Beautiful Boy includes lengthy discussions of the huge costs of residential treatment and recovery programmes as well as acknowledges author David Sheff’s privileged position to be able to pay for his son’s care. Sheff also explains the process of ‘externalization’ through which he is shown the impact ofNic’s addiction in the form of brain scans showing the areas of neurological damage to Nic’s brain (Kim, 2017). Interestingly, Nic would follow his father’s memoir with his own books recounting his addiction and attempts at recovery. In Nic Sheff’s Tweaker, he unravels the battle between his ‘addictive self’ and ‘sober self’. It has been suggested that reading these parallel accounts of addicted son and the father desperate to support his recovery could help in clinical and therapeutic settings by helping foster more empathetic understandings of the different experiences of addiction and the impact of addiction on close family members (Steenrod, 2008). Both as a book and in the latter movie adaptation, the central narrative arch is a father who felt he had ‘done everything right’ yet left searching for clues to what might have caused his son’s addiction, from divorce to his own frankness about youthful drug use (Balon, 2011). It is, however, notable that the movie adaptation removed or reduced much of the detailed content found in the book relating to the logistics and costs of accessing treatment for substance misuse in America. Whilst memoirs such as Beautiful Boy may rightly be praised for accounts of the impacts of drug addiction, other representations of drug use common in recent years rely more on immediacy and shock than confessional narratives. First used in 2004 by the Sheriff’s Office in Multnomah County in the US state of Oregon, ‘Faces of Meth’ drew on police mug shots showing the deterioration of methamphetamine users over successive encounters with law enforcement agen-

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cies. The faces in questions are harrowing: decaying or missing teeth, sores and rashes, sunken cheeks and eye sockets, gaunt and prematurely aged skin. While ‘Faces of Meth’ began as a high school initiative designed to use the shocking physical signs of drug addiction on the bodies, and faces, of users as a deterrent, the images were widely reproduced in ‘freak show-like’ tabloid media items and social media posts around the world. Images of ‘before’ and ‘after’ have become widely circulated in news media and online to illustrate the devastating physical impact of methamphetamine addiction. The original Faces of Meth has now been reused in media items internationally, often detached from any reference to local socio-economic conditions and policy. The people depicted in Face of Meth, and other similar campaigns, have no voice and the circumstances shaping their drug use are rarely mentioned. Rather, their collected images are used for their shock value. The act of viewing is more voyeuristic than empathetic. A point well made by Linnemann and Wall (2013: 323) in their analysis of Faces of Meth where they draw on Julia Kristeva’s concept of the abject—things that are disturbing and destabilising and need to be ‘cast off’ or removed in order for people, groups and societies to maintain a coherent identity—to suggest the initiative ‘locates meth users outside community, outside law, outside reason, outside bourgeois conventionality’. Abjection, from Kristeva, explains how people and things are made dirty, unpalatable and in need of removal and casting away. Likewise, Ayres and Jewkes (2012: 323) suggest that Faces of Meth is an updated form of long-running trend for ‘othering’ processes by which society condemns people to deviant status: they suggest that ‘from the rogue galleries of the nineteenth century to the mugshots of crystal meth users printed on the pages of 21st-century newspapers, photographs have recorded the criminal individual as a subject of the state and facilitated state surveillance of the body. The photograph makes these groups socially visible, individually identified, separated and sequestered, categorised and, if necessary, regulated or removed’. The implications of Face of Meth on a wider level are to reinforce the idea that addiction and associated criminality are residing in the bodies of certain people, or groups, and that feelings of revulsion, rather than compassion, can be harnessed to reassert boundaries of normality. A similar dynamic can be observed more recently in the case of the news media depiction of new psychoactive substance use in the UK (see Chapter 11). Stories depict the users of the synthetic cannabinoid ‘spice’ (Alexandrescu, 2020) and the substituted cathinone psychostimulants ‘monkey dust’ (Atkinson & Sumnall, 2020) as ‘zombies’, and images of prone or contorted bodies again prompt a response of fear or revulsion and a desire to cleanse. Such media coverage serves to stigmatise people who use drugs and to direct attention away from the outcomes

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of harmful conditions of deprivation and the impact of austerity policies towards scornful and sensationalised viewing of bodies. Images are public spaces, and the ‘panic’ is again one where the bodies of users are problematised and stigmatised. Such stories render bodies of drug users within ideological framings and metaphors. Thus, Alexandrescu (2020: 103) asserts that ‘dehumanising rhetoric not only ignores the lived experiences and suffering of those whose lives are scarred by poverty and substance abuse, but also desensitises public opinion towards the systemic, symbolic and oftentimes physical violence directed at them’. However, there are examples of more subversive and in various ways ironic representations of drug addiction. For example, Ruddock (2020) analyses the ‘I’m Methed Up’ Tumblr account as an interesting example of drug users resisting labelling by wider society. In this niche media space, meth users intersect with fan culture that adopts symbolism and imagery from Breaking Bad as part of ‘a cultural repertoire that lent meth and drug culture meaning’ (Ruddock, 2020: 268). Here, Social media allowed for expressions of drug use not acceptable elsewhere through the use of imagery and hashtags such as #tweakernation, using humour and cultural references to push back against stigma and social disapproval.

Summary This chapter has shown how traditional and new media are saturated with representations of alcohol, drugs, intoxication and addiction. Representations of alcohol and drugs are often ambivalent and at times contradictory. Whilst representations of drink and drugs in the print news media have been a significant driving factor in various ‘moral panics’, television, cinema and music videos have a long history of glamorisation of drunkenness and drug taking culture. Depictions of drugs and alcohol reflect the ambiguous relationships of the societies that produce them. It becomes clear there are ‘right’ and ‘wrong’ ways to become intoxicated, and with associated high stakes whereby media narratives frame the latter as a shameful moral failure. Representations matter because they reflect wider changes but they can also shape opinion. It is also the case that representations are shaped by the characteristics of those whose intoxication is being represented. Across the chapter, we have shown that gender, social class, geographical location, ethnicity and age all play a big part in how intoxication is portrayed as acceptable or not. While many of the media depictions discussed here either lack subtlety or are overtly discriminatory, they do speak in some sense to a real issue. Who you are, where you live and how you stand in society relative to other groups and the dominant culture can and do all shape how your intoxication, in

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whatever form it takes, is perceived by society. Over the next three chapters, we will look at how experiences and meanings of intoxication vary by such factors as age, life course stage, gender or sexual orientation and, lastly, ethnicity, religion or national identity. Points for Discussion

In what ways might celebrities and other public figures talking about their experiences of alcohol and drug addiction improve or damage public understanding? What are the key features of good and bad representations of alcohol and drug issues? What are the absences (i.e. what is not shown) in the representation of alcohol and drug use you are familiar with?

Read, Watch, Listen #7 Watch: In the University of Oxford’s 2011 Monica Fooks Memorial Lecture, Professor David Nutt asks ‘How can we get the media to tell the truth about drugs?’. A full video of the lecture is hosted on the University of Oxford website. Read: SHAAP (Scottish Health Action on Alcohol Problems) produces a weekly Media Monitor email which provides subscribers with a ‘snapshot’ of the latest alcohol-related news and media content from the UK and beyond. Separate sections cover recent news items, blog posts and commentaries as well as newly published research. Listen: The details of how drinks brands establish themselves and drive demand through advertising raise interesting questions about how alcohol is represented across the media. There are numerous industry podcasts including an episode of the Mind Your Marketing series on ‘Building The Brand: The History Of Guinness’ and the advertising industry magazine Adweek’s podcast series episodes ‘Why the Ad Industry Needs to be More Inclusive of Non-Drinkers’.

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Hailwood, M. (2013). “It puts good reason into brains”: Popular Understandings of the Effects of Alcohol in Seventeenth-Century England. Brewery History, 150, 39–53. Hayward, K., & Hobbs, D. (2007). Beyond the binge in ‘booze Britain’: Market-led liminalization and the spectacle of binge drinking. The British Journal of Sociology, 58(3), 437–456. Herd, D. (2009). Changing images of violence in rap music lyrics: 1979–1997. Journal of Public Health Policy, 30(4), 395–406. Hickman, T. A. (2002). Heroin chic: The visual culture of narcotic addiction. Third Text, 16(2), 119–136. Hopper, D. (1969). Easy Rider. Columbia Pictures. Iannicelli, P. (2001). Drugs in cinema: Separating the myths from reality. UCLA Ent. l. Rev., 9, 139. Jarecki, E. (2012). The House I Live In. Abramorama. J. J. Cale (1976). ‘Cocaine’. Troubadour. Kim, A. (2017). Book Review: Beautiful Boy: A Father’s Journey Through His Son’s Addiction. America Journal of Psychiatry, 12(12), 14–14. Linnemann, T., & Wall, T. (2013). ‘This is your face on meth’: The punitive spectacle of ‘white trash’in the rural war on drugs. Theoretical Criminology, 17(3), 315–334. Lyons, A. C., Dalton, S. I., & Hoy, A. (2006). ‘Hardcore Drinking’ Portrayals of Alcohol Consumption in Young Women’s and Men’s Magazines. Journal of Health Psychology, 11(2), 223–232. Manning, P. (2006). There’s no glamour in glue: News and the symbolic framing of substance misuse. Crime, Media, Culture, 2(1), 49–66. Measham, F. (2008). The turning tides of intoxication: Young people’s drinking in Britain in the 2000s. Health Education, 108(3), 207–222. Meyer, A. (2010). “Too Drunk To Say No” Binge drinking, rape and the Daily Mail. Feminist Media Studies, 10(1), 19–34. Newburn, T. (1991). Permission and regulation: law and morals in post-war Britain. Routledge. Nicholls, J. (2013). The politics of alcohol: A history of the drink question in England. Manchester University Press. Niland, P., McCreanor, T., Lyons, A. C., & Griffin, C. (2017). Alcohol marketing on social media: Young adults engage with alcohol marketing on facebook. Addiction Research & Theory, 25(4), 273–284. Nitschke, C. (2016). The free zone: Gang dynamics, de-differentiation, and pseudo-statehood in The Wire. Cultural Dynamics, 28(1), 103–118. Penfold-Mounce, R., Beer, D., & Burrows, R. (2011). The Wire as social science-fiction? Sociology, 45(1), 152–167. https://doi.org/10.1177/0038038510387199 Plant, M., & Plant, M. (2006). Binge Britain: Alcohol and the national response. Oxford University Press. Rehm, J., Room, R., Graham, K., Monteiro, M., Gmel, G., & Sempos, C. T. (2003). The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction, 98(9), 1209–1228. Ross-Houle, K., Atkinson, A., & Sumnall, H. (2016). ‘The Symbolic Value of Alcohol: The importance of alcohol consumption, drinking practices and drinking spaces in classed

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8

Intoxication Across the Life Course

Introduction This chapter will examine how the experience of intoxication varies considerably throughout the life of an individual. As we go through our lives, not only are there different opportunities to consume alcohol and take drugs but the meaning of those experiences, and the places in which they take place, can change in striking ways. For example, alcohol consumption involves a range of new experiences and entry into new places, such as bars and pubs, which are often associated with adulthood. From adolescence to adulthood and into middle-age, in many cultures, alcohol is associated with the rituals and rites of passage of ageing (Thurnell-Read & Young, 2022) and has a social function in being used to mark important moments in our lives such as birthdays, weddings and funerals. Many anthropologists have been fascinated by the use to which intoxicants are put in many societies where they may take on a transformative power, for instance, to mark the boundary between child and adult. Certain intoxicants, notably champagne, have become associated with celebration. You may have drunk a glass of champagne to ‘toast’ the commitment of a loving couple at a wedding or, perhaps, your own academic achievements at a degree graduation ceremony. In many cultures, alcohol consumption is an integral part of funerals. For example, in Ireland the hospitality shown by the host of a wake will invariably include offering drinks to mourners (Cashman, 2006). Another pertinent example of the role of intoxication in life course rituals and rites of passage are the groups of British men going on drunken ‘stag tours’ in Eastern European cities such as Krakow, Poland. Studying these events using ethnographic methods, Thurnell-Read examined how these drunken weekends away, typically held some weeks before the Bridegroom’s wedding day and orchestrated © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_8

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in detail by a Best Man, involve a hedonistic level of intoxication being pursued as a ritualistic way of marking the Groom’s transition from unmarried to married status through a celebration of excessive drinking and its accompanying bodily transgressions such as public nudity, urination and vomiting (Thurnell-Read, 2011). This important life course event uses alcohol to perform male friendships, as drinking together to excess is perceived to serve the purpose of bonding the group (Thurnell-Read, 2012). With an obvious logic for a chapter considering the role played by age in experiences of intoxication, this chapter will roughly follow the life course by starting with a consideration of youth drinking and drug taking. Following this, we consider the ways in which intoxication might be seen as biographical, as it can play a part in experiences of ageing and changes in one’s life as one ages. In the latter stages of the chapter we will explore the later stages of life where drinking and drug taking have for a long time been overlooked.

Coming of Age Through Intoxication Despite the popular assumption that children are naive to the presence of alcohol and other intoxicants before a period of discovery and experimentation in their teenage years, studies have also shown that pre-teenage children are in fact extremely aware of alcohol and its effects (Fossey, 1994). None of us are born with an understanding of the intoxicating effects of alcohol and other drugs on our bodies and those of others. At some point, we must go from a position of ignorance to one of knowledge and for most people this will involve awareness and knowledge gained through observation as well as personal experimentation and experience. Many children learn about alcohol, its effects and the physical and social difference between different drinking styles within the family home, having watched their parents and other family members drinking and getting drunk (Eadie et al., 2010). Jayne and Valentine (2015), for example, conducted interviews with pre-teen children in the UK and found that even very young children perceived alcohol as an ‘adult drink’. Children generally knew that alcoholic drinks had a smell and appearance that they found unpleasant and could associate the consumption of such beverages with the physical effects of drunkenness that left their adult family members ‘looking tired’ or prone to dizziness or falling over. Children and teenagers do not just learn about alcohol from their parents. Wilkinson (2019), for instance, shows that older siblings often play a critical role in the acquisition of knowledge about alcohol and drinking culture to younger brothers and sisters whilst also, by turn, enabling or restricting their access to it.

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Many educational initiatives aimed at informing and, usually, dissuading initiation into intoxicant use take place in mid-teens and in formal education settings, primarily in schools (Fossey, 1994). However, research shows that a lot of attempts to regulate the age at which young people can first encounter alcohol may lead to counter-intuitive outcomes. The best example is so-called ‘scared straight’ programmes where law enforcement professionals deliver measures to school-aged children with warnings about the harms of drugs or alcohol. Drug Abuse Resistance Education (DARE) programmes are perhaps the most widely discussed and widely evaluated variants of such schemes. Repeated evaluations have shown that the effect it has on prevention is moderate and these diminish over time (see Clayton et al., 1996) and that they even lead to the unintended outcome of initiating young people into experimentation with intoxicants. Thus, whilst it is in young adulthood and at university that people are ‘beginning to lay down particular understandings about alcohol’s role in their life’ (Conroy and Measham, 2019: 7) it is the pre-teen years that can be seen as appropriate time to engage in discussions about alcohol with children (Eadie et al., 2010). There is more to learn about alcohol and drugs than simply the age at which they are first encountered and experimented with either legally or illegally. Between the early and late teens, gendered differences in choice of drinks, locations of drinking and attitudes about what constitutes ‘normal’ or ‘risky’ drinking emerge (Plant & Plant, 1992). Plant and Plant (1992: 47) note that whilst ‘smoking and drinking have a potent appeal because of their commonplace roles as hallmarks of maturity’, the youth drug cultures to emerge in the second half of the twentieth century were ‘closely linked with the upsurge of youth culture and with music, behaviours and fashions designed to excite, entertain, rebel or shock’. As Fossey (1994: 43) observes ‘the concept of “peer pressure” in relation to substance use has come to be synonymous with the notion of the individual as an innocent who is subsequently tricked and led into “undesirable” activities by “undesirable” others’. The notion of the harmful and deceptive actions of ‘bad company’ leading otherwise decent young people astray is in many ways appealing, not least in its simplicity and the ease with which it lets parents, teachers and other authority figures absolve some children of culpability whilst blaming others. However, the reality appears to be more complicated and appears to rarely involve a sinister ‘pusher’ tempting otherwise innocent children away from a righteous path of sobriety. As Pilkington (2007) argues, whilst both the concept of ‘peer pressure’ and ‘normalisation’ have long held an appeal to account for youth drug taking, we should not ignore both local ‘micro’-level social context nor wider ‘macro’-level social change. The availability of drugs, and of friends to take them with, is an important factor.

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It is not just the consumption of alcohol and drugs that is for most young people a collective act; anticipating, financing, procuring and sharing in both the pleasurable and unpleasant outcomes all build social bonds at a time when many young people are forming lasting meaningful friendships. For many young people, the negative side effects of excessive drinking, such as vomiting, physical injuries and the embarrassment caused by regrettable behaviour whilst intoxicated are a justifiable price to pay for the good drinking stories that are told and retold within groups of friends to cement feelings of friendship, conformity and belonging (Fry, 2011). Indeed, prohibiting alcohol for children and adolescents invariably leads to it becoming associated with maturity and adult status. Academic studies of drinking amongst adolescents show us that intoxication plays a social function in the lives of many young people, where intoxication is bound up with self-exploration and seeking out of opportunities and spaces for autonomy. For example, in their study of Danish adolescents, Järvinen and Gundelach (2007: 64) found that ‘in all focus groups alcohol experience goes together with prestige: the earlier you have started to drink, the more parties you have gone to and the bigger your partying network is, the stronger is your position within the peer group’. Indeed, such is the emphasis on youth drinking as a marker of distinction between two opposing groups that those who drink are quick to disassociate themselves from those who do not drink, or who only begin to drink later or who are believed to do so with too much caution. When alcohol is associated with adulthood, being able to procure and consume it as well as being familiar with its taste, effects and meanings means alcohol carries with it an alluring symbolism of maturity (Demant & Järvinen, 2006). Getting drunk has thus been shown to offer teenagers a way to both build social bonds amongst peers and to explore new expressions of their own identity. Johnson (2013) studied 14 and 15 year olds in Northern Ireland and found that drinking alcohol was spoken of as an occasion to perform social belonging and individual identity. However, those who either pretended to drink alcohol or, conversely, who exaggerated or overplayed their drinking abilities to ‘act tough’ were seen as inauthentic. The same applies to cigarettes. Cullen (2010) studied how working-class teenage girls in the UK use cigarettes as a form of social currency where the giving, receiving and sharing of cigarettes were used in forming and maintaining friendships. Whilst initial incidents of smoking were motivated by boredom and the desire to ‘fit in’, teen smoking soon takes on a ritualistic form where calling ‘two’s up’ on a friend’s cigarette and smoking the same brand of cigarettes as peers served to perform group loyalty and belonging. A similar dynamic can be noted in relation to cannabis, where purchasing either through

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friends already in one’s social network or through acquaintances ‘referred to by buyers and sellers in the language of friendship’ act as important means establish trust and to mitigate the risks of entry into the illicit drugs market (Belackova & Vaccaro, 2013: 304). As we saw in Chapter 5, the taking of illicit drugs may be framed as a deviant act and a marker of outsider status. However, in many cases drug taking is ‘normalised’ and expected as part of often very mundane activities such as going to a music festival or playing computer games with friends. In many countries, even those young people who do not drink and have never experimented with drugs are quite happy to acknowledge that the drinking and drug taking of their peers is an acceptable part of growing up. As such, Duff (2005) draws on surveys of young bar and club goers in Melbourne, Australia to conclude that a key feature of the taking of illegal drugs such as cannabis, ecstasy and amphetamines was ‘the shift in drug use behaviours from more “underground” or sub-cultural youth populations and settings into more “mainstream” or popular milieux—from the margins to the centre as it were’ (Duff, 2005: 167). Similarly, Moore and Miller (2005) surveyed young clubbers in Sheffield and Manchester (cities in the North of England) to show that drug taking was a source of meaning and belonging quite at odds with narratives about young drug takers as either easily influenced by peer pressure or engaging recklessly in risk taking and thrill seeking. Participation in the drug taking culture of the club scene was, for these young people, a way to express their identity and social belonging whilst in many other ways their lives were characterised by change and a lack of stability. Because these tangible social benefits are at the forefront of clubbers’ own accounts of their drug use, Moore and Miller (2005: 32) conclude that it is important to understand the ‘pragmatic and at times rational’ choices made by young drug takers and to ‘resist the temptation to pigeonhole and demonise’ young people for their drug use. A common theme in research examining the drinking habits of adolescents and young adults is the importance of space and mobility to young people’s experiences of intoxication. Demant and Landolt (2014) analysed youth drinking in Zurich, Switzerland and found that the 15 to 19 year olds involved in the research regularly used urban space such as squares, parks and streets as a place to ‘hang out’. Young people experience attempts to control their behaviour with, for example, the arrival of police dispersing a crowd of young drinkers in the park. Similar dynamics were found in Wilkinson’s (2018) study of youth drinking in suburban Manchester. By using collaborative research methods that allowed her young participants, all between 15 and 24 years old, to ‘opt in’ to elements of the project such as interviews, observation, diaries, text messaging and mobile phone

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interviews, Wilkinson (2015) was able to draw insights into not just what young people drank but how drinking practices changes as young people negotiate their movement through and presences in different suburban and urban spaces. The young people in her research reported drinking in varied locations, each with different meanings and practices involved. This included parks and bus shelters but also pubs, clubs, bedrooms and the buses and taxis used to move between them. An important point made by Wilkinson (2018) is to acknowledge the diversity of drinking styles, habits and locations of young people. Rather than move from covert underage drinking on the margins of public spaces to ‘adult’ drinking in licenced venues such as pubs and bars, young people continued to mix public, semi-public and private drinking locations into their drinking repertoires long after reaching the legal drinking age as they balanced cost, accessibility and preference for the very different atmospheres on offer. Such studies are part of a now extensive literature showing alcohol and drugs to be common features of youth culture in the UK and elsewhere. Yet, a recent trend that began in the early 2000s means that a third of young people in the UK now say that they do not drink alcohol (Fat et al., 2018). Similarly, although cannabis remains the illicit drug of choice in the UK, rates of use over the last year, according to the Crime Survey for England and Wales (ONS, 2022) were around 18.7% of those aged 16 to 24 years old, down from 26% in 1995. Despite their now relatively large numbers, non-drinking youth may be marginalised at a time when alcohol consumption continues to operate as a means of demarcating social group belonging (Demant & Järvinen, 2006). Conroy and de Visser (2014) interviewed non-drinking students at British universities and found that the wide prevalence of drinking and drunkenness on campus meant that those students who chose not to drink, for a variety of reasons, had to negotiate their identity relative to a social context in which excessive drinking was normalised. For many of these students, this involved learning strategies to cope with pressure to drink and findings ways to communicate to their peers that did not drink. Intoxication in Contrast 8

In Fjær et al. (2016) study of the Norwegian ‘Russ’ ritual marking the end of high school, excessive alcohol consumption plays a significant role. Through fieldwork and interviews with young Norwegians they were able to reveal how young people formed into ‘teams’, created uniforms and modified party buses as a form of group bonding. Then, a period of ritualised intoxication provided a space of autonomy and transgression which functions to mark the transition to adulthood. Alcohol also plays a significant role in the passing of life course transitions in Janelle Joseph’s (2012) ethnographic study of a cricket club fre-

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quented by Afro-Caribbean men in Toronto Canada. Through observing drinking at cricket matches she saw how older men were able to offset the loss of physical prowess that comes with age by performing their masculinity through alcohol consumption. She also noted how they would drink certain brands of drinks to display both their Canadian and Caribbean identities. Fjær, E. G., Pedersen, W., & Sandberg, S. (2016). Party on wheels: mobile party spaces in the Norwegian high school graduation celebration. The British Journal of Sociology, 67(2), 328–347. Joseph, J. (2012). Around the boundary: Alcohol and older Caribbean-Canadian men. Leisure Studies, 31(2), 147–163.

Intoxication in Adulthood In this chapter so far, and in academic research more generally, we have focused predominantly on young people to understand how intoxication plays a role in growing up, making friends and pursuing pleasure, fun and excitement through drink and drugs. This is, in part, based on an assumption that drink and drugs are things that people ‘grow out of’. In follow-up work to the normalisation study we discussed previously, Williams and Parker (2001) analysed the patterns of intoxication amongst the North West longitudinal sample on reaching their early 20s. They found that although intoxication was still a prominent feature of many young people’s lifestyles, it was nonetheless moderated by the transitions into adulthood many were undergoing. The demands of paid work, in particular, acted as a driver towards more ‘moderate’ and ‘strategic’ drug use. As the sample matures the more unpredictable effects of taking stimulants or LSD became more undesirable due to the prolonged come down. Similarly, alcohol consumption during the week, but also at weekends, was moderated with the demands of work at the forefront of choices around intoxication. These patterns are even more noticeable when the sample reached the age of 27 as Aldridge et al. (2013: 200) note: By their late twenties, many of the cohort have made the key transitions to adulthood and their priorities have changed. The health risks they perceive are now being assessed alongside their life course position, which brings new risks and responsibilities with it. Some have begun to prioritise their careers or their roles as parents and find it more difficult to function effectively in these roles if they have taken drugs, For some, therefore, over time their transitions have led to decisions not to take specific drugs or desistence from drug use. For others, drug use has a specific function and they are still able to continue on their drug journey but at a slower pace.

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Whilst there are many who actively celebrate their continued commitment to hedonistic drinking styles well into adulthood (Smith, 2014), there is an assumed process of maturing out or ‘settling down’ characterised by a steady reduction in participation in the night-time economy. However, this does not mean there is necessarily a reduction in consumption. Instead, for many adults alcohol consumption shifts to the home, where it forms part of the ideology of domesticity and the ‘complex systems of sociality, hospitality and reciprocity’ where a bottle of wine is shared with visiting friends as a sign of hospitality or between a working couple to facilitating winding down after long workdays (Holloway et al., 2008: 534). There is, then, research which illustrates how the meanings and practices of drinking in middle-age are different from those in youth and adolescence. Emslie et al. (2012) conducted focus groups with middle-aged men and women in the West of Scotland and showed that whilst participants tended to position themselves as ‘older and wiser’ in contrast to their heavy drinking youth, they also made clear that alcohol consumption was commonplace and acceptable. Hedonistic drinking was understood as a young person’s activity, yet many still drank heavily on occasions but justified this with an emphasis on fulfilling their work responsibilities and domestic duties and tending to consume alcohol at home far more than in pubs, bars and nightclubs. However, the authors also warn against painting too smooth a picture of life course transitions from young reckless drinkers to older settled and sensible moderation. Participants spoke of divorces leading to a second youth of ‘making up for lost time’. Whilst as shown above, peer pressure is something associated with youth, here adult drinkers also spoke of pressures to maintain alcohol consumption or risk losing out on social connections with others. Non-drinkers, however, appeared to be more resistant: ‘They inverted the common cultural portrayal of drinkers as “fun” and non-drinkers as “boring”, so that people who did not drink were characterised as entertaining, creative, witty, making real connections with other people and taking responsibility for themselves, while drinkers were portrayed as dull, having repetitive conversations, having shallow relationships with others propped up by alcohol and being irresponsible and unimaginative’ (Emslie et al., 2012: 490). The transition through life is complex and in recent years there is an increased appreciation of the need to locate intoxication with perspectives that foreground ageing, generations and the life course (See Thurnell-Read & Fenton, 2022). Studies which draw on sociological and anthropological approaches lend an important interest in the way in which the roles we take on as we grow up and move through our lives are culturally prescribed. For example, several studies show that parenthood involves a complex renegotiation of the relationship with alcohol and drugs. For example, in their study of a group of suburban mid-

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dle-class mothers in Melbourne, Australia, Killingsworth (2006) draws on the example of Emma. In spite of perceived disapproval of the mothers of young children consuming alcohol, Emma, and other women in the group, referred to drinking as a way of maintaining a connection with their pre-motherhood selves as well as to perform autonomy and independence which helped the resist still relatively traditional norms about femininity and motherhood. In contrast, Radcliffe (2011) interviewed 24 women in the UK who were either pregnant or new mothers, all but two of whom had drug use histories including opiates, primarily heroin. Women participating in the research accounted for a ‘performance of self’ involving ‘their successful transition out of drug use and into normal, unremarkable and unstigmatised motherhood’ (Radcliffe, 2011: 984). Indeed, many of the women spoke of motherhood as a ‘turning point’ and a transformative opportunity to give their life a purpose that would finally allow them to successfully engage with drug support services and compliance with treatment interventions and leave behind the drug taking self. Lastly, it is worth noting that with a few exceptions (e.g. Dimova et al., 2021), there are few studies on the impact of becoming a father on alcohol and drug use has for adult men. Research such as that discussed above shows the complex development of the role of intoxication within the lives of individuals as they age. There is also considerable value in viewing these processes in a wider sense as cohort and generational transformations. Whilst drinking is still predominant amongst young people, the most recent birth cohorts are drinking less than previously whilst the decline in alcohol consumption levels in older age is becoming far less pronounced as the Baby Boomer and Generation X cohorts enter middle-age and later life (Meng et al., 2014). In short, the current generation of young adults is drinking less than previously and older generations, unlike previous cohorts, do not appear so readily decrease alcohol consumption as they age. Considering population level data in the UK, Colin Angus (2019) observes that: At the turn of the millennium, average weekly alcohol consumption decreased with age, with 18–24 year olds drinking most heavily, while the over 50s drank around half as much, on average. 43% of 18–24 year olds in the year 2000 regularly drank more than the current UK drinking guidelines compared to 26% of 55–64 year olds. By 2016 this pattern had changed completely, with 30% of 55–64 year olds exceeding the guidelines compared to 18% of 18–24 year olds. Since 2012, the age group with the highest levels of drinking has been 55–64 year olds.

Such trends invert long-established patterns showing youthful excess is ‘matured out’ of as more sensible ways of moderate drinking become established from the 30s and 40s onward and suggest that current and future research will be required to adapt and update assumptions about age-related drinking patterns.

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Intoxication in Later Life There are various reasons why intoxication in older age is an important yet understudied subject. Thus, whilst, as above, it is widely acknowledged that young people engage with alcohol because it can offer ways to socialise and build a sense of belonging with peers, for older people this can be particularly important as many of the activities that provide social connections and opportunities for integration in society, such as work and leisure, may decline or be lost (Wilkinson & Dare, 2014). As we move into older age, new freedoms may present themselves which allow for intoxication to be pursued. Empty nesters, older adults whose grown-up children have left home, may find new opportunities to drink or may drink to combat feelings of boredom or isolation. For many, alcohol may remain a means of engaging in sociable activities with friends and family meaning a reduction in drinking may be avoided even when the impact of drinking on health becomes apparent (Bareham et al., 2019). As with younger drinkers, older people’s alcohol consumption is often motivated by positive reasons such as pleasure and socialisation. However, as Haighton (2016) observes, for older drinkers alcohol consumption can be prompted by stressful life events, such as bereavement or retirement as well as feelings of boredom, loneliness and isolation that can emerge later in life in response to changing living arrangements, health conditions and transformed social roles. Older drinkers may consume alcohol in combination with prescribed medication to numb physical pain, ease feelings of stress and anxiety, or assist with sleeping (Haighton et al., 2018). For example, in Dare et al.’s (2020) study of the drinking habits of women aged 50–70 years in Australia and Denmark, older women drank at higher levels than younger women yet made use of social and cultural approved narratives to negotiate continued drinking often at the detriment of personal health and at odds with widely known health advice. Various justifications were given and often these made a clear contrast between younger women who were perceived as drinking recklessly and in order to get drunk quickly and their own drinking which was more controlled and justified by their economic (for example, the relative affordability of alcohol) or cultural position (such as an aesthetic appreciation of wine). Whilst many spoke of being aware of a need to ‘cut back’, for the women interviewed, ‘other behaviours such as a healthy diet and physical activity were perceived as important in neutralising or mitigating health risks associated with alcohol consumption’ (Dare et al, 2020: 44). As such, potentially harmful levels of alcohol consumption could be justified, and criticism avoided.

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There are various ways in which alcohol consumption can be at odds with the health needs of older people. Harmful alcohol consumption by the residents of care homes can be particularly challenging for care workers yet, as Klein and Jess (2002) found in their study of the alcohol policy of US care homes, there were few consistent policies relating to alcohol consumption in old age. They found that many care home policies operated in a field of ambiguity between prohibition, on health grounds, and promotion, for the social benefits of drinking particularly on certain occasions like birthdays and public holidays. In some ways, then, drinking in older age can present an inversion that is both fascinating and troubling. Entering older age may result in a loss of capacity and a reliance on others for care, this reduces autonomy and a retreat from the freedoms of adulthood gained during adolescence.

Alcohol and Drug-Related Deaths Many people die because of alcohol and drugs or have lives, in which ongoing problems with alcohol or drugs have been a feature, cut short. Deaths linked to substance dependency and misuse are often traumatic for family members but also involve the negotiation of stigma and negative perceptions of the deceased which can isolate mourning loved ones. In the face of such stigma, families may actively conceal the cause of death or be reluctant to acknowledge the role of substance abuse. Drug and alcohol-related deaths are often out of line with cultural ‘norms’ about a ‘good death’ being late in life, peaceful and dignified; in stark contrast, substance-related deaths can be violent, traumatic and alone (Valentine et al., 2015). Such deaths can involve both the shock of being ‘informed’ of a loved one’s death by police and then drawn-out legal processes to ascertain the causes of death. Stigma associated with addiction can transfer to the families, so that parents feel subject to social stigma akin to the idea that only a ‘bad mother’ or ‘bad father’ would abandon their son or daughter to be consumed and killed by their addiction. Because many drug and alcohol-related deaths are premature, traumatic and untimely, the loved ones of the deceased may struggle to follow ‘normal’ patterns of bereavement and commemoration. The nature of the long-term battle with addiction is that the families of some people who die through their substance misuse having been living with the possibility of death for a long time; as one bereaved mother puts it in Templeton et al., and and’s (2016: 344) study ‘Addicted families have been bereaved for a very long [time], they lost that person a long time ago’. Strikingly, in what is termed

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the Alcohol Harm Paradox, such harms affect those from deprived and disadvantaged groups more than those from economically advantaged groups (See Boyd et al., 2022). Alcohol and drug-related deaths are described as ‘diseases of despair’ for they become pronounced in localities and within communities where deprivation and social disengagement are most prevalent (Walsh et al., 2021). It is one of the great injustices in society that there are many solutions available to policy makers and practitioners that are viable for implementation in the UK, but there is often resistance to their introduction due to stigmatisation.

Summary This is the first of three chapters considering intoxication in relation to the socio-economic characteristics of users. We have sought to demonstrate how the experience of intoxication varies markedly at different points in a person’s life. From childhood and through the teenage years, an awareness of alcohol and drugs develops into personal experimentation for many, but not all. Moving into adulthood, intoxication is shown to act as a marker of group belonging and a means of demonstrating status. In later adulthood and through into middle-age and later life. The meaning and practice of intoxication changes. Shifting roles may mean a decline in drinking or drug use. There is, however, ample evidence showing intoxication to continue as a central feature in many people’s lives, up to and including death. Across the chapter, we can also see that there is a notable imbalance where research on alcohol and drugs in the lives ofyoung people far outweigh that examining alcohol and, in particular, drug taking in older age. That intoxication varies across the life course is not only a personal matter. As is the now familiar mode in this book, the chapter considered the wider social and cultural foundations of intoxication at different points in the life course. We have shown in this chapter that as we go through our lives different opportunities arise to consume alcohol and other drugs but these are shaped by context. As they age, opportunities for intoxication are also embedded with the other roles and responsibilities that people have at different points in their lives. In other words, the opportunities are constrained by notions of free time and disposable income but also cultural expectations of what being an adult, a mother or father, or what easing into retirement means for the accepted or stigmatised consumption of alcohol and drugs. As this is the opening of three chapters exploring how social identities and expectations in many ways shape the experience of intoxication, it is worth now reflecting on how intoxication is socially and culturally contingent. In the next chapter we pick up these themes looking at how our understanding of

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intoxication is shaped by issues around identity and diversity, paying particular attention to gender and sexuality. Points for Discussion

How does the meaning of intoxication change as we age? At what age do you think parents should talk to their children about alcohol and drugs? How do the roles we inhabit during our lives (e.g. ‘student’ or ‘mother’) shape our experiences of and attitudes to intoxication?

Read, Watch, Listen #8 Watch: Danish director Thomas Vinterberg’s 2020 film Another Round explores the impact of alcohol on a group of four middle-aged men who embark on an experiment that exposes the benefits and harms of drinking. Read: Several organisations produce guidance on talking to children and young people drugs. For example, the National Society for the Prevention of Cruelty to Children (NSPCC) website includes a page on ‘Children and drugs’ with suggestions on how to speak to children about drugs and the risks involved in their use. Similarly, the British anti-drug advisory service FRANK uses a ‘Concerned about a child?’ page of its website to advise parents and guardians on ensuring children make informed decisions about drugs. Listen: Recovery in the Middle Ages—Two Middle-Aged Suburban Dads Talk About Recovering From Addiction to Drugs & Alcohol is an informative yet often humorous podcast in which two middle-aged men discuss their efforts to recover from alcohol and drug addiction alongside competing demands of family, work and ageing.

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Thurnell-Read, T., & Fenton, L. (2022). Alcohol, age, generation and the life course. Palgrave Macmillan. Walsh, D., McCartney, G., Minton, J., Parkinson, J., Shipton, D., & Whyte, B. (2021). Deaths from ‘diseases of despair’ in Britain: Comparing suicide, alcohol-related and drug-related mortality for birth cohorts in Scotland, England and Wales, and selected cities. Journal of Epidemiology and Community Health, 75(12), 1195–1201. Williams, L., & Parker, H. (2001). Alcohol, cannabis, ecstasy and cocaine: drugs of reasoned choice amongst young adult recreational drug users in England. International Journal of Drug Policy, 12(5–6), 397–413. Wilkinson, C., & Dare, J. (2014). Shades of grey: the need for a multi-disciplinary approach to research investigating alcohol and ageing. Journal of public health research, 3(1). Wilkinson, S. (2015). Young people’s alcohol-related urban im/mobilities. In T. Thurnell-Read (Ed.), Drinking dilemmas: Space, culture and identity (pp. 148–165). Routledge. Wilkinson, S. (2018). Young people’s drinking spaces and Im/Mobilities: A case of ‘hyper-diversity’? Journal of Youth Studies, 21(6), 799–815. Wilkinson, S. (2019). ‘She was Like “Don’t Try This” and “Don’t Drink This” and “Don’t Mix These”’: Older siblings and the transmission of embodied knowledge surrounding alcohol consumption. Young, 1103308819858808. Valentine, C., Templeton, L., & Velleman, R. (2015). ‘‘There are limits on what you can do’: Biographical reconstruction by those bereaved by alcohol-related deaths. In T. Thurnell-Read (Ed.), Drinking dilemmas: space, culture and identity. Routledge.

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Introduction Having seen in the previous chapter how the meanings and practice of intoxication changes significantly across the life course, this is the second of three chapters which further explore the complex ways in which the experience and significance of intoxication varies depending on a person or group’s social position. Indeed, alongside age, gender—the subject of this chapter—is now one of the most extensively evidenced examples of how intoxication is subjectively experienced and responded to by authorities, the media, and society at large, in strikingly different ways. In this chapter, then, we will explore the ways in which alcohol and drugs have been in varied ways bound up with the expression of masculinity and femininity, as we shall see both allowing for conformity and subversion. Gender as a topic for alcohol and drugs scholars has been hiding in plain sight, only in recent decades did it become a specific focus of research and policy. As Hunt and Frank (2016: 328) observe, ‘historically, women have been disregarded from the world of intoxication and intoxication was viewed primarily as a characteristic of a masculine environment’. Across history, spaces in which intoxicants are consumed—from coffee houses of seventeenth century England to pubs of twentieth century—have tended to be male-dominated spaces from which women are totally or marginally excluded. Yet, paradoxically, the notion that gender shapes the right to drink alcohol or consume drugs, and the experience of and social response once intoxicated, is so common and consistent over time that it is only relatively recent that it has been studied in any depth. Women’s experiences of intoxication, as well as those of sexual minorities, have rarely been considered in and of themselves until ground-breaking scholarship in the late twentieth century provided a much needed corrective (e.g. Ettore, © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_9

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1992; Henderson, 1999). This is not to say the past is devoid of female characters and voices up until this point. On the contrary, a social history of intoxication is replete with examples of not only women’s intoxication but powerful female voices influencing the cultural discourses framing alcohol and drugs and those who use them. Women have traditionally been cast as a controlling or curtailing influence on men’s intoxication. For example, the Women’s Christian Temperance Union (WCTU) foregrounded the impact of alcohol on women, children and families (Walton, 2001). Intoxication as something that corrupts femininity is a recurring theme right up to modern media coverage of binge drinking. For example, in Chapter 4 we have already seen how the ‘Reefer Madness’ era anti-drug propaganda depicted drugs as a near demonic sullying force which would lead otherwise respectable women into a cycle of depravity. Indeed, the consistency with which intoxicants have been seen as a potential threat to respectable femininity across different historical periods and different cultural contexts means that gender is at the heart of most understandings of the place of intoxication in any given society. Scholarship has, however, been slow to catch up on this by making women’s experiences of alcohol and drugs topics of research and theory. Whilst epidemiological, public health and some criminological approaches have revealed the oftenvast differences in consumption, an emphasis on positivist empirical accounts has often justified the neglect or omission of women’s intoxication in favour of the statistically more dominant men’s intoxication. To this, we must add more recent scholarship which, over the course of the last three decades, has sought to explore how gender shapes many aspects of intoxication, how it is experienced, perceived and responded to. In the fields of alcohol and drug research, the specific experiences of women were largely absent until, form the 1970s onwards, the emergence of feminist scholarship and theories of gender began. It is only recently that intoxication has been theorised as a gendered matter. It has become increasingly clear that a nuanced understanding of the experience of intoxication requires considerable appreciation of the role played by gender and sexuality in shaping the consumption of alcohol and most recreational drugs.

Gendering Intoxication Despite (we hope) the readership for this book being from an array of personal, geographical and cultural backgrounds, there is also a good chance that even you view men’s and women’s intoxication as being in some way different or, more importantly, you recognise that it is treated differently. Further, this difference is likely to hinge on a double standard that means men’s intoxication is, to some

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extent, either accepted or encouraged whilst women’s intoxication is, to varying degrees, disapproved of, restricted, or prohibited. This pattern is neatly summarised by Elizabeth Ettorre (1992), whose work brought feminist scholarship into drug and alcohol research. In spite of there being no laws that formally discriminate by gender making, for example, making alcohol legal to purchase for men but not women or regulations that impose harsher punishments for male users of illicit drugs than female users, social conventions, for Ettore, along with stereotypes and prejudices shape often strikingly divergent response to men and women’s drug or alcohol use. We take gender as socially accepted and culturally specific ways of being masculine and feminine whereas sex refers to a set of biological traits relating to the labels male and female. As is discussed below, we consider gender to be performative and as something ‘done’ in the daily lives of individuals. Both gender and sex are most frequently proposed as binaries. There is growing awareness of the non-binary nature of gender but the experiences of trans and non-binary alcohol and drug users are, regrettably, seldom researched. One of the clearest examples of how cultural mores and social norms surrounding gender shape intoxication in various ways is the persistent double standard relating to how differently men’s and women’s drinking and drunkenness are treated. Alcohol consumption has a long history of being culturally gendered as a ‘masculine’ activity. A central feature of the gendering of alcohol consumption has been the public and private distinction. Historically, brewing beer was a domestic practice carried out by women known as brewsters. With industrialisation and urbanisation, the brewery industry coalesced around larger mechanised brewing serving growing markets. During the nineteenth century and early twentieth century pubs became established as male-dominated spaces associated with workplaces and the masculine rituals of public life, work and leisure of adult men. The layout of many traditional English pubs was sorted by sex in terms of who could be present where. The public bar, vault or taproom was a male only space, the lounge or saloon was where women could drink but only accompanied by a husband or male family member or in larger groups of family or colleagues. Thus, as Hunt et al. (2005: 227) neatly summarise, across many cultures ‘to drink is to be masculine, and to drink heavily is to be even more masculine’ and, conversely women’s drinking is seen as decidedly unfeminine (McDonald, 1994). As Plant and Plant (2006: 30) observe, ‘particular disapproval of women’s drinking appears to be deeply rooted in the culture of most, if not all, countries where people do drink’. Gender plays some part in the social ‘rules’ of who can drink or use drugs, where, when and how, but also what it means and what activities and feelings can be associated with it. Intoxication is an embodied experience in that it is an inescapably physical phenomenon involving affects upon the body and how it perceives and inter-

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acts with the sensory world around it, a world which is in myriad ways shaped by gender. Many of the expectations of how a male or female body should or should not behave in turn impact upon the intoxicated body, propagating often stark differences in how the intoxication of boys and men, on the one hand, and girls and women, on the other, are understood, judged and reacted to. Take, for example, a visible bodily expression of drunkenness such as slurring of speech or stumbling when walking. There is every chance that the sober onlooker would view a slurring, stumbling man with more tolerance and far less judgement than a woman whose speech and deportment reveal the same tell-tale signs of drunkenness. Thus, different degrees of acceptance of male and female intoxication relate to greater levels of moral judgement and social surveillance and control. The responses to male and female intoxication reveal vastly differing perceptions about both the autonomy and vulnerability of bodies. Alcohol associated with activities that were traditionally male-dominated such as the playing and watching sports is mirrored through advertising. The close relationship of sport, promotional culture and alcohol advertising is witnessed in the standard approach of a group of male friends sitting down to watch their favourite football team play, the team’s players wearing beer a global beer brand’s logo across their chests creates the assumption that beer will be drunk during the match (Crawford, 2009). Similarly, advertising breaks at half time dominated by adverts for beer (and betting!). The fundamental importance of gender as an organising structure of public drinking spaces is well illustrated in The Cocktail Waitress, a classic ethnographic study of ‘Brady’s Bar’, a bar in large city in the Midwest of the US (Spradley & Mann, 1975). Through extensive fieldwork involving one of the authors working as a cocktail waitress at the bar, gender is shown to directly structure numerous aspects of the bar for the almost exclusively male clientele and both the male and female staff who serve them. Gender, therefore, dictates the tasks carried out by male bartenders and female waitresses; whilst the former mix drinks, control money and oversee transactions with the outside world, the latter primarily service the customers seated at tables and in booths by taking orders, ferrying drinks and engaging in conversation with customers. Cocktail waitresses must, in order to fit in and be acknowledged as good at their job, quickly learn to talk and behave in a manner which confirms to ideals of ‘appropriate’ femininity. ‘Brady’s Bar’, they argue, is a ‘man’s world’ where ‘even the language and territorial arrangements reflect the dominance of males’ and a routine but complex repertoire of language and action is informed by entrenched assumptions about masculinity and femininity and the hierarchical roles and relationships of men and women. It is, perhaps, worrying that nearly half a century on from Spradley and Mann’s study such gender dynamics remain so common in many drinking venues.

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As we saw in the last chapter, the socially constructed ‘roles’ of mother and father directly shape perceptions of male and female drinking and drug use. The extreme to which drink or drug dependency would need to reach for someone to be adjudged a bad father in contrast to the low bar set for mothers, the precariousness and contingency of the line between ‘good’ and ‘bad’ motherhood in particular is troubled by intoxication. In an early paper exploring the gendered nature of alcohol consumption, Lemle and Mishkind (1989:214) descried alcohol abuse as a ‘male problem’ and asked: Why should it be that males drink and abuse alcohol in such magnitude and in such marked contrast to females? The most parsimonious explanation invokes the divergent ways that Western culture sanctions alcohol use for the two sexes: Drinking is a key component of the male sex role. Men are encouraged to drink, and in so doing are perceived as masculine. By contrast, drinking is discouraged for women, and is considered unfeminine.

Drawing on sex role theories, Lemle and Mishkind posited that alcohol consumption at all levels is socially and culturally recognised as a manly activity, symbolic of masculinity. Indeed, they go on to argue that the formation of drinking culture in Western nations is fundamentally gendered: from the earlier initiation of boys than girls to the assignation of public drinking venues as male space and the reinforcement in the wider culture, and the mass media in particular, that men who drink lots are more manly than those who moderate, abstain or fail to hold their drink. Drinking alcohol copiously and conspicuously in public, they argue, is also strongly associated with ideals of manhood and masculinity by being linked to other aspects of the male ‘role’ such as unconventionality, risk taking and aggressiveness. Various studies have described how alcohol consumption practices and spaces are a site for the performance and defence of the culturally dominant idea of manhood that Australian sociologist Raewyn Connell (2015) terms ‘hegemonic masculinity’. This involves the association of masculinity with strength and courage, autonomy and independence, aggression and competitiveness and describes a hierarchical gender order where many men strive to comply with a particular dominant form of masculinity whilst other expressions of masculinity and femininity are subordinated. This was shown by Gough and Edwards (1998) in a study focusing on the interactions of four young British men during a drinking session. As the group becomes drunk, attempts to outdo each other with witty or irreverent comments soon involve language that acted to marginalise women and other men, such as those from minority ethnic backgrounds.

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This association between alcohol and masculinity was also identified by the American sociologist Robert Peralta (2007), who observed how the white male college students supported an entrenched belief in the strong connection between heavy alcohol consumption and an idealised performance of manhood. Here, college men who can ‘hold their liquor’ and out-compete their peers in both the pace and quantity of drinks consumed are accorded higher status amongst the male peer group whilst those who moderate and abstain, or those who too readily submit to the intoxicating effects of the alcohol, are cast as weaker, often by an association with femininity, homosexuality or infantile immaturity (Peralta, 2007). Studying young men in London, De Visser and Smith (2007) also found a similar linkage between heavy drinking and the competitive performance of masculine status but observed a process of ‘trading masculine competencies’ where other normatively masculine abilities and accomplishments, such as sporting success or sexual conquests, could offset a lack of inclination to engage in excessive macho drinking. Training for elite sports, for instance, would be accepted as a justification for moderating alcohol consumption. Drinking and drunkenness provide activities and spaces in which boys and men can ‘prove’ themselves through manly drinking (Leyshon, 2005). Hugh Campbell (2000: 565) studied rural pubs in New Zealand and argued that ‘the performance of masculinity in the pub repeatedly represents a historically embedded notion of masculinity, integrated both in the drinking men's personal biographies and in their sense of localness, while powerfully excluding competing notions of what constitutes legitimate gender behavior’. In his analysis, Campbell focuses on the interactions and conflicts that structure the public performance of masculinity in public drinking spaces. Drawing on the dramaturgical analysis of behaviour in public, Campbell outlines the powerful social imperative requiring men to enact their manhood on the ‘stage’ of the local pub through drinking alcohol and displaying verbal skill in conversation whilst rejecting any encroachment of weakness, subservience or femininity. Campbell’s analysis suggests that in this context the two things that threaten to undermine a man’s public masculinity would be being seen to not hold one’s drink or, perhaps worse still, being publicly scolded by his wife or partner. Other studies have looked more broadly at the significance of drinking and drunkenness in men’s friendship groups and personal lives. Starting in their teenage years and continuing in various forms well into adulthood, drinking alcohol together is a central activity that binds together many male friendship groups (Thurnell-Read, 2012). Drinking together provides a shared history of drunken stories and experiences and provides the group with their own in-jokes, territory, legends and myths (Blackshaw, 2003). For many men, drinking with friends in the environment of male-dominated pubs and bars sustains a sense of both per-

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sonal and collective masculine identity which may be less easily achieved elsewhere. For example, Anoop Nayak (2003) studied a group of young working-class men in Newcastle who centred their social lives on the pub and the football ground. Both sites were seen as places where a proud working-class masculinity could be performed in spite of wider social, economic and cultural changes which were felt to rob them of the locations such as shipyards, colliery pit and factory floors, where a tough working-class masculinity was achieved by their fathers and grandfathers. The association between masculinity and the meanings and practice of illicit drug use is well illustrated in recent research by the Irish sociologist Clay Darcy. In his attempt to make ‘Irish men’s recreational use of illicit drugs visible as a gendered activity’, Darcy’s (2018: 20) analysis of interviews with a range of Irish men who use illicit drugs recreationally highlights how ideas about manhood and proper or deviant ways to be a man inform how perceptions of personal and group drug taking are framed and understood. As such, men who take cocaine were associated with higher status and a clear presumption that conforming to masculine ideals by holding down a well-paid job offset any negative connotation of drug use. Meanwhile, users of other hard drugs, particularly heroin, were subject to pejorative labelling as ‘scumbags’ and adjudged to have failed to uphold masculine standards of mental and physical self-control. The intoxicated behaviour brought on by illicit drug use potentially undermines, and in a few cases enhances, men’s ability to conform to expected and desirable standards of gendered comportment. Considering the participants who were active drug takers, Darcy (2018) observes the importance in the interviewee’s accounts of the homosocial context of recreational drugs use and how all were initiated into drug use by other men, with the majority describing how being offered drugs in their teens by older male peers was perceived as part of the transition to manhood. Importantly, Darcy (2020) suggests that the intersection of masculinity and recreational drug use involves not just the pursuit of pleasure and enhanced bonds with male peers but a complex negotiation of risk and emotional tensions, where the ‘chilled out’ effects of cannabis allow young men to cope with adversity in their lives and the ‘buzz’ of ecstasy means expressing an euphoric empathy. This could be seen to represent an outlet for emotions that are, at other times, restricted by expectations of masculine stoicism and emotional restrain which young men often ‘learn’ from an early age as ways of avoiding accusations of femininity or homosexuality. Thus, ‘while illicit drugs are resources that can be used in the social construction of masculine identities within homosocial contexts, men’s rationales for engaging in recreational drug use reveals that the way masculinities are sometimes performed are in tension with how they are experienced, embodied, and lived by drug-taking men’ (Darcy, 2020: 435).

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There is also recent research showing masculinity to play a role in experiences of treatment for problem drinking. For example, through interviews with male prisoners in Israel engaged in Narcotics Anonymous (NA) programmes, Gueta et al. (2021) suggest that such 12-step programmes (discussed in Chapter 6), with their emphasis self-disclosure and on admissions of powerlessness, initially contradict the structures of hypermasculinity that dominate prison life. This was well captured by Amit, one of their participants, who illustrated his initial reticence to participate in such treatment programmes in overtly gendered terms by saying: ‘I didn’t go to treatment because treatment is asking for help. Will I ask for help? I’m a man! Do I need help? That’s unimaginable: I understand, I know, I can, I’m strong!’ (Gueta et al., 2021: 112). However, they found that programme participants were able to reframe their engagement with treatment around notions of respectability and courage that recast treatment seeking and recovery as a masculine act of pragmatism and courage. Interestingly, for many participants, recovery involved not just a rejection of hypermasculinity associated with drug use and criminal violence but its replacement with a more caring and supportive framing of masculinity. We will consider in the next section, women’s experiences of alcohol and drugs are massively influenced by their gender and by social assumptions about the (un)suitability and (in)appropriateness of female intoxication. However, before doing so, it’s important to note the various implications of masculine ideologies and practices shaping men’s drinking and drug use. The imperative to perform masculinity through drinking and in drinking spaces can encourage heavy, reckless drinking and involvement in risky behaviour. Behaviour, such as aggression and violence towards other men and unwanted sexual attention and violence against women, is harmful to others. Alternatives to macho displays of intoxication are often positioned as unmasculine, as feminising or infantilising, and this means cutting down or abstaining can be seen as a weakness or disloyalty. This can also mean that acknowledging problems such as dependency and seeking help in either support or treatment are associated with weakness and failure. There can be an unspoken agreement that men should not reflect too deeply on their drinking or drug use; that as long as we all agree it’s just ‘what men do’ than the tricky task of unpacking the benefits and harms of intoxication need not be undertaken. Recently, however, there is some cause to hope for progress being made in how men talk about their relationships with alcohol and drugs with honesty and insight. Heavy drinking was for a long time seen as part of the macho lifestyle of professional football. Examples include stars like George Best and, later, Tony Adams, Ray Parlour and Paul Gascoigne. Drink and drugs were used to cope with the highs and lows of their sporting careers and to manage the huge physical and

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psychological tolls exerted on professional sportspeople and athletes. A trend in the early twenty-first century has been for disclosure and honesty by male sports stars about their battles with addiction. Tony Adams has become an articulate and vocal advocate for substance abuse support. Cricketer Andrew (Freddie) Flintoff and boxers Ricky Hatton and Tyson Fury have all spoken about how mental health struggles led them to drink or drugs. Indeed, all have spoken of how men, in general, and sportsmen in particular have for too long been bound up with the culturally enforced idea that strong men do not talk about weaknesses or loss. Further, implicit in all of their accounts is the acceptance that the heavily masculine-coded sporting lifestyle is one where a problematic relationship with drink or drugs hasbeen too easily masked behind a public image of sporting success and masculine achievements. We see many examples of psychological harms of maintaining the hyper-masculine persona expected of sports stars and athletes. While these candid interviews undoubtedly represent progress, it remains to be seen if having such prominent sportsman and male athletes talk openly about their struggles with addiction foster more acceptance of men in all walks of life reflecting on and, where needed, seeking help with their relationships with drugs and alcohol. Intoxication in Contrast 9

Sarah Gee and Steve Jackson (2012) made a critical analysis of the New Zealand beer brand Speight’s ‘Southern Man’ advertising campaign and found that it used ironic humour to perpetuate a representation of rural, white and ‘unapologetic’ masculinity. Nostalgia is used to marginalise ‘other’ forms of masculinity and to maintain an association between beer drinking and ‘authentic’ New Zealand masculinity. In contrast, Swee-Lin Ho examined changing values concerning women’s drinking in Japan and identified that from the 1990s onwards a concerted effort was made by Japanese drinks manufacturers to target professional women with new products and advertising campaigns. Companies such as Beam Suntory launched a form of whisky-soda mix drink known as a Highball. These new products were marketed using images of female celebrities, such as actresses and singers, depicted as independent, confident and knowledgeable drinkers in a way that framed drinking as an expression of modern femininity (Ho, 2015). Gee, S., & Jackson, S. J. (2012). Leisure corporations, beer brand culture, and the crisis of masculinity: The Speight’s ‘Southern Man’ advertising campaign. Leisure Studies, 31(1), 83–102. Ho, S. L. (2015). ‘License to drink’: White-collar female workers and Japan’s urban night space. Ethnography, 16(1), 25–50.

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The Feminisation of Intoxication The marginalisation of women in public drinking spaces is well illustrated by the British social geographer Michael Leyshon (2008) in his study of young women living in rural areas of the South West of England. Drinking in village pubs, but also experimenting with alcohol in other public or private spaces, such as bedrooms, affords young women an opportunity to perform their emerging gender identity and experiment with both compliance with and subversion of expected forms of feminine conduct. Alcohol, then, is a rule-bound activity in which gender is integral to expectations of how young people should behave but also an appealing opportunity for those transitioning through adolescence into young adulthood to explore forms of self-expression and bodily comportment that might otherwise be closed off to them, particularly given the restrictive limitations of rural social opportunities. Since the 1980s there is said to have been a ‘feminisation’ of the alcohol industry with drinks and venues marketed to women as part of a fun, independent ‘post-feminist’ lifestyle. Between 1992 and 2002 the average weekly consumption of alcohol for women aged 16–24 years rose from 7.3 units to 14.1 units. The most recent alcohol consumption statistics for England, collected in 2019 and published in July 2021, show a still present, but narrowed, disparity. 50% of men reported having drunk alcohol in the past week and 13% of men reported drinking on at least five days, whilst the equivalent figures were 50% and 8% for women. In spite of a trend towards ‘equality’ in alcohol consumption rates (Schmidt, 2014), the attitudes to male and female drinking continue to draw on notions of morality and stigmatisation. Thom (1994) and Ettorre (1992, 1996) have conducted research to reposition women’s drinking as a topic of specifically feminist research. Such perspectives assert that the experiences of women who drink, particularly to a point where they become labelled as deviant or flawed, were not simply the choices of individuals but part of wider structural inequalities and discriminating forces in patriarchal societies. As such, the especially harsh judgements passed on women who drink and the readiness to associate problematic drinking with a failure to uphold gender roles and expectations need to be exposed and critiqued. Women’s drinking is a threat to femininity and their experiences and struggles are misunderstood or rendered invisible and trivialised. Critically, these studies showed the role of psychological pressures of striving to uphold social standards as women and as mothers. Alcohol played an intimate role in some women’s lives, offering them solace and comfort. Women’s lack of access to treatment and public health discourses failed to recognise the specific role of gender and misogyny in shaping many women’s experiences of alcohol misuse.

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A recent trend is one of convergence where the ‘feminisation of intoxication’ has seen products and drinking venues marketed to young women through associations of intoxication with a desirable ‘post-feminist’ femininity. Simonen (2011) found a greater acceptance of intoxication-oriented drinking in young women’s accounts of drinking and drunkenness in Finland. Those interviewed in the 1980s actively distanced themselves from excessive drunkenness as a threat to femininity whereas interviews with Young Finnish women in the 2000s showed a culture of binge drinking being widely tolerated and even celebrated. The tricky balancing act for young women engaging in cultures of intoxication require them to both embrace drinking as an overt display of popularity and friendship whilst maintaining often hyper-sexualised femininity emphasising physical beauty is something explored in a number of recent academic studies of women’s drinking (Atkinson & Sumnall, 2016). Alison Mackiewicz (2015: 78) suggests that ‘the night-time economy, of which the ‘culture of intoxication is a part, is an example of this space within which some young women, in striving to negotiate contradictory and complex discourses of femininity, compete and critique each other on the basis of consumption’. However, we also consider the gendered risk and victim blaming associated with women who enter states of intoxication, where women who have been raped and assaulted are themselves blamed for ‘putting themselves at risk’ by being drunk. Notably, many drinking spaces and, more recently, drug taking associated with electronic dance music subcultures, offer unique opportunities for young men and women to socialise and engage in sexual activity. Studies showed gender to be an important factor shaping frequency of drug use and differing practices relating to when, where, how and with whom drugs are taken. Research by Powis et al. (1996) showed female heroin and cocaine users to use smaller amounts, less frequently and be less likely to inject then male users. Importantly, they also noted that women who injected heroin most commonly did so with a male (sexual) partner, a point also clear from Pearson’s (1987) studies of heroin use in the 1980s. We return to this issue later. Tuchman’s (2015) analysis of injecting drug practices based on her interviews with a sample of women at a syringe exchange service in the US showed that more than half the women interviewed received their first injection from other women within their network and that many women transitioned to injecting influenced by other women. These findings add further weight to the conclusions drawn from an earlier article (Tuchman, 2010), which reasserted how women with substance use disorders face significant, indeed multiple barriers to accessing treatment and that ‘the interplay of gender-specific drug use patterns and sex-related risk behaviors’ create ‘an environment in which women are more vulnerable than men to

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human immunodeficiency virus’. All of which means that it is vital to understand the gender differentials as these ‘have important clinical, treatment, and research implications’. The complexity of women’s drug use is also highlighted in Nelson’s (2021) recent research on female cannabis use in Nigeria. In adopting an intersectional approach, his findings demonstrate the importance of a range of social-identity categories impacting on the stigma surrounding drug use by some Nigerian women. These include levels of education, experiences of mental and physical illness and interpersonal relationships with family, friends and romantic partners, all of which played a part in shaping female interviewees’ experiences of cannabis use and the possible discrimination associated with being seen as a drug user by peers, family and the wider community. The idea that drug taking is part of the experience of constructing and maintaining a gender identity for women who take drugs is further theorised by British criminologist Fiona Measham (2002) who, in her influential article ‘Doing Gender, Doing Drugs’, draws on West and Zimmerman’s (1987: 126) conception of ‘doing gender’ whereby gender, as opposed to biological sex, is seen as culturally and socially sustained as ‘a routine, methodical, and recurring accomplishment’. Gender, therefore, is enacted in the routines and practices of daily life and even taken-for-granted ways of behaving are the result of social processes that reinforce the distinction between the masculine and feminine ways of doing things. Measham applies this to the increasing number of women taking recreational drugs, particularly ecstasy, from the 1990s onwards. At this time, there was a narrowing but still notable gender gap in drug use, with men reporting higher frequencies, greater quantities and wider combinations of drug consumption than women. Importantly, however, Measham’s analysis argued that, beyond these quantitative measures of drug use, ‘the ways in which people “do drugs” appears to be gendered in terms of subjective experiences, perceived positive and negative physical and psychological effects, and the desired states of intoxication’ (Measham, 2002: 341). Drug use, then, is not just influenced by gender but is, in itself, a way of accomplishing a gendered identity, particularly through its association with the leisure, music and style cultures of raves and clubbing. Drawing on extensive interview data with young people in the North West of England, Measham (2002) explained how certain drugs were seen by female users as an appealing means of increasing social confidence and the ability and willingness to socialise as part of a feminised ‘nighttime’ persona. A further finding, specific to young women, was that many users of stimulants, particularly ecstasy and amphetamines, allowed female clubbers to maintain stamina when dancing, and in the process burn calories as a way of slimming the female body in line with socially desired norms. Lastly, whilst noting the importance of narratives of freedom, pleasure and self-ex-

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pression framing young female clubbers’ accounts of drug taking, Measham notes that young women appeared more likely to show self-policing and self-restraint, both to remain gender ‘appropriate’ and to avoid gender-specific risks. A concern with the invisibility of female drug taking in criminology scholarship and in studies of youth subcultures is something Fiona Hutton (2016: 71) works to remedy in her study of female clubbers. Drawing on extensive interviews with female participants in Manchester’s club scene, she argues that ‘women are competent social actors that produce their own identities’. Thus, their experiences of drug taking in club spaces are part of an important and necessary development in understanding how women navigate the pleasures and risks of both drug use and associated activities such as dancing, socialising and expressing oneself sexually. Hutton’s study therefore offers an important corrective to the skewed focus on male drug use and illustrates the need to approach young women as active agents in negotiating drug-based club cultures. She notes, for instance, that as well as occupying key roles in the scene as DJs and club promoters, some women are active as drug dealers, a role so widely assumed to be malecoded. Notably, the women interviewed are reflective of the tensions that emerge between the promise of a social space where young women’s pleasure through drug taking, dancing and uninhibited socialising is made possible by more egalitarian gender relations and, conversely, the various risks such spaces create. There is also evidence that some drug taking contexts, such as the club culture in the San Francisco area studies by Hunt et al. (2010: 182) allow ‘young men and women to explain or excuse non-normative gender practice’. The effects of ecstasy and, importantly, the atmospheres and social interactions it gives rise to allow young women a space in which they can be disinhibited and socially assertive whilst young men are afforded opportunities for a more emotional and empathetic masculinity less focused on the competitiveness of proving macho status in through heteronormative ‘hook ups’.

Alcohol, Drugs and Sex Historical accounts of intoxication dating back to at least the seventeenth century make the connection between intoxication and sex. Some of the early descriptions of opium making the user ‘vigorous and brave’, were, according to Davenport-Hines (2004: 16), a euphemism for ‘sexual stamina’. Many people find or perceive themselves to be more sexually adventurous when intoxicated. Alcohol and certain drugs may have physiological and psychological effects that make people more amorous and less inhibited. Plant and Plant (1992: 112) evaluated

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the extensive research and cautiously concluded that there is ‘an association betweenalcohol, certain drugs and risky sexual behaviour’, whereby ‘some people doubtless use alcohol and other drugs for sexualpurposes, being influenced by both popular and obscure beliefs and misconceptions about their disinhibitions and allegedaphrodisiac properties. For many groups of young men, an integral part of the ritualistic drinking of alcohol in urban settings is an overt, and often aggressive, surveillance of women and pursuit of sexual conquests amounting to a public performance of heterosexual masculinity (Grazian, 2007). Two other studies illustrate this association between alcohol consumption and sexual activity well. Dumbili’s (2016) research with students in Nigeria showed that both male and female students saw alcohol as a resource to increase arousal and reduce inhibitions. Notably, female students saw alcohol as allowing the confidence to be bolder in initiating sexual relationships and enhancing sexual satisfaction, whilst many male students spoke of certain drinks as improving sexual prowess and prolonging stamina. Similarly, a study in Denmark by Jensen and colleagues (2019) found that the intoxication brought on by alcohol consumption was associated by some young Danish women as a pleasurable freedom allowing the confidence and disinhibition needed to engage in flirtatious and sexually charged behaviour in urban leisure spaces such as bars, clubs and at house parties. Interestingly, many of the young women involved in the research reflected on the risks present in such settings but also the expectation that close female friends would ‘help’ them by looking out for each other and, where needed, assisting them to detach themselves from unpleasant or risky situations. Yet it is not just in initial or fleeting encounters that intoxication is often seen as being part of relationships. There is a growing body of research that looks at the specific context of intoxication that exists within intimate romantic relationships. The drug use of intimate partners is intertwined and understanding individual decisions about when, how and why to use illicit drugs, or not, is informed by the often-intense connections formed within romantic relationships. Indeed, certain drugs are often felt to be more conducive to psychological and sexual intimacy, with ecstasy having in the past been termed a ‘love drug’. Herold (2015) interviewed young Danish women in the process of reducing or ceasing previously extensive illicit drug intake and found that many young women interviewed spoke of their past or present boyfriends as central to their experience of both increased drug use and varied attempts to either reduce or cease. Thus, boyfriends could be cast as either heroic or irresponsible others with the young women framing their efforts to reduce the drug taking of themselves and their romantic partners in terms of responsibility and maturity. Further, for some interviewees, the romantic relationship is an important context in which illicit drugs are expe-

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rienced and understood with the couple forming what Herold (2015) refers to as an ‘oppositional unit’ sharing together an opposition to parental authorities and social expectations. Recently, research has begun to reveal the importance of intimate interpersonal relationships as a context in which women’s initiation into drug taking, especially of harder drugs such as heroin, takes place (Mayock et al., 2015). The sociologist Fiona Martin carried out qualitative research in Australia examining the significance of intimate relationships in both initiation into (2010) and disengagement from (2011) injecting drug use. The young women interviewed ‘almost always accounted for transitions and variations in their drug use by referencing their involvement with a boyfriend or husband at the time’, whilst some women recounted their first experience of injecting drugs by describing ‘the importance of injecting for the first time with someone they trusted, which brought about a stronger or unique bond between them’ (Martin, 2010: 516). Thus, for many of the young women, the decision to begin, continue or cease injecting drugs such as heroin is irreducibly coupled with the connections and conflicts which ebb and flow in their romantic relationships. Taking or not taking drugs and making important decisions about their own drug use are bound up with those of their present and former partners. Tellingly, accounts of disengaging from injecting drug use involved a complex process of needing to ‘disentangle themselves from their previous, “addict” identities’ whilst also negotiating the loss of ‘practices and relationships that were once integral to their sense of self’ (Martin, 2011: 356). Sexual activity and the negotiation of sexuality was also a central theme in Hutton’s (2016) study of female clubbers discussed in the previous section. Thus, whilst Hutton observes that ‘club spaces are generally argued to be places where women can take part in drug taking, dance and abandonment without fear of harassment and sexist behaviour from the men that are present’ she also notes that ‘club space still involve women clubbers negotiating the pleasurable experiences of their sexuality within the constraints that ‘openness’ about sexuality leads to’ (Hutton, 2016: 20). Whilst club spaces were felt to offer relatively novel ways for women and men to relate to each other in more egalitarian and less sexualised ways, so too did female clubbers feel both a pressure to embody particular expressions of sexually confident femininity and a requirement to navigate risks associated with unwanted sexual attention. Ideals about the club scene being safer, more inclusive and less focused on heteronormative hook ups were problematized by expectations about the lowering of inhibitions and interactions with strangers in club spaces when high on ecstasy and other club drugs.

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Drawing sex and sexuality into understandings of substance use is important. For instance, Andersen and Thing (2021) have recently suggested that sexual experiences and relationships are part of a ‘gendered storyline’ for some young women. Therefore, a better appreciation of the pleasures, risks and potential traumas of sexual experiences being bound up with drug use and the relationships which provide a context for it should be incorporated into treatment and support. The reliance of gender stereotypes to frame understandings of the perceived risks of hazardous drinking is clear in the You Wouldn’t Start Your Night Like This campaign by the UK Home Office which produced different materials by gender, each positioning a range of concerns and dangers which young reckless drinkers might be prone to. Tellingly, the video featuring the young man depicts a range of physical harms to the body whereas the counterpart video featuring a young women emphasises implied sexual vulnerability; similarly, a poster accompanying the campaign featuring a near empty beer class and the caption ‘WOULD YOU SMASH THIS IN SOMEONE’S FACE?’ and for woman a half opened car door on a dark street and the phrase ‘WOULD YOU GET IN WITH A MAN YOU’VE ONLY JUST MET?’. Alcohol and drunkenness are not a direct focus of Peggy Reaves Sanday’s (1990/2007) study of case of fraternity gang rape at University of Pennsylvania in 1983 but they are, tragically, central to the harrowing account of how a culture of macho privilege provided the fertile ground for the rape and subsequent injustice. The case relates to a female student, Laurel, who was gang raped by male students whilst heavily drunk at a party at a fraternity house. In seeking justice for her assault, Laurel faced an institutional cover-up of their star athletes’ behaviour. Central to this was the victim blaming where the depiction of Laurel as a girl who ‘liked to party’ and by drinking in frat houses put herself in a position of danger. Her drinking was used as example of her mental instability. All this is framed by gender and sexuality. Ideas of young men’s sexual desire as unlocked by drink and victim blaming of a woman who ‘should have known better’. Reaves Sanday investigates the culture of proving masculinity through ‘riffing’—picking up or persuading girls to sleep with them in which alcohol was often used strategically to get female students drunk and fraternity practice of bonding through sex and an ideology of male dominance which presumes aggressive male heterosexuality to be ‘natural’. Research suggests that most women are acutely aware of potential violence and predatory sexual behaviour in the alcohol-fuelled spaces of the night-time economy and may develop a range of strategies to mitigate their vulnerability to such risks. These include an individual or group plan to pace drinking so that one or more of a group remain alert to possible risks. Brooks (2014: 312) states that

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‘the majority of participants in the current study disclosed an experience where their safety had been compromised in a bar or club through sexual assault, sexual harassment or possible drink spiking’. Similarly, Sheard (2011) found amongst her interviewees a recurring concern with safeguarding their drinks on a night out. Both Sheard (2011) and Brooks (2014) suggest that the narrow focus of media depictions of ‘drink spiking’ as an act perpetrated by a predatory stranger seeking to covertly contaminate women’s drinks with a drug such as Rohypnol detracts from a more diverse range of experiences and understandings of the women’s negotiation of environments that make them physically and sexually vulnerable. Such discourses serve to narrow understanding of what is a far more nuanced reality where women enter the night-time economy with an awareness of the risks involved and both an ability to perceive and respond to risks and a retained desire to enjoy alcohol-focused leisure spaces. Recent research which explores ‘Chemsex’ provides a useful illustration of the complex interplay of sexual behaviour, identity,drug use and risk. The term ‘chemsex’ was coined by the British LGBT + activist and health worker David Stuart in the mid-2010s in the UK to describe what has been depicted as a widespread use of drugs such as crystal methamphetamine, mephedrone and GHB by gay men during sexual activities. Møller and Hakim (2021: 2) preface a special edition of the journal Sexualities by suggesting the ‘chemsex as risk’ paradigm which rapidly established itself in media, public health and some academic debates has recently been challenged by a range of critical scholarship seeking a more nuanced and empirically informed understanding of the practice as a personal, cultural and health phenomenon. For example, within the same special issue, Florêncio (2021: 2) suggests that sexualised drug use by gay men has a long history that precedes the advent of chemsex as a practice within some queer subcultures and argues that the ‘collectively eroticised consumption of drugs’ is ‘a form of subcultural reproduction, one that cannot be exhausted by extant attempts to reduce it to a self-harming practice’. Arguing that chemsex cultures are specific social worlds for participants, informed by the negotiation of identity, belonging and pleasure, he suggests that chemsex can be a life-affirming experience for participants and one that connects them to a queer subculture. Similarly, and also writing in response to a public health paradigm framing of chemsex as deviant risk taking, Milhet et al. (2019) interviewed French gay men and other men who have sex with men (MSM) about their motivations and experiences and found the practice to involve more than just bodily pleasures. Thus, the men interviewed spoke of a complex mix of pleasures and risks including liberating sexual interactions with men who went on to become romantic partners and close friends, but also vulnerability and regret including sexual violence and drug dependency.

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Queering Intoxication Alcohol, drinking and drunkenness can carry specific meanings relating to gender identity and sexuality expression. Drawing on focus groups conducted in Scotland with LGBT participants aged 18 to 52 years old, Emslie et al. (2017) observed the centrality of alcohol on the commercial gay scene and its role in the performance of queer identities. The research identified a range of often playful stereotypes around beverage choice, with ‘gay drinks’ typically including alcopops and cocktails for gay men and pints of beer and cider for lesbian women. Participants also raised concerns relating to alcohol misuse and dependency, with alcohol becoming a coping mechanism for those experiencing discrimination and isolation. The British sociologist Beverly Skeggs (1999) studied the leisure venues of Manchester’s gay village and theorised the gay leisure spaces occupying the previously disused warehouses flanking Canal Street to be an important visible expression of gay identity. Further still, the venues were appealing ‘safe spaces’ for heterosexual women to escape the ‘male gaze’ of judgemental surveillance and ‘process of categorization by which they are constantly judged as inadequate/ inferior/pathological’ that, as noted above, is a feature of many women’s experiences of mainstream commercial venues (Skeggs, 1999: 228). Annette Pritchard and colleagues (2002: 118) also studied Manchester’s gay village, and found that whilst the ‘gay and lesbian spaces have emotional and psychological importance as empowering places in a “straight” world’, lesbian women struggled to assert autonomy and legitimacy given the dominance of the established gay male community. This was also the conclusion of research carried out at University College London evaluating the importance of nightlife venues to welfare and well-being of the city’s Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) community (Campkin & Marshall, 2017). Venues such as pubs, music venues, nightclubs catering to members of the LGBTQ+ community were ‘important spaces for education and intergenerational exchange’ and valued as ‘non-judgemental places in which diverse gender identities and sexualities are affirmed, accepted and respected’ (Campkin & Marshall, 2017: 10). However, the report also stressed that due to a range of issues from redevelopment, licensing complications to financial adversity, the London’s LGBTQ+ venues to be closing at an alarming rate and this impacts the cities LGBTQ+ community. An example of the importance of gay venues to the city and their inclusion in narratives about urban heritage is The Royal Vauxhall Tavern, a South Lon-

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don pub and arts venue that, as one of the city’s oldest gay venues, was the UK's first building to be listed in recognition of its importance to LGBTQ community history. In adding to its list of historically important heritage sites in 2015, Historic England cited the pub building to have a ‘historic and cultural significance as one of the best known and long-standing LGB&T venues in the capital’ and ‘an enduring symbol of the confidence of the gay community in London’. Gay venues in major cities in Western liberal countries tend to be the focus of much of the literature around queering intoxication but studies also show the importance of bars and clubs as spaces for gay community in Seoul’s Chong-ro district (Alexander, 2019) providing a sense of belonging in restrictive societal contexts, which is also seen in Soweto, South Africa (Livermon, 2014) and Bali, Indonesia (Waitt & Markwell, 2015).

Summary In this chapter, we have seen how the pleasures and risks of intoxication are negotiated in different ways depending on one’s gender and sexuality. Whilst we did not dwell on the long history saturated with examples of men's and women’s intoxication being treated differently, we have shown that any understanding of how our present ideas about gender, drink and drugs must include some appreciation of this long history which shapes both the actual phenomena and public and academic understanding of it. Many regions have seen a recent closing of a once vast ‘gender gap’ in alcohol consumption but often sexist stereotypes about women who consume and are seen to enjoy alcohol and drugs persist with alarming continuity. Whilst women are central to the night-time economy both as workers and customers, there is space to argue as Marion Roberts (2018) has, that with some notable exceptions the policy and planning supporting the growth and development of urban nightlife has failed to adequately acknowledge and account for the ‘traditional versions of masculinity and femininity embodied in the places of night-time entertainment’ which ‘require concerted and explicit action to challenge’ (Roberts, 2018: 143). There is a need to move beyond accounts that position female drug users as either victims to be pitied or empowered individuals to be celebrated (Mayock et al., 2015). Rather, gender, sex and sexuality are clearly integral to many, if not all, peoples’ negotiation of alcohol, drugs and intoxication. Gender must be appreciated and taken into account in treatment provision but also in policy discourse in ways that it has not been until this point (Hamilton and Eastwood, 2017).

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Points for Discussion

How and why do attitudes and expectations of men's and women’s alcohol or drug use differ? Is the relationship between intoxication and sex problematic? How might the experiences of people from gender and sexual minorities differ from those presented in mainstream policy, media and academic debates?

Read, Watch, Listen #9 Read: Social Context of LGBT People’s Drinking in Scotland is a 2015 report by Emslie, Lennox and Ireland for Scottish Health Action on Alcohol Problems (SHAAP) examining the prominence of alcohol on the commercial gay scene and the role of drinking alcohol in the identities of LGBT people. Watch: In the 2022 documentary for BBC Northern Ireland Janet Devlin: Young, Female and Addicted former talent show star Janet Devlin explores the impact her alcohol addiction has had on her life and looks at how risky drinking is affecting other young women in Northern Ireland. Listen: Intoxicated Masculinity with Mishka Shubaly is an episode of the Sober Curious podcast series in which host Ruby Warrington speaks to writer Mishka Shubaly about the often problematic relations.

References Alexander, E. (2019). Chong-ro: A Space of Belonging for Young Gay Men in Seoul. Boyhood Studies, 12(2), 11–28. Andersen, D., & Thing, I. F. (2021). Let’s talk about sex: Discourses on sexual relations, sugar dating and “prostitution-like” behaviour in drug treatment for young people. Nordic Studies on Alcohol and Drugs, 38(5), 399–413. Atkinson, A. M., & Sumnall, H. R. (2016). ‘If I don’t look good, it just doesn’t go up’: A qualitative study of young women’s drinking cultures and practices on Social Network Sites. International Journal of Drug Policy, 38, 50–62. Blackshaw, T. (2003). Leisure life: Myth, masculinity and modernity. Routledge. Brooks, O. (2014). Interpreting young women’s accounts of drink spiking: The need for a gendered understanding of the fear and reality of sexual violence. Sociology, 48(2), 300–316.

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Intoxication, Ethnicity, Faith and Nation

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Introduction In this chapter we will explore the role played by ethnicity, religion and nation in shaping drug and alcohol practices and consider how notions of race, faith and nation have shaped attitudes and responses to drug and alcohol use. This ranges from the acceptance of drinking cultures through to the sustained persecution of ethnic minority people via stereotypes and stigma that associate them with drug-related crime or, for others, with abstinence unfitting of a supposed national drinking culture. Importantly, we see that distinctions between nations, ethnic groups and religious faiths have historically been used to shape attitudes to drugs and alcohol, often by positioning another group and their intoxication as problematic, immoral or threatening. Just as Christianity played a key role in shaping the Temperance Movement of the nineteenth century, in the twentieth century racist tropes would be used to demonise specific groups in society. In the US and the UK a long history of ‘scapegoating’ involves linking an illicit substance and its harms to a specific rationally subordinate group (Reinarman & Levine, 1997). It is important to consider the social divisions relating to race, religion and ethnicity for several reasons. They shape our own experiences, exposure to intoxicants, attitudes and beliefs and influence the meanings we attach to alcohol and drugs both for ourselves and for others. There are also striking inequalities in how the drinking or drug taking of some groups has been framed as deviant and threatening, whilst that of others goes unnoticed and unremarked upon. This has fed into vast disparities in how rules, regulations and laws relating to illicit substances are imposed. Such discriminatory treatment also further entrenches prejudices and has in recent decades played a huge role in exacerbating inequalities and furthering divisions within many societies. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_10

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Drinking Nations and National Drinking Cultures We start at the national level and the widespread idea that nations have distinct styles of drinking and culturally embedded ways of relating to alcohol and intoxication. As we saw in Chapter 5, anthropological and sociological accounts have tended to foreground cultural continuity that explains how drinking styles are learnt through social learning and transmission. Over time, the prevailing social and cultural conditions in a given country are bound to shape the ways in which people can access intoxicants, where and how they consume them and what meanings are attributed to them and their effects. A drinking culture is one that persists over time and is transmitted between generations whereby certain ways of thinking about and relating to alcohol and drunkenness are learnt by individuals but also upheld and continued by structural factors like policy and infrastructure. There are many factors that go into shaping a drinking culture of a nation (not least how it is represented and framed in the media and other cultural forms, see Chapter 7). Academic interest in ‘drinking cultures’ has typically addressed macro-level society-wide patterns and looked for typologies (Savic et al., 2016). A clear example of this is given by Ruth Engs (1995), who reviews the varied literature on European drinking styles to suggest drinking cultures today originate in the legacies of two distinct pre-modern drinking cultures. There are the Romanised ‘Mediterranean’ drinking cultures such as those of Italy, Spain, Portugal, southern France and Greece where wine drinking dominates and alcohol is consumed regularly with meals and culturally inscribed in everyday rituals. Engs refers to these as ‘wet’ drinking cultures, for alcohol is a common and ‘normal’ part of everyday life and is accompanied with a low social tolerance of drunkenness. In contrast, in the Germanic ‘dry’ drinking cultures of Northern Europe including Scandinavia, the Netherlands, Britain and Germany, the drinking of beer and spirits as part of heavy, often episodic drinking occurs on weekends or special occasions. Importantly, in such cultures, alcohol holds an ambivalent status by being associated with extremes of heavy drinking and drunkenness at moments of festivity (for example, at weddings or during university inductions and ‘freshers’ weeks) but it is also subject to moral regulation and a distinct but flexible boundary between abstinence and excess. Under this account, two young adults born in Copenhagen and Madrid would literally learn distinct ways of drinking. As children, our Danish example might have been aware of alcohol after seeing relatives drunk at a celebration such as a wedding whereas our Spanish example would have grown accustomed to the presence of wine on the family table, even being offered a taste of watered-down wine at an early age. Then, once both begin to experiment with alcohol in their

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own right, the ‘wet’ wine drinking culture would mean the Spanish example enjoys a glass of wine when meeting friends as an accompaniment to their sociability whilst the ‘feast’ drinking of the Northern ‘dry’ culture would see our Danish example likely to drink for the purpose of getting drunk, in spite of stricter prohibitions and social regulation. In each case, their way of drinking would likely be mirrored by that of their peers and condoned by their immediate social groups and wider social and cultural representations. In both situations, it would feel entirely normal and acceptable to relate to alcohol and enjoy its various pleasures and risks in the way they do. Whilst Engs’ account is a historical one, in that it traces the persistence of these expressions of drinking over time and finds their formative roots in the religion, climate and agricultural context of the two European regions, ideas about such national distinctions remain common and widely accepted. For example, Jayne et al. (2008: 85) analysed contemporary debates about alcohol policy in the UK to show that geographical framings contrasting hedonistic ‘British’ drinking with the more civilised ‘continental’ European styles interpreted into public understandings and policy. In viewing national drinking cultures as fixed and stable, there is a risk of reifying complex processes that in fact result in social change and variety. Nations themselves are not fixed and national cultures are in fact far more heterogenous than such invocations contrasting the Binge drinking Brit with the suave cultured French wine drinker allow. Migration and mobility have always played a role in shaping drinking tastes, practices and meanings. German immigrants into the American Midwest established a brewing industry dominated by lager beers whilst French immigrants into California brought wine growing culture. In the UK, since a number of Eastern European countries joined the European Union in 2004, Polish and Lithuanian beer brands have become common in corner shops and off licences. We can look at some prominent examples of how specific alcoholic drinks become not just associated with a given country or nation, but deeply symbolically tied. Thus, the French philosopher and essayist Roland Barthes (1972: 67) wrote that the performance of drinking wine ‘is a national technique which serves to qualify the Frenchman, to demonstrate at once the performance, his control and his sociability’. As a semiotician who made signs and symbolism the centre of his analytical activities, Barthes suggests that French wine and its consumption symbolise values at the heart of French culture. In each of the following cases, some type or brand of alcoholic beverage is shown via detailed analysis to be cultural and socially interwoven with understandings of nationhood and national identity. Each is best understood as resulting from quite complex and long-running developments in terms of social and cul-

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tural trends but also economics and commercial activities, for attaching a drink to an appealing concept of nationhood has reaped huge profits for many brewers and distillers. Carrying on from Barthes’ observations relating to wine drinking and the essence of French national identity, studies by Demossier (2010) exploring French wine drinking culture and Guy (2007) examining how champagne became a symbol of French national identity illustrate these processes. Demossier (2010) examines how the changing symbols and discourses connecting wine production and consumption with French national identity illuminate ‘the values embedded in wine consumption and the attachment of French people to rural society, time, commensality and sociability, as well as their concern for the future represented by the forces of globalization, modernity and multiculturalism, which are the new points of tension’ (Demossier, 2010: 127–128). Whilst wine culture has long symbolised the French connection to the land via the concept of terroir, this has changed and in recent years, Demossier argues, the centrality of wine drinking to French social and cultural life has shifted away from daily drinking of vin de table and vin de pays (literally table wine and country wine) towards less frequent consumption of higher classification of wine for the purposes of social distinction or, indeed, away from wine towards more Americanised elements of global consumer culture such as fast food. Similarly, whilst champagne has been seen as an embodiment of the national spirit and its consumption ‘provides natural access to an authentic, organic France’, Guy (2007: 1–2) examines the process by which these bonds between beverage and nation forged. Far from being innate or timeless, the symbolic connection between French identity and champagne, argues Gay (2007), was forged from the nineteenth century onwards. During this period of intensive social and economic change, new technologies allowed the production, distribution and advertising of champagne and other luxury wines throughout the nation and, later, internationally. Further, new social groupings in French society sought out ways to establish shared identity and the rituals so that the symbolism of champagne production and consumption rapidly took a central position to French bourgeoise society. Alcohol can be a way of thinking about and feeling the nation. Alcohol branding, for example, often reflects an imagined image of national character. A similar relationship is identified by Thurnell-Read in an analysis of real ale branding that suggests alcohol branding offers clear examples of ‘invented traditions’ (Hobsbawm, 1983) and ‘banal nationalism’ (Billig, 1995). Spitfire Kentish Ale originally brewed to mark the 50-year commemoration of the Battle of Britain and took name of fighter plane that flew from and fought over the English county of Kent. There is also a notable predominance of ale brands and imagery that invoke a romanticised rural idylistic past. In addition, occupational titles relating

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to industrial work, heroic figures from local and national history serve to symbolically associate alcohol with the current or past nation. National imagery and branding are not just appealing to the sensitivities of producers but are commercially desirable. The tensions between tradition and globalised modernity are also present in Brenda Murphy’s (2015) study of Guinness and Irish culture and national identity. Forged over decades of advertising campaigns and cultural representations in film, television and music, the Irish Stout brand has become globally recognised as a abiding symbol of Ireland and Irishness. It is telling that many Irish people, Murphy found, who do not frequently consume Guinness whilst living in Ireland do so when abroad, either as tourists or migrants, finding solace and connection to home. Whilst the spread of Irish-themed pubs to every corner of the world is viewed with some cynicism by many in Ireland, and beyond, many of those same venues provide a focus of social and economic life, and a sense of ‘community’ and identity away from home, for Irish migrants around the world. Irish- ‘themed’ pubs are a global phenomenon. In such venues, the atmosphere of a supposedly traditional Irish pub is created, with walls adorned with artifacts and images of Ireland, Irish food is served and Irish music played, yet customers remain ‘keenly aware that these environments are not entirely authentic and what they are experiencing is in fact an idealized version of reality’ framed more in reference to media representations of Ireland and Irishness (Lego et al., 2002: 72). Whilst such is the appeal of this offering that the Irish Pub Concept (IPC), a design initiative by Guinness PLC, has exported thousands of packaged to-order Irish pub interiors to dozens of countries around the world (Muñoz et al., 2006). The appeal of these bars is to a particular vision of a convivial drinking culture rooted in a somewhat caricatured vision of both the Irish drinking culture and Irishness more generally. It is easy to wince at the process by which a single company offers to contrive an ‘authentic’ Irish pub, from the wooden panelling, light fittings and memorabilia to the menu and staff training. Such venues draw value from a wider culture of movies, television and literary representations through which, particularly in North America, ‘heavy drinking became an index of Irishness’ (Grantham, 2009: 264).

The Racist Origins of Drugs Prohibition Whilst the culture and values that shape the consumption of alcohol in a given society tend to speak to the majority culture, there is also now a long history of minority groups within nations being in various ways labelled and stereotyped

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for their use of alcohol and drugs. The aggressive expansion of countries such as Great Britain, the Netherlands and France, their empires in the Americas, the Caribbean, Africa and, in particular, Asia from the sixteenth century onwards brought them into contact with use of intoxicants in other areas of the world. Perceptions of and attitudes to certain intoxicants were profoundly shaped by the context in which Europeans first encountered them. For example, when an army led by Napoleon Bonaparte, the Future Emperor of France then still a general, invaded Egypt in 1798 to install a brief period of French rule in the Middle Eastern region, French troops were brought into contact with the then widespread consumption of cannabis amongst Egyptian men in the form of hashish resin. Hostility to this newly encountered drug, based on the fears that the habit of smoking hashish was being taken up too readily by French troops, was further heightened by an inaccurate but influential connection being drawn between hashish and the Hashishyun, a secretive sect whose members were falsely said to imbibe hashish-based potions to bring on a mortal frenzy in which they would murder, literally assassinate, their enemies. Cannabis-based preparations would be readily endorsed as medications for every type of ailment by European physicians yet, at the same time, there was a growing fear or revulsion of so-called ‘Orientals’ using such intoxicants for spiritual or pleasurable reasons. Britain’s role in the opium trade, particularly between India and China, created a huge amount of wealth and underpinned colonial inequalities and exploitative economics. For a large part of early modern history, Britain was the world’s biggest drug dealer. Essentialist and racially charged thinking saw white Europeans being able to control and exploit both the medicinal and economic potentials of naturally occurring intoxicants like opium and cannabis, whilst non-European ‘others’ succumbed in body and mind. Repeatedly, during the eighteenth century and into the nineteenth century, depictions of drug use in North Africa, the middle east and Asia would strive to embody the fears of Western societies in the accounts of drug use. Indeed, opium use in the Ottoman Empire in the eighteenth century informed European imagination of the drug but also, more generally, established ways of thinking about the ‘Orient’ and the ‘Oriental’ as exotic and mysterious (Davenport-Hines, 2001). Throughout history and into the modern era, drugs are associated with people positioned as ‘other’. The connections between drugs and their use and wider societal prejudices and fears about ethnic minorities continue during the nineteenth, twentieth and twenty-first centuries. Such is seen in nineteenth-century London, where the areas around the docklands of the Thames, and Limehouse with its large and growing population of lascar sailors and Chinese immigrants, were subjected to demonisation in the national press and repressive policing of supposed Chinese

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opium dens. These early encounters between Europeans and drugs in non-European contexts offer a clear example of what the Palestinian American scholar Edward Said called ‘Orientalism’, a way of thinking about and representing the people and culture of the Middle East and Asia as polar and contrasting opposites to those of Western Europe. European writers, artists and intellectuals could depict the cultures of the so-called ‘Orient’ as uncivilised, irrational, sensual and mystical to further entrench notions of the superiority of civilised and rational European cultures. Drugs such as cannabis and opium provided the ideal vector through which such Orientalist thinking could be furthered. Writing and art works of the period depicted drug use associated with exotic places, foreigners in mystical lands. Such representations, at a time when the meaning and value of newly encountered substances were still very much in flux, did a lot to frame the attitude of drugs as something external to European, and later North American, sensibilities. In the US, racist narratives of Chinese-run opium dens on the East Coast and ‘cocaine-addled’ African Americans on Southern plantations played out endlessly in the press and occasionally on film (Madge, 2001), doing considerable damage to race relations in America in the process. Indeed, the first opium prohibition laws in California were specifically drawn up to target Chinese labourers positioned as a threat to American stability. The background to many of these racist panics, those migrant labourers were unwanted competition to ‘white’ workers during the Great Migration, a period of the middle decades of the twentieth century that saw more than 6 million African Americans travel from the rural Southern states to cities of the North and Midwest. During this period, the racialisation of drugs in America became entrenched and the media readily stoked fears the presence of black Americans on city streets and, worse still, in cafes and bars both playing and listening to jazz bringing them into contact with white women. The Federal Bureau of Narcotics, led by Harry Anslinger, did much to depict all drugs, but especially cannabis and cocaine, as something that was polluting America, brought in by foreigners or ethnic minorities. Anslinger led particularly attacks on African-American figures and black people in the South and in films like Reefer Madness, depicting the sort of jazz musicians who were out there to seduce and use drugs to manipulate and lead young white Americans astray. Prominent African Americans such as the singer Billie Holliday were targeted and their connections with drugs were linked to shocking accounts of abuse and disorder. Anslinger and the FBN were a driving force in shaping early debates about drugs and their prohibition in America which were characterised by a racism that saw Black Americans and Asian migrants used as villains in an Orientalist ‘assassin of youth’ narrative linked to Arabic ‘hashish’ cults and murderous acts. In a concerted propaganda campaign, the FBN pushed for ‘cannabis’ to be

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replaced with the more Latin-sounding ‘marihuana’ or ‘marijuana’ to play on anti-Mexican sentiment.

Contemporary Racism and the War on Drugs We have already seen, in Chapter 4 on regulation, that the latter decades of the twentieth century were characterised by increasingly hostile, and deeply problematic, enforcement of drug prohibition through a ‘War on Drugs’ narrative that has, since the 1970s, supported heavy policing and punitive law enforcement as the primary means to confront the presence of drugs and associated issues in society. The War on Drugs pioneered by Americans and imitated in varied forms around the world over the last four decades has faced frequent criticism for structural racism. Drugs bring people into contact with law enforcement and the criminal justice system. Ethnic minorities are not innately more prone to drug use but the conditions in which they live their lives may make the drug use of those who do more visible, more readily criminalised and likely seen as a ‘problem’. Also, those living in poorer neighbourhoods is more likely to suffer from economic upheavals such as recessions and deindustrialisation. The US provides prominent examples, given it’s the home of the War on Drugs and also because of its fraught race relations. In the 1980s, crack cocaine became the focal points of both police enforcement of increasingly draconian drug laws and the wider media panic relating to the threat of the drug and its users to American society. In both cases, black Americans were featured disproportionately, and both sustained and further entrenched racist tropes. Crack cocaine, produced by combining powder cocaine with substances such as baking soda to form solid ‘rocks’ which were easily sold in smaller quantities by street dealers, was associated with poor urban areas, the black ghetto, whilst the media fuelled fears by sensationalising the addictive power of the drug and the horrifying violence committed by users. In response to public concern, the US congress hastily passed the 1986 Anti-Drug Abuse Act, creating mandatory minimum sentences of five- and ten-years imprisonment for possession of five and ten grams of crack cocaine, of any level of purity, respectively. Tellingly, the quantities of powder cocaine, far more likely to be consumed by white than by black Americans, required to command a five-year sentence remained unchanged at 500 grams whilst 100 kilograms of marihuana, again a drug widely consumed by white middle-class Americans, would be needed to initiate a comparable sentence. The laws were applied more strictly to black crack cocaine users and targeted lowlevel street users in spite of the acts framing as an attack on dealers. Such can

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be seen as what Provine (2011: 51) terms ‘a self-reinforcing phenomenon’ where stigmatising language and imagery supported by media framing encourages heavier surveillance and policing in poorer black neighbourhoods leading to increased arrests and prosecutions that further the noting that crack is a ‘black problem’ (Provine, 2011: 51). Thus, as Provine (2011: 50) suggests: The answer to racial disproportion in punishment must be sought, not in overt racism, but in the routines of policing, prosecution, and punishment and in covert racism that may not be evident, even to its practitioners

Since the advent of the War on Drugs in the 1970s (see Chapter 4 on Regulation), existing racial disparities for drug-related arrests and for the use of powers to stop and search have widened, with ‘reasonable suspicion’ being used to increase police hostility to Black and Latino Americans (Cooper, 2015). Mitchell and Caudy (2015) consider several explanations for racial disparities in drug-related arrests in the US. They consider that the extent of drug offending by racial minorities might explain the differences, in which case black Americans might have become more exposed to drugs because of wider structural inequalities relating to poverty, unemployment and social marginalisation that make drug use, or engagement with illicit activities relating to drug procurement and sale, either more appealing or trickier to resist. They then consider how the nature of drug use may differ according to racial group, with Black and Latino urban neighbourhoods lacking private spaces and, as such, making what drug use there is more public, more visible and thus more readily subjected to the attention of law enforcement authorities which target heavy policing on certain known drug ‘hot spots’ and away from whiter middle-class suburbs. Third, and finally, they suggest that both conscious and subconscious racial bias in the police force and criminal justice system produces higher rates of arrest and prosecution for minority drug users, with persistent and prevailing racial stereotypes framing police decision making and strategies. Drawing on national survey data to test these three explanations, they found that only a small difference could be associated with the extent and nature of black Americans’ drug use. Thus, ‘roughly 85% of African-Americans’ higher probabilities of drug arrest are not attributable to differences in drug use, drug sales, nondrug offending, or neighborhood context’, leaving a strong implication that attributes a sizable part of ‘African-Americans’ higher probability of drug arrest to racial bias in law enforcement’ (Mitchell & Caudy, 2015: 309–310). In Canada, where a punitive US-style War on Drugs was initiated from the 1980s onwards, structural vulnerabilities such as poverty and entrenched stigma-

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tising framings linking young black men to crime mean young Black Canadian men are over-exposed to aggressive enforcement of draconian drug laws. The intensive policing of black neighbourhoods and far higher levels of prosecution and incarceration for drug offences committed by young black men means ‘many young Black men have also been traumatized by their interactions with militarized police units’ enforcing drug laws disproportionately targeting young black men (Khenti, 2014: 194).

Intoxication, Identity and Inequality Recent years have seen more empirical research into how ethnicity, religion and both local and national identity shape the practices, meanings and harms of alcohol consumption and drug use. As briefly mentioned in Chapter 3, the consumption of alcohol is prohibited in Islamic religion. In both the Quran and the Islamic Hadith, drinking of wine and drunkenness are said to cloud the mind, lead to sinful and angry behaviour and are, therefore, prohibited as haram. However, historically alcohol production and consumption existed in nearly all Muslim countries and the attitudes, practices and experiences of Muslims vary greatly across both conservative or more permissive Muslim majority countries and within religious minority communities in non-Muslim majority countries (Michalak & Trocki, 2006). Whilst alcohol and drug use does happen in Muslim countries, both academic knowledge and clinical services such as treatment for substance misuse can be problematic (Al Marri & Oei, 2009). In many Muslim-majority countries, aside from total or extensive prohibition, public health measures relating to alcohol are only recently being put in place (Al‐Ansari et al., 2016). Studying rates of alcohol consumption and alcohol abuse and dependence amongst Muslim, Christian and Druze students in Lebanon‚ Ghandour et al. (2009) showed religion to influence both the likelihood of drinking and age at which alcohol was first experimented with. Of those who did drink, rates of abuse and dependence were comparable across religions however abuse and dependence were lower amongst students of all backgrounds, including Christians, who reported stronger religious faith. However, in recent years, studies of young Muslims living in Western countries have developed important insights into the role of religion in shaping attitudes to alcohol and the interaction of religious faith and identity with other social identities such as age and gender. In a national survey of students in the Netherlands, van Tubergen and Poortman (2010) not only found far lower levels of alcohol consumption amongst ethnic minority pupils, and Muslim students in particular, but also that schools with a higher proportion of Muslim students saw

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alcohol consumption levels were lowered amongst non-Muslin students. Bærndt and Kolind (2021) interviewed young Danish Muslim women to better understand how they negotiated growing up amidst a culture in which heavy drinking and public drunkenness were expected parts of youth culture and the social life of young women. Their interviewees spoke of a growing divide from their non-Muslim peers once alcohol became more central to youth socialising in the mid-teenage years onwards. As young women, they also experienced greater social controls than their brothers and other male relatives, with the surveillance of both parents and the wider ethnic community meaning those who did experiment with drinking alcohol needed to employ strategies of secrecy. Particularly for younger members of various British Muslim communities, the centrality of alcohol and drinking to the point of drunkenness to contemporary British youth culture presents an often problematic tension which must be negotiated. Alcohol is therefore an ‘absent presence’ in the Pakistani Muslim community (Jayne et al., 2016) where prohibition of alcohol under Islam is sustained by a ‘culture of abstinence’ and reinforced by social and cultural practices relating to family, kin and community. Pakistani Muslims may experience feelings of being ‘out of place’ and risking family reputation in spaces associated with alcohol and purposively avoid times and spaces associated with alcohol, such as public houses and bars. Even when non-alcoholic beverages are available, presence in these sites can draw suspicion. However, whilst this research identified the importance of maintaining honour in ‘the eyes of the community’ as central to how young British Muslims engaged with alcohol, or not, they also noted both gendered and generational patterns. For example, a strong pressure amongst second generation British Muslim men to drink in their youth meant it was relatively common for individuals to find considerable appeal in youthful rebellion prior to dabbling with drink and, even, drugs, in their youth prior to ‘settling’ down as a good abstinent Muslim father. In such cases, strategies of concealment and secretive consumption were critical in allowing young British Muslim men to find ways to engage with a youth culture where intoxication is seen as a youthful rite of passage whilst navigating cultural and community pressures and surveillance. Rastafarianism, and its association with cannabis smoking, is another example of cultural and religious influences on intoxication. According to Benard (2007), marijuana gradually gained prominence in the emerging spiritual movement of Rastafarianism in Jamaica, first being used by black Jamaica as a palliative during the period of indentured labour but gaining cultural and economic prominence amongst poorer urban Jamaicans following independence and during the transition to a capitalist economy (Benard, 2007). In her ethnographic study of Rastafarianism in England, Waldstein (2020: 915) found the daily practice of smoking

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cannabis to be central to the spiritual and cultural life of Rastafari, and ‘a spiritual practice that increases consciousness of the connections between humans and the other animate beings in our environments’. Waldstein (2020), for instance, indicates that marijuana is given agentic power by Rastafari spiritual practices, where ‘she’ is a ‘plant teacher’ who inspires knowledge, insight and harmony. This of course creates a dilemma where the religious freedoms—that Rasta should smoke cannabis as a central tenant of their spiritual practices—are in conflict with criminal law that make all use of cannabis prohibited (Gibson, 2010). The role of drugs in the lives of already marginalised ethnic minorities is complex, particularly when involving young people in often fraught and harmful interaction with the criminal justice system. Danielle Horyniak and colleagues have carried out interviews with refugee-background young Africans living in Melbourne, Australia, about their use of alcohol and drugs. They found that many of these young people drank heavily, both as a way of coping with past traumatic experiences and current boredom and frustration (Horyniak et al., 2016). Although alcohol would lead to harmful consequences, such as poor health and exposure to violence, and involvement with the police, these young people also found public drinking to be an important social experience, giving them a sense of solidarity and belonging otherwise denied to them in their marginalised position in Australian society. Amongst those who used drugs, racialised interactions with the police were marked with derogatory language and provocative behaviour that the young people experienced as disrespectful and marginalising, and left them feeling unfairly targeted for the colour of their skin (Horyniak et al., 2017). Injecting drugs was seen as shameful and hidden from peers and from family, creating culturally specific risks relating to unwillingness and inability to access support and treatment (Horyniak et al., 2014). Alcohol and drug practices are entrenched in wider social inequalities. There is an absence of drug policies in the UK to address the health status and health care needs of black and ethnic minority (Rassool, 2006). Similarly, there is a need for alcohol support services to target communities with cultures of abstention in order to reach ‘hidden’ levels of problem drinking (Valentine et al., 2010). Recent studies have explored the role of alcohol and drugs in the lives of members of different ethnic groups with more nuance, often paying attention to what we might call the ‘intersectional’ nature of identity and belonging—that is, the complex relationship between different social characteristics and elements of personal identity and experience relating to things such as ethnicity, religion, gender, social class and age. We can illustrate this by looking at two research projects analysing alcohol consumption amongst communities of migrant origin people engaged in playing the sport of cricket. Fletcher and Spracklen’s (2014) study

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of British Pakistani Muslims at a Yorkshire cricket club shows how religion, ethnicity, masculinity and local identity are bound up in sporting contexts and social interactions where the consumption of alcohol is assumed as a prerequisite for inclusion. Thus, whilst white British and British Pakistani Muslim players bonded over the playing of the game itself, the supposedly obligatory drinking of beers following the match proved a point of contention. Whilst white British players expected alcohol to be consumed in line with expectations concerning sporting masculinity and homosociality, and also as a sign of ‘integration’ into local culture, Muslim players often refused to drink alcohol, in line with their religious practices, or, in some cases, even to set foot inside the club house where alcohol would be consumed. A similar sporting context is used by Joseph (2012) in her ethnography of older Caribbean-Canadian men’s drinking practices at non-league cricket matches in suburban Toronto, Canada. She found that consuming alcohol at the cricket ground is a means for Caribbean men to reaffirm their understandings of themselves as physically capable, masculine and middle-class diasporic subjects. They use alcohol to mask the effects of old age (limping, forgetfulness and declining physical strength) and compensate for their subordinated (due to age and race) masculinity through nostalgic stories, and loud talk. Getting drunk allows them to retain a sense of freedom and individual identity, and to temporarily escape their family responsibilities (Joseph, 2012: 149). Notably, in both cases, ethnic identity is integral to not just status as migrants or the descendants of migrants, but with notions of local identity and spatial belonging which are also heavily influenced by ideas about gender. In both cases, cricket provides a context in which male sociability can be played out, but through which tensions relating to inclusion and exclusion based on ethnic and/or religious identity also become animated. These examples demonstrate the complexity of identity and intoxication. Whilst discourses aiming to position particular kinds of drinking or drug use as being typical of a specific nation or ethnic group, we see that nation and ethnicity intertwine with age, gender and social class. Location and mobility also play a part, and recent research exploring the lived experience of people demonstrates the importance of contextualised insights. Intoxication in Contrast 10

Whilst a lot of research talks about the national context of drug policies, studies of minority ethnic groups and migrant communities are less common. Osman and Söderbäck (2011) conducted interviews with Somali immigrants living in Sweden to examine their perceptions of the use of khat, a leaf chewed

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for its mildly narcotic effects and illegal in Sweden but widespread in Somalia and other countries in the Horn of Africa. Whilst khat was spoken of as a part of Somali culture, more akin to a food than a drug, its use was viewed as having health and social costs which harmed Somali families and the Somali diasporic community more generally. The intermittent timing of arrival of khat from Somalia meant that khat use was felt to disrupt working life and undermine the ambitions of migrant workers hoping to establish themselves in Sweden. Ethnic identity was also a factor in Hunt et al. (2011) study of Asian American drug use. They found attitudes to drugs to be ambivalent and particular to the social and cultural context of minority ethnic communities. They identified different patterns. Some saw their own drug use as an exception from the ‘norm’ that Asian Americans did not use drugs. However, others saw drug taking as a means of navigating their liminal status in American society. Lastly, a final group of participants felt that drug use had become normalised amongst Asian American young people but, at the same time, that this was constructed around boundaries of taste and lifestyle attachments to youth culture. Osman, F. A., & Söderbäck, M. (2011). Perceptions of the use of khat among Somali immigrants living in Swedish society. Scandinavian Journal of Public Health, 39(2), 212–219. Hunt, G., Moloney, M., & Evans, K. (2011). “How Asian am I?”: Asian American youth cultures, drug use, and ethnic identity construction. Youth & Society, 43(1), 274–304.

Summary Ethnicity, religion and national identity appear to play a role in shaping practices, meanings and experiences of intoxication. They are also central to the construction of many expressions of ethnic identity, religious faith and national identity and belonging. It is important for these factors to be considered in debates about the regulation, commercialisation and treatment of consumption and use of alcohol and drugs. Because such factors shape our upbringing, values and experiences in society they also play a part in influencing how and when we are exposed to intoxications and intoxication. Our response to opportunities to experiment with alcohol and drugs can be influenced by our upbringing and identity, but these also shape our attitudes to others who use alcohol and drugs. Ethnicity and religion shape intoxication at a society, state and individual level. Racialised fears have been used to demonise young people from ethnic

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minorities. Often this projects fears about the areas in which they live or serves to exclude them from spaces where their presence is deemed threatening. Thus, this chapter has illustrated that attitudes to intoxication are bound up with society′s prejudices. And yet contemporary research can play an important role in challenging entrenched and harmful prejudices about minority communities and alcohol and drug use. As Hunt and Kolind (2017: 227) suggest, there is a need to ‘move beyond essentialist views on ethnicity in the study of drugs and alcohol and instead consider notions of ethnicity as dynamic, fluid and context specific’. Indeed, the intersection of ethnicity, national identity and culture, gender, age and religious faith create a nuanced and multifaceted picture. However, such studies remain marginal and a great deal of public, media and academic debates about alcohol and drugs remains rooted in assumptions about homogeneous national cultures or, where minority groups are considered, continues to invoke prejudicial or, at least, inaccurate and at times outmoded stereotypes. Points for Discussion

What roles do race and racism place in influencing the form of modern alcohol and drug policies? How might the country you were born and/or raised in shape your attitudes to alcohol and drugs?

Read, Watch, Listen #10 Read: Amongst the now extensive coverage of drug related topics offered by Vice Media through their YouTube and Vice Video site is a short documentary titled ‘The Racist Legacy of The War on Drugs’ examines the relationship between drug policy and racial discrimination in policing. Watch: In 2019 a rapid evidence review on Drinking problems and interventions in black and minority ethnic communities was produced for the charity Alcohol Change UK by a team of researchers at Middlesex University London. The report is available to download on the Alcohol Change UK website. Listen: A 2019 lecture hosted by the Department of Social Policy and The International Drug Policy Unit to mark the launch of a report titled The Colour of Injustice: ‘Race’, Drugs and Law Enforcement in England and Wales is available as a podcast from the London School of Economics website.

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References Al-Ansari, B., Thow, A. M., Day, C. A., & Conigrave, K. M. (2016). Extent of alcohol prohibition in civil policy in Muslim majority countries: The impact of globalization. Addiction, 111(10), 1703–1713. Al Marri, T. S., & Oei, T. P. (2009). Alcohol and substance use in the Arabian Gulf region: A review. International Journal of Psychology, 44(3), 222–233. Barthes, R. (1972). Mythologies. Paladin. Bærndt, M. F., & Kolind, T. (2021). Drinking and partying among young Muslim women: Exclusion in the context of a normalized youth drinking culture. International Journal of Drug Policy, 93, 103170. Benard, A. A. (2007). The material roots of Rastafarian marijuana symbolism. History and Anthropology, 18(1), 89–99. Billig, M. (1995). Banal nationalism. Sage. Cooper, H. L. (2015). War on drugs policing and police brutality. Substance Use & Misuse, 50(8–9), 1188–1194. Davenport-Hines, R. (2001). The pursuit of oblivion: A social history of drugs. Orion. Demossier, M. (2010). Wine drinking culture in France: A national myth or a modern passion? University of Wales Press. Engs, R. C. (1995). Do traditional western European drinking practices have origins in antiquity? Addiction Research, 2(3), 227–239. Fletcher, T., & Spracklen, K. (2014). Cricket, drinking and exclusion of British Pakistani Muslims?. Ethnic and Racial Studies, 37(8), 1310–1327. Ghandour, L. A., Karam, E. G., & Maalouf, W. E. (2009). Lifetime alcohol use, abuse and dependence among university students in Lebanon: Exploring the role of religiosity in different religious faiths. Addiction, 104(6), 940–948. Gibson, M. (2010). Rastafari and cannabis: Framing a criminal law exemption. Ecclesiastical Law Journal, 12(3), 324–344. Grantham, B. (2009). Craic in a box: Commodifying and exporting the Irish pub. Continuum, 23(2), 257–267. Guy, K. M. (2007). When Champagne became French: Wine and the making of a national identity. John Hopkins University Press. Hobsbawm, E. (1983). The invention of tradition. Cambridge University Press. Horyniak, D., Higgs, P., Cogger, S., & Dietze, P. (2017). The role of respect in interactions with police among substance-using African refugee young people in Melbourne, Australia. Journal of Ethnicity in Criminal Justice, 15(2), 185–204. Horyniak, D., Higgs, P., Cogger, S., Dietze, P., & Bofu, T. (2016). Heavy alcohol consumption among marginalised African refugee young people in Melbourne, Australia: Motivations for drinking, experiences of alcohol-related problems and strategies for managing drinking. Ethnicity & Health, 21(3), 284–299. Horyniak, D., Higgs, P., Cogger, S., Dietze, P., Bofu, T., & Seid, G. (2014). Experiences of and attitudes toward injecting drug use among marginalized African migrant and refugee youth in Melbourne, Australia. Journal of Ethnicity in Substance Abuse, 13(4), 405–429. Hunt, G., & Kolind, T. (2017). Researching ethnicity and substances: A contested arena. Drugs: Education, Prevention and Policy, 24(3), 227–229.

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Jayne, M., Valentine, G., & Holloway, S. L. (2008). Fluid boundaries—British binge drinking and European civility: Alcohol and the production and consumption of public space. Space and Polity, 12(1), 81–100. Jayne, M., Valentine, G., & Holloway, S. (2016). Alcohol, drinking, drunkenness: (Dis) orderly spaces. Routledge. Joseph, J. (2012). Around the boundary: Alcohol and older Caribbean-Canadian men. Leisure Studies, 31(2), 147–163. Khenti, A. (2014). The Canadian war on drugs: Structural violence and unequal treatment of Black Canadians. International Journal of Drug Policy, 25(2), 190–195. Lego, C. K., Wodo, N. T., McFee, S. L., & Solomon, M. R. (2002). A thirst for the real thing in themed retail environments: Consuming authenticity in Irish pubs. Journal of Foodservice Business Research, 5(2), 61–74. Madge, T. (2001). White mischief: A cultural history of cocaine. Mainstream Publishing. Mitchell, O., & Caudy, M. S. (2015). Examining racial disparities in drug arrests. Justice Quarterly, 32(2), 288–313. Muñoz, C. L., Wood, N. T., & Solomon, M. R. (2006). Real or blarney? A cross-cultural investigation of the perceived authenticity of Irish pubs. Journal of Consumer Behaviour: An International Research Review, 5(3), 222–234. Murphy, B. (2015). Brewing identities: Globalisation. Peter Lang. Michalak, L., & Trocki, K. (2006). Alcohol and Islam: An overview. Contemporary Drug Problems, 33(4), 523–562. Provine, D. M. (2011). Race and inequality in the war on drugs. Annual Review of Law and Social Science, 7, 41–60. Rassool, G. H. (2006). Substance abuse in black and minority ethnic communities in the United Kingdom: A neglected problem?. Journal of Addictions Nursing, 17(2), 127– 132. Reinarman, C., & Levine, H. G. (1997). Crack in America: Demon drugs and social justice. University of California Press. Savic, M., Room, R., Mugavin, J., Pennay, A., & Livingston, M. (2016). Defining “drinking culture”: A critical review of its meaning and connotation in social research on alcohol problems. Drugs: Education, Prevention and Policy, 23(4), 270–282. van Tubergen, F., & Poortman, A. R. (2010). Adolescent alcohol use in the Netherlands: The role of ethnicity, ethnic intermarriage, and ethnic school composition. Ethnicity & Health, 15(1), 1–13. Valentine, G., Holloway, S. L., & Jayne, M. (2010). Contemporary cultures of abstinence and the nighttime economy: Muslim attitudes towards alcohol and the implications for social cohesion. Environment and planning A, 42(1), 8–22. Waldstein, A. (2020). Smoking as communication in Rastafari: Reasonings with ‘professional’ smokers and ‘plant teachers.’ Ethnos, 85(5), 900–919.

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Introduction In this chapter we explore how drugs are used to improve upon the self. There are two central strands to this. First, the premise that substances are designed and used strategically and for specific purposes and, second, that these purposes are increasingly related to what we might call various forms of self-improvement. The ability to produce drugs and other substances which have a specific and quite often quite profound effect on the human mind or body that we’ve advanced to a stage where almost no problem in our lives cannot be addressed with drugs. Angus Bancroft suggests that in this modern society: Individuals are allowed and encouraged to use drugs to enhance their sexual performance, concentration at work and performance in social interactions with others. This is not merely the creation of a generation of shiny happy people, but a development in prosthetic culture – using drugs to extend and develop the self. (Bancroft, 2009: xi)

Rather than something that people do for pleasure or for the sensory stimulation through a sense of escape, drugs are increasingly developed to ‘improve’ or ‘enhance’ human functions and capacities. This move from experiential to functional motivations for using drugs is interesting because it signals a notable shift from pleasure and expression to enhancement and actualisation. Drugs are taken to improve and to augment the body or the brain. Such a trend is in keeping with the neoliberal climate emphasising individual aspiration and competition. Specific drugs are used to gain an advantage in an exam or to better craft the

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physique to be slim or muscular in line with increasingly extreme cultural expectations. Getting drunk, getting high, getting intoxicated can feel like something that improves friendship and bonding. For so many decades, thinking about intoxication, whether that be from academics from different discplinary backgrounds, from religiously informed moral crusaders and from politicians and policymakers and criminal justice bodies, assumed drugs to be in essence dangerous and to be something harmful to the body or, in other ways, to society. This conception of drugs as a trade off between hedonistic pleasure, in the short term, and potential physical and psychological harms in the longer term, is deep rooted in how we think about intoxicating substances. Critically, the promise or hope of a new king of ‘pharmaceutical society’ is that drugs of various forms increasingly come to improve us and to make us better than normal. A person could regularly use a substance because it makes them more, rather than less, able to succeed in their workplace, in their educational endeavours, in their love life or in their question for an optimised brain and body. There is, however, a risk of overstating the novelty of new substances and their strategic use to enhance or augment particular human capabilities or aptitudes. As shown in Chapter 2, when cocaine and opioids like heroin first entered the European market in the nineteenth century they were new substances and heralded as miracle cures and marketed as a solution to all physical ailments. Whilst coca, poppies and cannabis were naturally occurring they were still cultivated, processed, manufactured and branded, often drawing on the scientific and cultural innovations of the day. A contemporary parallel is the claimed benefits of Cannabidiol (CBD) derived from the cannabis plant but lacking the psychoactive high-inducing compound THC, which has been stated can be used as a remedy to anxiety, depression, insomnia and addiction, as well as high blood pressure, chronic pain, epilepsy and seizures. The chapter will explore several contemporary examples of new substances being used in novel ways.

New Psychoactive Substances (NPS) Whilst many intoxicating substances originate in nature and are later cultivated and processed to produce consumable substances, in recent decades there has been a growth in chemical substances created in laboratories. In the twentieth century, drugs such as LSD, MDMA and methamphetamine were discoveries of relatively formal scientific experimentation that were then, after some initial optimism for their use in varied contexts including therapy and the military, prohibited in all but limited situations. As seen in Chapter 4, use would of these sub-

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stances continued to grow and illicit production of such substances, made through mixing what are often actually quite commonly available industrial chemicals, continued in clandestine labs. More recently, since the 2000s, new chemical substances were created in laboratories to mimic the effects of illicit drugs such as heroin, MDMA and cannabis. Thus, ‘new’ drugs such as mephedrone (‘meaw’) and synthetic cannabis (‘spice’, ‘Black Mamba’) emerged from the idea that by making something which is chemically very similar to an existing illegal drug, it will have a similar—and often more intense—effect on the body. For example, synthetic stimulants could be created that have a similar function to traditional stimulants such as amphetamine, cocaine and ecstasy by increasing either the chemical availability of neurotransmitters such as dopamine and serotonin. New psychoactive substances (NPS) ‘comprise a diverse and ever-growing group of substances’ and understanding their chemical structure, mechanisms of action and any potential harms and dangers requires considerable knowledge (Shafi et al., 2020: 10). Research suggests that the early uptake of NPS was amongst ‘polydrug’ users—or ‘psychonauts’—as they are colloquially known, who already had a repertoire of drug consumption, who sought to combine substances and negotiating inconsistent supply and quality of illicit drugs. Synthetic cannabinoids were initially used in contexts such as prisons, elite sports and the military where regular testing for existing illegal intoxicants such as cannabis took place (Shafi et al., 2020). Blackman and Bradley (2017) describe such ‘psychonauts’ as testing the limits of their bodies and perceptions through consumption of novel substances. This was in no small part encouraged by the sale of NPS in so-called ‘head shops’, common on British high streets and selling a range of drug-related and themed artefacts and paraphernalia. NPS appeared in such retail spaces, and online, often described euphemistically as ‘room deodorisers’ or ‘plant food’ labelled ‘not for ingestion’ yet belied by psychedelic imagery and branding and sharing shelf space with bongs, pipes and other equipment for the preparation and consumption of illegal drugs. That these ‘novel psychoactive substances’ were created partially with the law in mind, and that moves to prohibit them have been slow and cumbersome, indicate the changing landscape of NPS use since late 2000s (Hutton, 2020). As a new substance, chemically unique yet similar in effect to lucrative existing drugs, the producers and retailers of NPS could circumvent laws put in place to prohibit the production, sale and use of specific substances. In other words, new intoxicants could be created quicker than authorities could respond to them through regulation and prohibition. This legal ambiguity resulted in the widespread, yet problematic, label ‘legal highs’. The response to these substances would be piece-

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meal, with steps taken to restrict the supply of the chemicals used in their production or eventually tightening rules about how and where they could be sold. These substances were new or novel in the sense that they had been synthesised to circumvent the main piece of legislation controlling drugs in the UK—the 1971 Misuse of Drugs Act. However, the rapid proliferation of every increasing numbers of NPS, peaking at a rate of at least one new substance appearing per week in 2015 (Shafi et al., 2020), gave rise to a battle that regulators simply could not win. Mephedrone was banned in 2010 in the UK and given a Class B designation. It took until 2016 for a blanket ban to be put in place under the Psychoactive Substances Act 2016 in the UK. Whilst a blanket ban was seen as a practical way of ending the cat and mouse game which pitted regulators against recurring waves of new substances, the Psychoactive Substances Act (PSA) has been widely criticised. Notably, defining and operationalising psychoactivity is highly problematic and makes the application of prohibition difficult, not least because there is no clear provision for linking specific substances with harms upon which a morally and legally justified penalty can be stipulated (Reuter & Pardo, 2017). Novel Psychoactive Substance emerged into the repertoire of drug taking of many people in the UK in the years prior to the legislation. Declaring such a heterogeneous range of substances illegal proves an insufficient guide for the complex range of activities from policing to sentencing. This led the authors of a paper in leading medical journal The Lancet to declare that: A profound lesson from the emergence of NPS is that focusing on responses to specific drug classes might be no longer fit for purpose in a world in which different substances can be rapidly introduced and people who use drugs can equally change their patterns of use on the basis of market availability and their preferences. Responses must instead be focused on, and developed in consultation with, those people who experience health and social harm from substance use. (Peacock et al., 2019: 1680)

The classificatory journey from ‘legal highs’ to NPS is only one of the most recent illustrations of the impossibility of a neutral definition of drugs and other intoxicating substances. A definition which is purely biochemical, in referencing only the altering effects of a substance on the human body, mind and senses, fails to account for the social, cultural, legal and criminological facets of how drugs, drug taking and drug takers are perceived and understood within society. In drafting the 2016 legislation, the definition of psychoactivity adopted by the Home Office—the Government Department—responsible for drug control was:

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… a substance produces a psychoactive effect in a person if, by stimulating or depressing the person’s central nervous system, it affects the person’s mental functioning or emotional state; and references to a substance’s psychoactive effects are to be read accordingly. (http://www.legislation.gov.uk/ukpga/2016/2/section/2/ enacted)

There are significant problems with the notion of psychoactive effect employed in the legislation. Falling within this definition could be any number of substances including flowers, air freshener and incense. Not only that, but the Government’s also own scientific advisors the Advisory Council on the Misuse of Drugs (ACMD) had warned that this would happen. Critics thus pointed out how the Psychoactive Substances Bill—which became the Act—was ‘legally flawed, scientifically problematic, and potentially harmful’ (Stevens et al., 2015), meaning the legal declarations about NPS struggled to align with the complex realities of their production, sale and use. Tellingly, the use of NPS like Mephedrone continued after criminalisation, indicating that their previous legality was only part of the reason for its use. Continued use and concern about poisoning amongst vulnerable groups meant that: …there has been a shift away from the experimental and recreational use of NPS by niche groups of young adults, to problematic use of synthetic cannabinoids by those individuals with degrees of stigma linked to vulnerable groups of young people and prison populations. (Blackman & Bradley, 2017: 70)

So, whilst legislation has developed to contain the rise of NPS, they remained very cheap and in many cases very potent, meaning their use continues amongst particularly vulnerable, marginalised groups such as prison populations.

Image and Performance Enhancing Drugs An area where established understandings of how to respond to drugs and their use has been most dynamic in recent years is the increasing use of a broad diversity of substances to improve the body as well as the mind. Under the umbrella term Image and Performance Enhancing Drugs (IPEDs), substances which can improve an aspect of an athlete’s physical abilities, such as stamina and strength, or that can prompt noticeable changes in the physical appearance of those striving to achieve bodily ideals of strength or slimness have received increasing cultural prominence and even social acceptance. However, anabolic steroids and various substances used to gain a chemically assisted advantage in elite sports are impor-

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tant for us here because they raise to a range of ethical issues which are very revealing of new ways of thinking about drugs and their place in society. One of the most prominent examples of this is the American cyclist Lance Armstrong. Victorious in his sport’s most challenging and prestigious event, the Tour de France, on a record seven consecutive occasions, and successful in an against all odds battle against testicular cancer in his mid-20s, Armstrong was widely feted as one of the greatest athletes of his generation. However, following the revelations in 2012 that he and his team of riders had been involved in a longterm systematic doping regime, including the use of erythropoietin, a banned hormone regulating the production of red blood cells and administered to give the recipient an advantage in cardiovascular endurance, his Tour de France wins were voided and his reputation left in tatters. That the sport’s most prominent hero could sustain such systematic deception for so long has now been the subject of much debate, both in sports media and in academic research, reveals the complexity of drug use in sports. That the heroic narratives framing Armstrong were sustained for so long by an eager sports media, who then rushed to condemn him following doping revelations (Reed, 2019), reveals a great deal about the cultural and economic contexts in which complex networks sustaining illicit doping activity could flourish unchallenged for so long (Bell et al., 2016). Dimeo (2014: 951), for example, argues that ‘the public humiliation of arguably the most triumphant sportsman of the twenty-first century’ should be understood as contextual to the decades-long evolution of attitudes and practices relating to doping in the sport. An era in which doping was ubiquitous coincided with Armstrong’s entry into the sport and his most successful years of competition. By the mid-2000s, as Armstrong retired at the height of his success but with a worldwide strategy led by the World Anti-Doping Agency (WADA) beginning to make an impact, the culture of secrecy and deception on which doping in cycling could remain widespread yet unchallenged began to crumble. With scientific advances in testing procedures closing loopholes by which team doctors could administer banned hormones with the confidence of not being detected, and with an increasing willingness on the part of riders to speak out, the sport’s leadership at team and sport level could no longer excuse the use of PEDs in the sport as the dishonest behaviour of a few ‘bad apples’ (Dimeo, 2014: 960). This is a useful stance as it acknowledges that for PED doping to proliferate in a given sport requires not just a few dubious individual ‘cheats’ but a culture which both encourages the use or at least the goals that PED use are felt to help achieve and a culture that turns away in subtle ways—either knowingly or by being too ready to buy into cults of personality around specific heroic figures whose feats of endurance are given god-like sta-

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tus and who are invariably then surrounded by a network of power and influence where too many have too much at stake for any doping to be investigated and revealed. The boundary between acceptable and unacceptable uses of PEDs is typically policed by standard appeals to fairness and health risks that suggest, respectively, that using many PEDs bestows an unfair advantage of competitors and poses a grave danger to the health of participants so that both are seen as antithetical to the normative standards of sporting culture rooted in ideas of equality and fitness (Loland, 2018). Morgan (2009: 164) considers an important distinction between treatment, where substances are used to treat an ailment and restore ‘normal’ function, and enhancement, where similar substances and approaches are used to improve ability beyond that which would normally be possible, but warns that the boundary between the two is ‘so porous that it is ripe for exploitation’. Critical here is how to understand, perceive and evaluate the points at which the use of a substance go from removing an impediment to augmenting the thresholds of ability. Wiesing (2011) argues that legalising PEDS, even under close medical supervision, would not make sports any fairer and would, in fact, introduce new occasions of unfairness given vast disparities in access to drugs, knowledge and ability relating to their use and natural variations in bodily responses to them. Beyond this, such a scenario is also suggested as undermining of the very ‘spirit of sport’, meaning the triumphs of individuals would always be suspect and the function of sports and sportsmen and sportswomen as role models would be lost. As PEDs become more widespread in a range of settings, not just elite athletics and committed bodybuilders, it is important to recognise the diverse motivations and justifications of use. Monaghan (2002) found that body builders in South Wales used strategic language and practices to justify illicit steroid use for body enhancement. This included accounts focusing on self-fulfilment, where steroid use is framed as something constructive and self-improving in contrast to recreational drugs that harm health and merely involve a short-term hedonism, as well as casting those who criticise steroid users but, for example, drink alcohol, smoke cigarettes and use recreation drugs as being hypocritical. Importantly, these individual accounts frequently involved the denial of injury by downplaying the harms of steroid use or a positioning focused on knowledge and risk awareness allowing them to navigate and safely use without negative health impacts. By conducting qualitative interviews with both male and female anabolic steroid users in the UK, Grogan et al. (2006: 852) found that a ‘desire to get more muscular outweighed the importance of any health concerns’ and that this meant that, during their varied histories of steroid use, the perceived ‘short-term gains

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(increased muscularity) would have outweighed long-term health risks (kidney and liver damage, heart disease, risk of HIV infection from injecting)’. Murray et al. (2013) also study the importance of social context to PED use and find, for example, that professional baseball players were more likely to commence using PEDs when transferred to a team where use was common amongst team mates, as opposed to being less likely to use when moving to a ‘clean’ team. They suggest that peer influence and social learning, where both the value and practices of PED use are picked up and shared between teammates, is of particular importance in sports where a team ethos prevails. An interesting attempt at a unified theory is offered by Christiansen et al. (2017). They present a four-fold typology based on two overarching factors, users’ approach to risk and to effectiveness. Thus, they identify an ‘Expert’ type of users who have a lower acceptance or risk but place a higher priority on effectiveness, seeking out and applying pharmacological knowledge and positioning themselves as testing the results. Then, the ‘Athlete’ type of user exhibits a high acceptance of the risks involved in taking steroids coupled with a high concern with their effectiveness. These users are likely to be engaged in high-level competition and mix steroid use with any number of strategies, such as extreme dieting, to push their athletic abilities to the limits. The remaining two types, both of which have a lower concern for effectiveness, are interesting not least because they shine light on a more casual, less planned and strategized, type of use. Thus, the ‘Well-being’ type users who have both a low concern of the effectiveness and a low acceptance of risk ‘see themselves as sensible in their approach and modest in their goals through direct or indirect contrasts to a mode of use characterised as improbable and hazardous’. Similarly, the ‘YOLO’ type, short for You Only Live Once, have a lower and more fragmented concern with effectiveness but couple this with a high acceptance of risk resulting in ‘a largely uncritical and haphazard engagement with steroids’ heavily dependent on peer bonding, unlikely to involve any sustained engagement with medical knowledge. The connections between steroid use and gender were shown clearly in Alan Klein’s, 1993 book Little Big Men: Bodybuilding Subculture and Gender Construction. He argued that steroid use was, for many men, a means to achieve a desired ‘masculine’ physique through building a body of muscularity, bulk and strength. For Klein (1993), this was a symptom of widespread and increasing gender inadequacy and a masculinity-in-crisis as men in Western nations like the US felt their status to be under threat from economic, social and cultural upheavals of the preceding decades. This suggests that steroid use should be understood in a wider context where the cultural representations of hypermasculinity, from the action heroes of the 1980s onwards and the more recent revival of superhe-

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roes, are proliferating alongside a time of increasing uncertainty and instability in male identities and status. Achieving a perfected masculine body, hard, strong and bulky, gives a sense of purpose, control and a promise of status. The evident link between steroid use and the highly gendered cultural expectation of what male or female bodies should look like and be capable of is a telling reminder that even substances with a very clear physiological purpose cannot be abstracted from the social and cultural contexts in which they are used. Men who use steroids do so, often, in pursuit of a socially constructed ideal of the male body as muscular and strong whereas women who use steroids are putting their conformity to gender embodiment standards at risk given society’s insistence that for bodies to be truly feminine they must not be strong or muscular. Lydia Johnston’s (1996: 336) study of female body builders: …the discourses around steroid use are sex-specific. The women are discouraged from using steroids based on the premise that they will become non-women. Men using steroids can be read as enhancing their ‘natural’ testosterone levels…I suggest that the woman who takes steroids becomes too dangerous to accept. She disrupts the sexed body dichotomy

Another theme prominent in recent research on performance enhancing drugs is that the rise of the internet, and the various platforms for sharing both formal and lay expertise it offers, has, in a sense, democratised pharmacological knowledge so the sharing of information and strategies for using substances for alternative purposes spreads rapidly and, importantly, within subcultures and niche online communities away from the gaze of the medical establishment. As the case of steroid use above indicated, networks of knowledge and support are created in gyms, within sports teams and in other contexts where users navigate the risks and legality of substances. Medical orthodoxy is challenged by ‘lay’ knowledge about the benefits and risks of use of anabolic steroids (Monaghan, 1999). For those that Christiansen et al. (2017: 3) describe as the ‘expert type’ in their typology, steroid use is likened to ‘an applied science project’ and ‘is based on a fascination with the effects of pharmacological substances on human physiology as well as the knowledge and control one can acquire over one’s body’. Increasing availability of IPEDs sold on the internet, with sellers using strategies to entice customers through deception or misinformation about legality and risk (van de Ven & Koenraadt, 2017). Elsewhere, the rationales for control have focused on risk with a particular emphasis on the unknown qualities, accepting that whilst there are benefits to the use of such substances the potential for harm based on their misuse through lack of knowledge is vast. In the context of competitive sports there is both more reason to take PEDs, given the vast financial rewards and prestige at stake, and more reason to abhor

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their use, given the sport arena, for many, is a projection of cultural values about fair play, personal and collective triumph over adversity. It is less obvious, however, why and how the regulation of the use of such substances outside of organised sporting contexts should occur and on what basis interventions in people’s lifestyles could be justified. Henning (2017), for example, argues that extending a regulatory approach based on testing, detaching and banning from professional and elite level competitions into amateur settings faces significant challenges, and suggests an alternative approach using health-centred strategies which empower amateur athletes through informed decisions relating to risk and reward. It also exposes the internal logic of regulatory approaches that long conceived of drugs as being worthy or prohibition or control because they are harmful, to individuals and others. To think of why and how to regulate substances which make people function better, requires a rethinking of the rationale for control and management. So far, a lot of this has focused on fairness, the idea that taking a substance which dramatically increases your strength, speed or stamina is, in a sporting contest, unfair and against long-held notions of fair play. The emergence of cognitive enhancements and the notion of academic ‘doping’ draws readily on a framing borrowed directly from sport to position these substances as against a spirit of meritocratic and pedagogic equality. Perhaps another element of this is that so many pharmacological enhancements appear to stem from feelings of inadequacy. Steroids to be more muscular, Viagra to maintain sexual potency, Ritalin to pass the exam all based on deep-rooted expectations that weigh heavily upon us and leave many striving and desperate. Here we might circle back to the chapter on history of intoxication and note that the emergence of many substances in their infancy was promoted as panaceas, and as miracle cures to solve the many and varied ailments and anxieties of the day. Now, in the present era, current economic and cultural conditions give rise to a proliferation of insecurities necessitating the witnessed remarkable pace with which new substances can be created to address them.

The Pharmaceutical Society In recent decades, there are an increasing array of examples of this use of pharmaceuticals to improve or perfect the self. Whilst elite sports furnish us with the most prominent cases of this, we can now see far more prosaic examples. Take, for example, the chemical compound Sildenafil more commonly known by its now notorious brand name Viagra. First tested as a treatment for hypertension

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and angina, in early medical trials the compound was found to the surprise of researchers and trial participants to induce penile erections. Once confirmed that by stimulating blood flow the drug is able to assist men in achieving stronger and more consistent erections, Viagra was patented in 1996 and approved for sale by the US Food and Drug Administration (FDA) in 1998. Tiefer (2006) argues that the conditions under which Viagra could achieve its rapid global commercial success and cultural notoriety actually took many decades to develop. Sexual health and sexual disorders had become increasingly medicalised, most notably by the American Psychiatric Association’s (APA) classification of sexual disorders within the Diagnostic and Statistical Manual of Mental Disorders. Notably, pharmaceutical companies had begun to see a lucrative market for medicines relating to sex, particularly amongst the so-called Baby Boomer generation who were edging steadily into older age yet retained expectations about sexual activity and pleasure. This market potential was coupled with a period of relaxing of laws relating to drug developments during and since the AIDS crisis of the 1980s. Like many ‘lifestyle drugs’, which deploy pharmacological innovations to enhance the body in line with cultural expectations and desires rather than to treat illnesses, the debates surrounding Viagra and its use are ideological, not least in how they are based on discourses about manhood and, in particular, male heterosexual desire (Mamo & Fishman, 2001). In cultures where masculinity is underpinned by notions of sexual prowess and virility, impotence is a threat to male honour and identity. Viagra does not simply treat a physical ailment, it offers salvation to many men who associate erectile dysfunction with a loss of male power and identity. Based on culturally entrenched understandings about male sexuality and ‘potency’, and the pressure for men to maintain sexual activity, much of the appeal, the commercial success and the cultural notoriety of Viagra stems from not just its efficacy but a more pernicious sense of what it means to be a man, or not. Potts and colleagues (2003: 699) argue that ‘Viagra is a device (or technology) which itself is coded with various social and cultural understandings about sexuality and masculinity (particularly, what constitutes “normal” and “healthy” male – and female – sexuality)’. They interviewed women in New Zealand whose male partners used Viagra and found that there was a worrying lack of consideration of partner perspectives in prescribing Viagra to older men. Viagra is just one example of an era in which new substances have emerged which offer a means of ‘fixing’ or ‘enhancing’ what humans are and what they are capable of. Nikolas Rose (2003) describes the emergence of ‘psychopharmacological societies’ based on the ‘promise’ of using drugs and other pharmaceutical substances to enhance the self:

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They are societies where the modification of thought, mood and conduct by pharmacological means has become more or less routine. In such societies, in many different contexts, in different ways, in relation to a variety of problems, by doctors, psychiatrists, parents and by ourselves, human subjective capacities have come to be routinely re-shaped by psychiatric drugs. (Rose, 2003: 46)

Sitting alongside any number of new technologies, drugs are increasingly seen as just one of a number of ways in which to optimise body and mind. They promise to make us better versions of ourselves. Anti-depressants are widely prescribed and widely used in many countries and have been for a long time, which means there is a long history of drugs being used to chemically adjust our emotions, our personalities and our sense of self. For many people who have used anti-depressants, over time a long-term prescribed use becomes part of their self-identity and coming off those anti-depressants can be a hugely challenging experience because they’ve become central to their sense of self and interaction with others. Such drugs become something that is used to manage and negotiate emotions and mental states. A doctor might prescribe anti-anxiety medicines but many people ‘self-prescribe’ alcohol or other intoxicants like cocaine and cannabis to feel relaxed, sociable and confident. Again, we can see the hazy boundary between treatment of an ailment and enhancement, taking something to compensate for an illness or ailment or to gain on an already acceptable level of health and ability. Ritalin, a sort of mild amphetamine, is a stimulant that’s given to primarily children or young people with diagnosed with attention deficit hyperactivity disorder. Ritalin is meant to stabilise you, to allow you to focus, to become less fidgety and less distracted. However, in the last couple of decades the use of Ritalin as a so called ‘study drug’ by those who are not actually directly prescribed it but, having aquired it, then use it to allow greater focus in studying or at work. One critique is to see such drugs as part of a wider trend in the medicalisation of ordinary human emotions such as sadness, anxiety or feelings of inadequacy. In an age where social media, the traditional media advertising and the cultural industries bombard us with messages signalling that we have to work on ourselves as individuals to be as fit, attractive, intelligent, successful as possible, a discourse of selfimprovement is deeply embedded in modern life and contemporary neo-liberal socioeconomic arrangements. In such a context, the solution to our problems is that we take control of our lives and to seek self-actualisation through chemical assistance. Coveney et al. (2011) suggest we have seen a process of ‘pharmaceuticalisation’, where substances originally closely controlled by the medical profession, and used for specific therapeutic treatments, transfer into first niche then main-

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stream uses as enhancement to capacities and abilities where there is no defined medical or clinical ‘need’. Here, substances such as Ritalin become seen as ‘fixers’ for a personal or social problem and are associated with individual social goals, aspirations and dreams. Performance and cognitive enhancing drugs are therefore increasingly seen to get a short-term ‘fix’ to allow operation and performance at optimum level and to gain a competitive edge over others (Coveney et al., 2019). This appears particularly true in contexts in which, for example, workplace cultures tolerate the pursuit of achievement and productivity above other concerns, where pharmacological neuroenablement might be readily accepted as offering the possibility of ‘producing happy, hope-filled people who are contributing to society, who are fit for life’ (Fitzgerald, 2015: 215). Intoxication in Contrast 11:

Jeanette Bjønness (2019) conducted 60 interviews with Danish students and analysed their narratives about using prescribed pharmaceuticals for enhancement purposes. The analysis identified gender differences in how male and female students narrated their opinions about and experiences of using prescribed drugs for non-medical purposes. Whilst male participants’ narratives were framed in terms of competition, performance and success, female narratives were more likely to focus on overcoming anxiety and other vulnerabilities to achieve ‘normal’ functions and expected conduct in academic contexts. Emeka Dumbili and colleagues also studied the use of prescription drugs for non-medical purposes by young people in Nigeria. Drawing on qualitative interviews, they found participants spoke of having ready access to drugs such as codeine, rohypnol and tramadol through social networks and from unregistered or poorly regulated pharmacies. These were taken in different ways with the hope of meeting and exceeding social pressures at work and in academia and were framed in the context of employment precarity and parental expectations specific to Nigerian society. Gender differences were also notable, as male interviewees spoke of being motivated to increase performance in sports. The authors reflected that prior to the study little research had been conducted exploring pharmaceutical enhancement in non-Western countries. Bjønness, J. (2019). Gendered aspects of Danish students’ non-medical use of prescription pharmaceuticals for enhancement purposes in the ‘performance society’. Drugs: Education, Prevention and Policy, 26(4), 309–318. Dumbili, E. W., Gardner, J., Degge, H. M., & Hanewinkel, R. (2021). Enhancement motivations for using prescription drugs among young adults in Nigeria. International Journal of Drug Policy, 95, 102995.

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A final trend worth considering is the growing interest in what has become known as ‘microdosing’, whereby small doses of psychedelic substances such as LSD and psilocybin containing mushrooms are consumed with the aim of achieving various enhancement effects to brain function and emotional states without experiencing the disruption to perception brought on by a full dose. As with IPED, microdosing can be framed in relation to pressure to achieve ideal standards of productivity and creativity as they are linked to much desired achievements of success, mastery and perfection. It is perhaps no surprise that the resurgence of interest in LSD and other hallucinogenic has emerged from Silicon Valley where an emphasis on augmenting one’s powers of creativity and productivity through microdosing fit well with a wider culture of ruthless self-advancement buttressed by the hero worship of maverick start-up entrepreneurs. Whilst research on this field is still forthcoming, there are now studies examining the motivations of those who see themselves as leading the vanguard of experimentation. Johnstad (2018) interviewed users who take small doses of psychedelic drugs to enhance everyday functioning and found such individuals justified this practice as an experimentation to enhance mood, increase creativity or mitigate feelings of anxiety and depression. Whilst less experienced microdosers simply experiment, more established microdosers used a ‘regimen’ often informed by their own research. Interviewees reported effects including mood improvement, energy boosts and creativity and, for some, increased openness and extraversion.

Summary This chapter has considered recent trends relating to the creation of new substances and new uses for both novel and traditional drugs. The long history of drugs explored in Chapter 2 and alluded to regularly throughout this book bequeaths certain ways of thinking about intoxication. New substances are taken for their ability to enhance and optimise bodily or mental performance, at least initially, fail to ‘fit’ within long-established association between drugs, pleasure and harm that have become so entrenched in our laws, culture and prejudices. Indeed, a thread running through these discussions is how received framings about drugs and intoxication based on hedonism and transgression do not capture the reality that most people using IPEDs or cognitive enhancements, and those experimenting with microdosing, do so with the desire of conforming to and even surpassing societal expectations relating to physical accomplishments, aesthetic beauty and mental intelligence. Yet, as we have seen, both regulatory approaches

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and, perhaps even more noticeably, cultural norms and values can quickly adapt to the emergence of new substances. The complexity of this picture is important, as substances can and do traverse medical and recreational settings. Both regulatory responses and academic understandings must adapt and remain forward looking if they are to keep pace. As pharmacological innovations accelerate in parallel with the rate that society creates dissatisfaction there is the very real possibility that new substances, and the cultures and practices of their use, are already being developed at a far greater rate than which existing regulatory powers can respond. We are already entering an era of personalized medicine, of bespoke pharmacology for those who can afford what will no doubt be an expensive luxury, a palate of drugs that matches to an individual’s genetic and psychological profile. As the final chapter of the book will consider, the futures of intoxication are increasingly looking like they will continue to test and recalibrate the established structures of regulation and control. Points for Discussion

Thinking of a sport that you are most familiar with, how might the drug use of a particularly prominent sportsman or sportswoman be treated by those involved in the sport such as organisational bodies and fans? Should performance enhancing drugs (PEDs) be banned from all competitive sports or is there a case for their use in some situations? Is the use of performance and cognitive enhanceing drugs a response to feelings of inadequacy in a society that puts ever-increasing pressures on people to perform, achieve and succeed?

Read, Watch, Listen #11 Watch: The use of Performance Enhancing Drugs (PEDs) has received increasing media coverage. Icarus is a 2017 documentary by American filmmaker Bryan Fogel examining illegal doping in sports. Part of the BBC’s Newsbeat series, 2018’s ‘Steroid Nation’ is a short documentary about steroid use amongst bodybuilders in South Wales. Read: How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence is a 2018 book by the American journalist and writer Michael Pollan.

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Listen: In 2015 the BBC Radio 4 series Moral Maze featured an episode on ‘Drugs in Sport and Human Enhancement’ in which a panel of guests discuss the moral and policy implications of doping in sport and cognitive enhancements in wider society.

References Bancroft, A. (2009). Drugs, intoxication and society. Polity. Bell, P., Ten Have, C., & Lauchs, M. (2016). A case study analysis of a sophisticated sports doping network: Lance Armstrong and the USPS team. International Journal of Law, Crime and Justice, 46, 57–68. Blackman, S., & Bradley, R. (2017). From niche to stigma—Headshops to prison: Exploring the rise and fall of synthetic cannabinoid use among young adults. International Journal of Drug Policy, 40, 70–77. Christiansen, A. V., Vinther, A. S., & Liokaftos, D. (2017). Outline of a typology of men’s use of anabolic androgenic steroids in fitness and strength training environments. Drugs: Education, Prevention and Policy, 24(3), 295–305. Coveney, C., Gabe, J., & Williams, S. (2011). The sociology of cognitive enhancement: Medicalisation and beyond. Health Sociology Review, 20(4), 381–393. Coveney, C., Williams, S. J., & Gabe, J. (2019). Enhancement imaginaries: Exploring public understandings of pharmaceutical cognitive enhancing drugs. Drugs: Education, Prevention and Policy, 26(4), 319–328. Dimeo, P. (2014). Why Lance Armstrong? Historical context and key turning points in the ‘cleaning up’ of professional cycling. The International Journal of the History of Sport, 31(8), 951–968. Fitzgerald, J. (2015). Framing drug use: Bodies, space, economy and crime. Springer. Chapter 11, ‘Neuroenablement and Hope’. Grogan, S., Shepherd, S., Evans, R., Wright, S., & Hunter, G. (2006). Experiences of anabolic steroid use: In-depth interviews with men and women body builders. Journal of Health Psychology, 11(6), 845–856. Henning, A. (2017). Challenges to promoting health for amateur athletes through anti-doping policy. Drugs: Education, Prevention and Policy, 24(3), 306–313. Hutton, F. (2020). Cultures of intoxication: ‘New’ psychoactive substances. In Cultures of intoxication (pp. 87–110). Palgrave Macmillan. Johnston, L. (1996). Flexing femininity: Female body-builders refiguring ‘the body’. Gender, Place and Culture: A Journal of Feminist Geography, 3(3), 327–340. Johnstad, P. G. (2018). Powerful substances in tiny amounts: An interview study of psychedelic microdosing. Nordic Studies on Alcohol and Drugs, 35(1), 39–51. Klein, A. M. (1993). Little big man: Hustling, gender narcissism, and bodybuilding subculture. State University of New York Press. Loland, S. (2018). Performance-enhancing drugs, sport, and the ideal of natural athletic performance. The American Journal of Bioethics, 18(6), 8–15.

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Mamo, L., & Fishman, J. R. (2001). Potency in all the right places: Viagra as a technology of the gendered body. Body & Society, 7(4), 13–35. Monaghan, L. (1999). Challenging medicine? Bodybuilding, drugs and risk. Sociology of Health & Illness, 21(6), 707–734. Monaghan, L. (2002). Bodybuilding, drugs and risk. Routledge. Morgan, W. J. (2009). Athletic perfection, performance-enhancing drugs, and the treatment-enhancement distinction. Journal of the Philosophy of Sport, 36(2), 162–181. Murray, J., Van de Rijt, A., & Shandra, J. M. (2013). Why They juice: The role of social forces in performance enhancing drug use by professional athletes. Sociological Focus, 46(4), 281–294. Peacock, A., Bruno, R., Gisev, N., Degenhardt, L., Hall, W., Sedefov, R., White, J., Thomas, K. V., Farrell, M., & Griffiths, P. (2019). New psychoactive substances: Challenges for drug surveillance, control, and public health responses. The Lancet, 394(10209), 1668–1684. Potts, A., Gavey, N., Grace, V. M., & Vares, T. (2003). The downside of Viagra: Women’s experiences and concerns. Sociology of Health & Illness, 25(7), 697–719. Reed, S. (2019). Who is to blame? An examination of American sports journalists’ Lance Armstrong hero narrative and post–doping confession paradigm repair. Journal of Sports Media, 14(1), 67–91. Reuter, P., & Pardo, B. (2017). Can new psychoactive substances be regulated effectively? An assessment of the British psychoactive substances bill. Addiction, 112(1), 25–31. Rose, N. (2003). Neurochemical selves. Society, 41(1), 46–59. Shafi, A., Berry, A. J., Sumnall, H., Wood, D. M., & Tracy, D. K. (2020). New psychoactive substances: A review and updates. Therapeutic Advances in Psychopharmacology, 10, 2045125320967197. Stevens, A., Fortson, R., Measham, F., & Sumnall, H. (2015). Legally flawed, scientifically problematic, potentially harmful: The UK Psychoactive Substance Bill. International Journal of Drug Policy, 26(12), 1167–1170. Tiefer, L. (2006). The Viagra phenomenon. Sexualities, 9(3), 273–294. van de Ven, K., & Koenraadt, R. (2017). Exploring the relationship between online buyers and sellers of image and performance enhancing drugs (IPEDs): Quality issues, trust and self-regulation. International Journal of Drug Policy, 50, 48–55. Wiesing, U. (2011). Should performance-enhancing drugs in sport be legalized under medical supervision? Sports Medicine, 41(2), 167–176.

Conclusion: Intoxication and Its Futures

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Introduction We opened this book with a series of rhetorical questions designed to provoke some initial self-reflection on the experience, knowledge and prejudices each reader might be carrying into their encounter with intoxicants and the people that use them. We also observed that a reader entirely unfamiliar with intoxication might be a rare thing (Bancroft, 2009). Even a lifelong abstainer from all alcohol and drugs who has never smoked and has either by design or luck avoided those medications with intoxication-like side effects must, nonetheless, accrue an awareness of the omnipresence of intoxication in most societies. Mindful of this, our task has been to present the issues relating to alcohol and drugs in a relatable way. We have done this primarily from a social science perspective. As criminologists and sociologists, these are our disciplinary strongholds from which we make our forays into topics and debates that are inescapably interdisciplinary. Unavoidably, our preferences and predilections show. We have always kept an eye on the social and cultural themes cutting across the topics the book has covered chapter by chapter. This means that strictly medical accounts have only concerned us where the interplay of biological or psychiatric concerns interlock with social and cultural issues. The first five chapters of this book were written to provide a foundational knowledge in how matters relating to alcohol and drugs, and their regulation, are understood. This involved an appreciation of the historical context of issues relating to intoxication and important overviews of both how alcohol and drugs have been controlled but also some consideration of the theories that underpin these approaches. Then, in chapters discussing addiction and its treatment and how alcohol and drugs are represented in cultural content and the mass media in © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8_12

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particular, attention was focused on how society responds to those who use drugs or who drink alcohol to excess. We saw trends towards both stigma and empathy that, we hope, speak to a concern with the individual lives and experiences of people, even those who are most marginalised by the moral panics of discourses around intoxication. The latter section of the book, particularly chapters 8, 9 and 10 focusing on age, gender and sexuality and ethnicity and religion, respectively, have drawn on recent empirical research that shows experiences of intoxication to be both diverse and unequal. Finally, in Chapter 11, we used the notion of ‘design’ to examine recent examples of new substances being created and, with them, new narratives about drugs and their place in the modern world. We say how many such drugs are taken up with relish not because they offer escapist transgression but because they promise to enhance and perfect the capacities of the human body and mind. For those readers who have come to this book as part of formal education, we suggest that this text is viewed as a starting point. Covering a topic so vast, with such a long and multifaceted history, as this has required us to make some sacrifices of detail in favour of narrative. Following the reference lists from the chapters that have interested you most will open new and more detailed avenues. Likewise, the ‘Read, Watch, Listen’ text boxes you will have encountered as you read will help you broaden out your ‘diet’ of content relating to intoxication, alcohol and drugs. Some readers may have come to this text as a primer ahead of designing and executing their own research on topics related to intoxication. For such readers we apologise for having said less about the many interesting methodological concerns and challenges one is faced with when researching matters relating to alcohol and drugs, particularly when it involves some attempt to capture ‘lived experience’ which can be complicated and elusive. Where we have included specific empirical examples, we often mention whether the research drew on surveys, interviews, ethnography or other methods. We would reiterate the value of a close reading of how established researchers present their methods in published research. This is particularly important given the divergence of epistemological (i.e. theories of knowledge and how it is created) foundations of different disciplines; public health scholars’ research tends to be almost entirely quantitative and led by the analysis of large data sets and national samples in contrast with scholars working in academic fields such as youth studies, cultural studies, sociology or criminology who may use a wider range of methods and, in particular, favour the ‘close up’ detail afforded by qualitative approaches.

Self, State and Society: Revisiting the ‘Scales’ of Intoxication

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Self, State and Society: Revisiting the ‘Scales’ of Intoxication In closing the book, it is worth revisiting the three themes or ‘scales’ which, in the Introduction, we suggested as a useful heuristic for thinking about and through intoxication. Regarding the self, we have not shied away from acknowledging that a primary motivating factor for a lot of alcohol and drug use is the pleasure taken in intoxication. Indeed, this is fundamental to understanding both why intoxication proliferates despite widespread regulation and control and, not least, how entire industries emerge to cater to the desire for hedonistic pleasure. These pleasures are often rooted in a very human desire for friendships, social connection and bonding between individuals and groups (Thurnell-Read, 2016). We saw in Chapters 2 and 5, for example, how the night-time economy so central to many towns and cities since the 1980s places intoxication and pleasure at the heart of its social, cultural and economic activity. We also saw the various ways in which the identity shapes experiences. This was particularly overt in Chapters 8, 9 and 10, where research illustrated how your age, gender and ethnicity greatly impact your engagement with alcohol and drugs and, in various ways, influence the avenues through which you navigate the competing opportunities and risks associated with intoxication. In various ways, we have foregrounded individual experiences. This has been helped in no small part by the recent proliferation of outstanding academic research dedicated to appreciating the lived experiences of specific individuals and groups. Such studies play an important role in widening both the quantity and quality of our insights into intoxication allowing us, as we must, to go beyond general patterns at the national level. Whilst a very interesting book solely focusing on the experiences of individuals could be written, it has been important to give due attention to the state and governments and their institutions. State policies shape drug and alcohol realities. We see this with efforts to close off and criminalise the 1980s rave culture thriving on its existence outside of the mainstream economy. Laws enacted to control illegal raves, enforced by institutions such as the police and courts, eventually had the effect not of eradicating drug taking and dance music but of channelling these into more formal, regulated and contained arenas in which their existence aligned with the value of market capitalism and urban renewal. Drug legislation, in particular, ought to be seen as an issue of international relations. Global convergence of approaches following UN charters but also, going back further, acknowledging that the trade in drugs has always been a global issue as the British initiated Opium Wars fought against China illustrate. We have returned to the topic of the

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American-led War on Drugs on several occasions but equally, the state has featured in a more subtle role, as a basis for the economic, social and cultural infrastructure upon which alcohol and drug taking is overlaid. Going to a local pub for a beer and stepping outside to smoke a cigarette (assuming you are in one of the many countries where alcohol is legal but smoking inside public buildings is prohibited) may feel reassuringly routine to many, but those rather quotidian actions still require a functioning state to license and tax the sale and distribution of alcohol and tobacco. Also, despite the shrinking of the welfare state in many countries during recent years of austerity policies, the state remains one of the most frequent providers of treatment and support for those beset with alcohol and drug use disorders. Finally, in relation to our third scale society, it has been important throughout that we accept issues relating to alcohol and drugs as not occurring in a social vacuum but as stemming from the complex and changing social world. Both historically and in contemporary times, a great deal of intoxication could be said to have a social function in being a means for people to establish and maintain social networks and friendships but also to manifest changing norms and values, roles and rituals. At the same time, the justification for the most draconian interventions into individual freedoms when it comes to choices to drink alcohol or take any number of mind-altering drugs is typical that such actions are a social issue with real harms to society that go beyond the individual. Social change is important here. Whilst at times it has been difficult to present a smooth and orderly chronology as we chased different topics and issues across the book and within each chapter, we have often zoomed in on specific periods for more detailed examinations of the fluctuating context of alcohol and drug use and control. Thus, the early twentieth century reappears on various occasions as a time and place of moral sensationalism and regulatory zeal. In contrast, the 1960s and 1980s stand out for the ways in which drug use by first counter-cultural movements like the ‘hippies’ and then the rave culture emerging from post-industrial society are points at which drug taking aligned with certain progressive or, at least, dynamic changes in society. As such, where possible we have sought to give some context to these moments both in terms of the prevailing politics but also socio-economic conditions which shape individual experiences and societal responses. This is an important and ongoing task. As the final section of the book will now consider, it is difficult not to view our current times as marked by a volatility which is likely to transform many of the issues this book has addressed.

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The Futures of Intoxication A task of this book has been to guide the reader through the various histories and presents of intoxication. It frequently felt beneficial to comment on the striking similarities and continuities between past and present and, even when separated by centuries, attitudes and responses to intoxication can seem remarkably similar. In every era and at every turn, there seem to be recurring concerns about responsibility, morality, deviance and societal harms. Yet, in a number of ways, we hoped to direct this book towards the future. Several key trends emerged and we have done our best to comment on them even when the pace of change is such that our understanding of them presented here may soon be overtaken by developments. Many of the assumptions we might confidently make about how alcohol and drugs are viewed in society may change. Indeed, even whilst the War on Drugs presses belligerently on its chosen path, many US states now follow the examples set by Washington and Colorado in 2012 by legalising both medical and recreational uses of cannabis. Perhaps in subsequent additions we will say more about these. Cannabis-based medicines have become permissible in the UK since 2018 for the treatment of a very limited number of conditions, but at the time of writing very few prescriptions are written by the medical profession (Schlag et al., 2020). It remains to be seen how this might change over coming years. It is worth remembering that it is less than a decade since the suggestion that young people in countries like the UK and US increasingly see alcohol and drunkenness as dull and a boorish distraction from more urgent concerns like personal health and well-being or career advancement might be greeted with amusement, if not open ridicule (Caluzzi et al., 2022). As we saw in the previous chapter, new psychoactive substances and pharmaceutical augmentations continue to proliferate and heading into the future we can be confident that new needs and desires for chemical enhancement will emerge. There are several policies which may, based on their success and subsequent uptake in further countries, become increasingly central to discourses surrounding alcohol and drug use and their regulation. The impact of Portugal’s national decriminalisation of all drugs continues to be debated. The success of Minimum Unit Pricing in Scotland and, more recently, in Wales could prompt a succession of similar public health initiatives globally and we might for now speculate on how the alcohol industry and its powerful lobby either redouble its efforts to resist this or, alternatively, revise its business practices to circumnavigate such price controls. Likewise, drug testing at dance events and music festivals appears to be putting harm reduction initiatives back on the policy agenda (Measham

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& Turnbull, 2021). Charities such as the UK-based collective The Loop are not just involved in pragmatic action, testing drugs at festivals and club events, but are making increasing use of social media to foster new narratives about risk and agency that destigmatise drug users. Indeed, social media is an increasingly important arena for the education and information exchange. The #crushdabwait hashtag has been used by The Loop and others as harm reduction advice for those considering using MDMA at festivals over the summer. In a similar vein, the ‘Nice People Take Drugs’ Campaign by Release, the UK’s foremost charity with expertise around drugs and the law, sought to engage the public with more open debate about who drug users are and the kinds of backgrounds they have. The ultimate aim here was one of destigmatisation. This book was written at a time of great upheaval and uncertainty. It remains to be seen how the impact of the covid pandemic shapes alcohol and drug use and regulation. One consistent feature seems to be that despite reduced opportunities to use alcohol and drugs socially through nationally enforced lockdowns, the insatiable appetite for becoming intoxicated remained and continues (Fernandes et al., 2021). Alcohol sales actually increased and drug markets remained buoyant during the peak of the pandemic (Roberts et al., 2021). This showed the adaptability of those who make, distribute and consume intoxicants but also invoked grave concerns about the intractability of the many harms associated with alcohol and drugs. That intoxication so quickly became a means of ‘coping’ with the physical restrictions and psychological challenges of lockdowns, work furlough schemes and the many forms of social dislocation are worrying. Such developments mean, as we move forward, there remains much to be gained in a willingness to allow our understandings of intoxication, drugs and alcohol and their changing place in the lives of individuals, institutions and whole societies to be open, flexible and subjected to regular re-examinations and reappraisals. Points for Discussion

How have your attitudes to alcohol, drugs and intoxication changed after reading this book? What impact do you think recent global events such as the Covid-19 pandemic have had on the ways people, states and societies relate to alcohol and drugs? Looking to the future, will alcohol and drugs become more or less prominent in society?

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Index

A Abstinence, 49, 126, 130, 134, 135, 137–142, 147, 221, 222 Addiction, 4–6, 16, 20, 30, 34, 64, 73, 81, 100, 102, 103, 105, 116, 125–131, 133–135, 137–141, 146–148, 157, 160, 162, 164, 166, 172–176, 191, 205, 240, 257 Advertising, 54, 108, 119, 147, 154, 166–169, 172, 200, 205, 224, 225, 250 Advisory Council on the Misuse of Drugs (ACMD), 79, 80, 86, 88, 127, 142, 144, 243 African Americans, 75, 227 Alcohol-free Zones, 58, 59 Alcoholics Anonymous, 130, 135, 148 Alcohol industry, 39, 54, 60, 61, 63, 111, 147, 172, 206, 261 Alcoholism, 102, 119, 128–131, 135, 137, 138, 147, 148, 158, 165, 230 Alehouse Act 1552, 44 Amphetamines, 2, 34, 37, 39, 133, 185, 208, 241, 250 Anslinger, Harry, 10, 38, 74–76, 81, 104, 159, 227 Anthropology, 3 Asian Americans, 234 Availability, of alcohol, 44, 53, 54 Availability, of drugs, 183

B Baby Boomers, 189, 249 Bacchus, 23 Becker, Howard, 10, 104–106, 120 Beer, 1, 23–25, 27, 28, 45, 50, 51, 53, 55, 56, 62, 63, 101, 167, 169, 199, 200, 205, 212, 214, 222, 223, 260 Binge drinking, 6, 170, 171, 198, 207, 223 Bouncers, 59, 60 British Crim Survey (BCS), 13 British Empire, 32, 226

C Caffeine, 1, 19, 91, 131 Cannabis, 3, 8–10, 12, 14, 20, 26, 36, 38, 50, 71, 73, 74, 77, 79, 80, 83, 85–87, 89–92, 99, 104, 106, 109, 110, 113–115, 131, 133, 134, 161, 163–165, 184–186, 203, 226, 227, 231, 232, 240, 241, 250, 261 Capitalism, 21, 259 Champagne, 171, 224 Chemsex, 213 Children, Childhood, 79, 157, 168, 182–184, 189, 190, 192, 198, 222, 250 Classification systems, 79, 80, 161

© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 T. Thurnell-Read and M. Monaghan, Intoxication, https://doi.org/10.1007/978-3-031-19171-8

289

290 Coca, 21, 23, 25, 26, 29–31, 33, 240 Cocaine, 11, 12, 14, 20, 21, 26, 27, 29, 30, 34, 36, 40, 71, 72, 77–80, 83, 86, 91, 99, 111, 112, 162, 165, 166, 203, 207, 227, 228, 240, 241, 250 Coffee, 1, 7, 19, 22, 26, 30, 85, 197 Commodification, 21, 26, 28 Consumerism, 120, 158 Crack cocaine, 79, 109, 228 Crime, 12, 13, 44, 50, 51, 58, 59, 61, 70, 76, 82, 84, 102, 103, 105, 106, 130, 145, 154, 160, 163, 221, 230 Criminology, 3, 14, 105, 209, 258

D Decriminalisation, 44, 89, 115, 261 Defence of the Realm Act (DORA), 45, 72, 73 Denmark, 190, 210 Dependency, 5, 77, 105, 113, 125, 127, 128, 131, 135, 140, 141, 143, 146–148, 165, 191, 201, 204, 213, 214 Deregulation, 170 Deviance, 102–105, 107, 110, 112, 117, 118, 120, 261 Diagnostic and Statistical Manual of Mental Disorders, 131, 249 Disease model of addiction, 129, 131 Distillation, 24, 29 Douglas, Mary, 101 Drink driving, 55 Drinking cultures, 6, 24, 221–223 Drinking guidelines, 62, 63 Drug dealing, 163 Drug education, 138 Drug Enforcement Administration (DEA), 37 Drug-related deaths, 38, 78, 83, 84, 126, 127, 162, 192 Drug testing, 261 Drunkenness, 3, 4, 6, 16, 46, 51, 54, 58, 61, 100, 101, 114, 128, 129, 154, 156, 170, 172, 175, 182, 186,

Index 199, 200, 202, 207, 212, 214, 222, 230, 231, 261 Dry and wet drinking cultures, 6, 222

E Ecstasy, 14, 20, 33, 37–39, 77–80, 83, 106, 107, 110, 117, 161, 162, 165, 168, 185, 203, 208–211, 241

F Femininity, 189, 197, 198, 200–203, 205–207, 211, 215 Freud, Sigmund, 24, 29, 31 Friendship, 109, 118, 154, 172, 182, 184, 185, 202, 207, 240, 259, 260

G Gay community, 215 Gin, 27 Guinness, 168, 225

H Harm reduction, 16, 54, 55, 83, 85, 107, 134, 138, 141–145, 261, 262 Harrison Act 1914, 133 Heavy episodic drinking, 222 Hedonism, 24, 109, 118, 119, 165, 245, 252 Hepatitis C, 13 Heroin, 12, 20, 28, 34, 39, 70, 75, 77–80, 82, 84, 85, 88, 91, 99, 109, 125–127, 130, 133, 138, 140, 141, 143, 154, 160, 161, 189, 203, 207, 211, 240 HIV/AIDS, 142–144

I Identity, 16, 107, 118, 120, 138, 172, 174, 184–186, 193, 203, 206, 208, 213, 214, 223–225, 230, 232–234, 249 Injection, 144, 160, 207

Index L Labelling theory, 108 Legalisation, 44, 70, 71, 81, 88, 89, 165 Liberalisation, 171 Licensing Act 1872, 45 Licensing Act 2003, 45, 61, 171 Licensing hours, 61 LSD, 3, 19, 20, 33, 35–38, 40, 76, 77, 79, 161, 187, 240, 252

M Magazine, 33, 107, 154, 171 Magic mushrooms, 77, 79 Masculinity, 187, 197, 200–205, 209, 210, 212, 215, 249 MDMA, 2, 20, 37, 38, 40, 78, 88, 92, 109, 127, 161, 240, 241, 262 Measham, Fiona, 39, 40, 77, 112, 113, 168, 183, 208, 209 Medicalisation, 128, 129, 148, 250 Medical use of alcohol, 30 Medical use of opioids, 84 Mental health, 80, 141, 205 Mephedrone, 87, 213, 241–243 Methadone, 134, 140, 141 Minimum Unit Pricing (MUP), 56, 57, 261 Misuse of Drugs Act (1971), UK, 8, 77, 79–81, 86, 87, 105, 134, 242 Moderation, 49, 54, 62, 188 Morality, 10, 100, 128, 158, 173, 206, 261 Moral panic, 27, 38, 39, 106, 111, 120, 171, 175, 258 Motherhood, 189, 201

N Narcotics Anonymous (NA), 135, 137, 164, 204 New Labour, 144 Nicotine, 1, 30, 127 Nightclubs, 6, 37, 39, 188, 214 Night-time economy, 5, 39, 40, 59, 60, 110, 116, 119, 170, 188, 207, 212, 213, 215, 259

291 Normalisation thesis, 6, 107, 109–113

O Off-trade sales, 56 Opiate Substitute Therapy, 134, 140 Opium, 20, 21, 25–27, 29–33, 40, 69–73, 85, 86, 125, 129, 130, 158, 166, 209, 226, 227 Opium Wars, 32, 259

P Pain relief, 31, 33 Pharmacy Act (1868), UK, 72 Physiology, 247 Pleasure, 2, 4, 6, 7, 10, 29, 33–35, 40, 63, 99, 106, 112, 118, 119, 132, 155, 162, 187, 190, 203, 208, 209, 212, 213, 215, 239, 240, 249, 252, 259 Police, 12, 59, 69, 80, 97, 134, 144, 160, 164, 170, 173, 185, 191, 228–230, 232, 259 Poly drug use, 84 Portman Group, 60, 147 Portugal, 89, 115, 222, 261 Prison, 13, 36, 53, 75, 82, 83, 87, 134, 204, 241, 243 Prohibition of Alcohol in the USA, 47 Psychoactive Substances Act 2016, UK, 80, 86–88, 242 Public health, 14, 19, 43, 44, 50, 55, 62, 83, 89, 90, 143, 148, 198, 206, 213, 230, 258, 261 Public houses, 231 Purity, 31, 85

R Racism, 142, 162, 163, 227, 228, 235 Rave, 3, 37, 38, 106, 107, 117, 208, 259, 260 Representations of intoxication, 63, 153, 155

292 Rolleston Committee (1926), 130, 133

S Scotland, 13, 38, 56, 57, 142, 143, 188, 214, 261 Sobriety, 147, 183 Sociability, 24, 223, 224, 233 Social class, 110, 112, 134, 232, 233 Social media, 54, 156, 165, 166, 169, 171, 172, 175, 250, 262 Social problems, 46, 47, 106, 172 Sociology, 3, 14, 30, 258 Steroids, 77, 243, 246–248 Stigma, 62, 117, 130, 148, 175, 191, 221, 258 Student drinking, 186 Subculture, 10, 37, 39, 110, 207, 209, 213 Substance Misuse Disorder, 148

T Taxation, 45, 50, 55, 81, 85, 89 Television, 111, 119, 154, 155, 163, 168–170, 175, 225 Temperance movement, 46, 49, 156, 221 Tobacco, 12, 19, 20, 30, 43, 44, 50, 69, 78, 89, 91, 113, 114, 127, 131, 260 Treatment, 8, 10, 12, 13, 16, 27, 37, 64, 79, 82, 84, 105, 113, 114, 116, 126, 127, 129–131, 133–135, 137– 141, 143, 145–148, 161, 162, 166, 173, 189, 204, 206–208, 212, 215, 221, 230, 232, 234, 245, 248, 250, 257, 260, 261 Twelve-Step Facilitation (TSF), 137, 138, 140

U Underage drinking, 168, 186 United Kingdom (UK), 6, 8–10, 13, 14, 20, 38–40, 47, 55–59, 62, 63,

Index 72, 73, 77, 78, 80, 81, 84, 86, 87, 91, 105, 114, 115, 133–135, 137, 138, 140, 141, 143–147, 167, 169, 171, 172, 174, 182, 184, 186, 189, 192, 212, 213, 215, 221, 223, 232, 242, 245, 261, 262 United States of America, 3, 9, 38, 44, 50, 74, 89, 104 Units of alcohol, 63

V Values, 2, 8, 11, 37, 38, 41, 91, 97, 107, 112, 117, 119, 120, 137, 138, 147, 153, 161, 167, 168, 174, 189, 205, 214, 223–225, 227, 234, 246, 248, 253, 258–260 Viagra, 248, 249 Vietnam War, 125 Violence, 37, 52, 60, 61, 110, 138, 156, 160, 162, 175, 204, 212, 213, 228, 232

W War on drugs, 5, 40, 47, 81, 83, 142, 163, 164, 228, 229, 260, 261 Whisky, 25, 167 World War I, 3, 45, 55, 72 World War II, 34, 35, 76

Y Young, Jock, 78, 82, 86, 105, 106, 186 Young people, 6, 9, 36, 38, 104, 107–114, 134, 168–172, 183–187, 189, 190, 206, 208, 232, 234, 250, 251, 261