The doctor cited in Cocaine: the Legend had treated some of the first problematic cocaine users of La Paz and offered an explanation for the tendency of regular cocaine users to keep taking the drug. ‘The intervals of abstinence from chronic use are invariably followed by a rebound effect, manifested in bad humour, irritability, and permanent tiredness. This in turn deepens the exhaustion, closing the circle and establishing the psychological drug dependency.’ Ted’s explanation of escalating use echoed the doctor’s. ‘Cocaine is like spending your whole pay cheque on Friday night. It feels great on Friday night, but it sucks to wake up broke on Saturday morning. That’s what cocaine does to your dopamine levels. You’ve used up your capacity to feel pleasure for the foreseeable future. Like Freud says in The Cocaine Papers, cocaine is not addictive. It’s just that discontinuing the dose produces a feeling of lethargy and ennui that is immediately relieved upon repeating the dose.’
‘As soon as I’d get high, I’d want some more,’ Doris told me. ‘Heroin is more physical, but that cocaine, it’s a psychological addiction. The desire is so strong, when you run out, you feel desperate. It makes you think “man, I’d do anything.” I never killed anybody, but I’d prostitute myself, steal, lie, manipulate, whatever it took to get the money. The mind is a powerful thing, and it can have us do things that we don’t want it to.’ Yet as the user starts to take cocaine on a habitual basis, what was once a completely engaging experience ultimately becomes a boring one. ‘With all this stuff, the longer you use it, you don’t get the same high any more,’ Pam said. ‘You spend a lot of time trying to get that same high back, and you just can’t.’ Unrealistic expectations lead to inevitable disappointment, yet habitual users seem to have a perverse need to experience that disappointment, perhaps to puncture expectations they know to be unreal.
The feelings that accompany withdrawal from heroin or the delirium tremens of the recovering alcoholic set in hours or days after the user has stopped taking the drug. Because the physical symptoms of withdrawing from a cocaine habit are minor, many doctors initially classified cocaine as a non-addictive drug, or at least one which all but the pathologically pathetic could resist. Habitués of cocaine were not thought to be addicted to the drug, but to pleasure itself. The problem lay not so much with the drug, as with its users, who saw no reason to cease gratifying their basest instincts. As a result, compulsive cocaine users were generally given shorter shrift than heroin addicts, with enforced abstention being the typical means of breaking the habit. Ted disparaged the very idea that people become addicted to cocaine. ‘People who talk about their addiction to cocaine are basically weak-minded pussies. With heroin you get physically sick, you’re vomiting, you’re shitting in your pants as you walk down the street. With coke, you feel like shit and life sucks, but what exactly is the difference between that and real life? If you can’t handle the shit that’s around you, you should go and get a heroin habit or something.’
Asa Hutchinson was head of the DEA between 2001 and 2003. In a speech he made on accepting his new job, he echoed the notion that drug addiction is essentially a character flaw. ‘I will bring my heart to this great crusade. My heart will reflect a passion for the law, a compassion for those families struggling with this nightmare, and a devotion to helping young people act upon the strength and not the weaknesses of their character.’
There was a time when ‘addiction’ was used exclusively to refer to compulsive use of alcohol or class A drugs like heroin. These days, we can be addicted to just about anything, from pornography and chocolate to shopping and love. The advocacy group Action on Addiction claims that one in three British adults suffers from some form of addiction.32 So in what sense is cocaine ‘addictive’? Repeated use of a substance is no indication of addiction (if it were we would all have to admit to an addiction to toothpaste). Compulsive use would be a better description, and a substance’s potential for being used compulsively seems to depend on several factors. The first is how intoxicated the user feels after taking it. In terms of intoxication, alcohol is an even stronger drug than heroin, which is in turn stronger than cocaine, which is stronger than marijuana. Reinforcement is a measure of how often users dose themselves with the substance. Alcohol tops the list, followed by heroin, then nicotine, then cocaine. The third factor is withdrawal. Nicotine has the severest withdrawal symptoms, followed by heroin, then cocaine, then alcohol. The factor that best highlights the potential dangers of cocaine use is dependence, which refers to the likelihood that users will continue using the drug even after it has started to do them harm, how hard they find it to stop using the drug and, having stopped, how easily they relapse into using the drug again. Cocaine is more likely to attract dependants than heroin, alcohol, nicotine or marijuana.33
But the physical qualities of any substance only go so far in explaining why people become dependent on it. Compulsive internet use is reported to be a problem all over the world, but it became an issue in South Korea when young people started dropping dead from exhaustion after playing online games for days on end. South Korea claims to be the most internet-savvy country in the world. Ninety per cent of homes have broadband internet connections. There are 140 internet-addiction counselling centres and 250,000 of the country’s under-eighteen year olds are said to show signs of internet addiction, a syndrome characterized by an inability to stop using computers, rising levels of tolerance that drive users to seek ever longer sessions online, and withdrawal symptoms like anger and craving when prevented from logging on. Dr Jerald J. Block, a psychiatrist at Oregon Health and Science University in the United States, estimates that up to nine million Americans may also be at risk of developing the disorder.34
What Dr Block calls ‘pathological computer use’ cannot be explained by scrutinizing South Korea’s computers or the online games that users play. It has its roots in an intensely competitive society that regularly sacrifices the rounded self-development of its young people to a conformist, target-driven education system. The ‘compulsive escapism’ that this has created might also be a better explanation for problematic drug use. The law and the medical profession generally focus on the drug, rather than the life and mind of the drug user, when trying to explain why people lose control of their drug use. But if young South Koreans can suffer withdrawal symptoms when deprived of online entertainment, in what sense can it be said that drugs are more dangerous than computers? Ted is critical of the pharmacocentric approach to understanding compulsive drug use. ‘It’s an easy cop-out from personal responsibility to blame the drugs. Skiing is a dangerous activity involving a white powder. It involves starting up real high and then coming down real fast. And it takes all sorts of effort, like a ski-lift, to get back up to the top. Is that an addiction? Is it pernicious? Should ski lifts be banned?’
Pain and intoxication are intimately bound, as the doctor from La Paz, Bolivia, made clear. ‘In almost all cases where there is this type of abuse of cocaine, I have found in the user’s previous history depressive states of the most varied origins: losses in life, dependent personalities, low tolerance for frustration, etc. These states in turn create conditions for easy dependency. Really, [drug abuse] is a desperate and intuitive search for treatment, an uncontrolled self-medication, which only results in the worsening of the previous depression.’
A verse from Proverbs 31:6 advises the reader to ‘give strong drink unto him that is ready to perish, and wine unto those that be of heavy hearts’. Popular iconography of the drug addict suggests that social deprivation and self-destructive drug abuse go hand in hand. While there is a lot of truth to this, this materialistic focus on poverty masks the many, more familiar instances in which depression leads to substance misuse, as in the case of Gabrielle. ‘I’d come home having worked really hard all day and I’d have a line to give me the energy to do the things that I needed to do at home, to feel like I could have my spliff, to feel like I’d earned it. I had to earn everything. Cocaine was very linked to my working pattern, being on my o
wn at work and being on my own at home. The cocaine use was easy to keep hidden, but it was also completely miserable because I’d have a lot more time to consider what I was doing and to feel shit about it the next day. I was coping really well with the rest of my life. But when there’s no one to stop you, you just keep going. I ended up going deeper and deeper into it to try to escape. I’m quite frightened of cocaine now.’
‘Oftentimes, the issues underneath drug use aren’t the issues that people expect them to be,’ Pam told me. ‘I had all the intellectual, material and physical things you could ever need. I was a state finalist in gymnastics and finished 11th in a class of 700 people. The way I saw it, as long as I was getting good grades, the drug use didn’t really matter. A lot of my coke use was about procrastinating for as long as I could on my assignments, and then using cocaine for the last six weeks of term to get them all done. I didn’t have any major trauma as a child, but my parents were pretty much emotional and spiritual zeros. They threw a lot of money at me to try to make up for other things and I spent most of it on coke and pot. Our society puts so much emphasis on the physical, the trivial and the intellectual, and a lot of people completely short-change the spiritual and the emotional. I really believe that drug abuse is just a symptom of a spiritual and emotional disease.’
Intoxication by any substance offers an escape from circumstances. It follows that the most dissatisfied people tend to take the most intoxicating drugs. The most marginalized and isolated among them continue to take hard drugs in spite of the harm it does them because all too often there is nobody to stop them. Crack cocaine is not a drug that appeals to many people. Less than one in a hundred British people have tried it, and most of them never smoke it again. One in five hundred Britons used it in 2005, and only half of them had used it in the past month.35 Whether in London, Los Angeles or Lima, crack is generally consumed by people suffering from trauma or depression, who find themselves with few resources to ease the burden of either. Louis is a crack user from New York City. He told me that he first started using drugs as a form of pain relief. ‘I’d left home at a very early age. I’d lost a very close friend, and there was some other trauma that occurred, so I was going around with these feelings, not knowing where to put them. I was hanging around with a gang, so sometimes those feelings showed up in violent ways. I did my first institutional bid when I was eighteen, but I knew that violence wasn’t going to lead me to freedom. With speed and crystal meth I discovered that I could alter how I felt. The depression that I was feeling lifted. So drugs weren’t just experimentation. They were an escape.’
Most crack users begin using drugs in adolescence and most use the drug compulsively. Nine out of ten of London’s crack users have been found to suffer from depression and a third have attended a mental health service. These people don’t develop crack habits because they try the drug and become addicted to it. Most of them were so damaged before they even picked up a crack pipe that it’s hard to know how much responsibility for their frazzled state should be borne by the drug, and how much by the lives they led before they found the drug. In London, the average age of first arrest for a crack user is sixteen, well before they ever started taking crack.
Crack is not the sort of drug that you can indulge in at leisure. It picks you up and runs with you, all the while convincing you that you are more in control of your life than you have ever been. Many of the people interviewed by the authors of On the Rocks: A Follow-Up Study of Crack Users in London spoke in glowing terms of the pleasure they got from ‘running about’ and being ‘on a mission’.36 The pleasure of crack might be lost on the average Londoner, but the motive for taking the drug is a familiar one. For every City of London stockbroker with a weekend cocaine habit, smiling with satisfaction at the pace and excitement of his life, there is a compulsive crack user smiling for the same reason. But since most Londoners have a barely restrained contempt for ‘crack-heads’, compulsive crack users tend to flock with those of their feather. Half of London’s crack users have at least one family relation with a drug or alcohol problem and over two thirds of them say that most of their friends also have problems with drugs or alcohol.
But crack use is not necessarily compulsive. A crack user can stop using rocks, and experience no physical withdrawal symptoms. In many ways, wealthy former crack users, such as the magazine publisher Felix Dennis, are surer guides to the harmful effects of crack because their wealth insulates them from much of the chaos that regular use of such a powerful stimulant brings in its wake. To suggest that the drug is responsible for the dependent relationship that many users develop is to gloss over the deprivation and neglect that many of them have experienced. Far from facing up to the origins of problematic drug use, it would seem that the greater society’s reluctance to confront mental illness and depression, the more strictly it prohibits the use of certain drugs.
The settings in which users of criminalized drugs congregate are always likely to be furtive. This makes it easier for their dealers to adulterate their product. Much of the physical damage done by crack is a consequence of its poor quality. For example, crack that has been washed in ammonia can cause permanent lung damage, a condition known as ‘crack lung’.37 Crack users have on occasion organized themselves to improve matters. Crack Squad is a users’ group that has taught East London GPs how to make crack pipes with a glass stem, so that the doctors can then teach users how to avoid burning their fingers and lips, which is the main cause of the high rates of transmission of hepatitis C among crack users. Unfortunately, most efforts to reduce the harm done by crack smoking are dismissed as only encouraging a habit that should be prohibited. This moralizing approach to drug policy is irrelevant to most drugs users and does nothing to protect their health.
‘Hell is of this world,’ wrote the French theatre critic and opium smoker Antonin Artaud in 1934, ‘and there are men who are unhappy escapees from hell, escapees destined eternally to reenact their escape.’38 In discussing the prohibition of opium, Artaud wrote that nobody can stop another from intoxicating himself. But he also insisted on a much broader definition of intoxication, to mean something more akin to immersion. He described the intoxicating effects of solitude, reading and anti-sociability. People value intoxicants, not just for the immediate pleasure they give, but for the measure of independence from the outside world that they supply. Most people enjoy that independence in small doses, but those buckling under the pressure exerted by the outside world will crave it. Sigmund Freud defined drugs as ‘painkillers’. It is precisely because painkillers offer refuge from external pressures that they will always be potentially dangerous.
Why some people enjoy cocaine from time to time while others let their drug intake define the course of their lives, is a question of what sobriety means to the drug taker. Mass drug addiction is a recent phenomenon that has flourished in a specific culture, one notable for the stresses that many of those who live in it have to bear and the solitude that many of them bear it in. But modern city dwellers don’t just take drugs to escape the world. They also take drugs in a misguided attempt to kick-start their participation in it. They are actively encouraged to believe that there is a product that can be bought that can satisfy their every desire, including their desire to participate more fully or escape entirely. The market for escape is partially fed by our notions of success, many of which are as prohibitive and exclusive as our favourite goods. Those deemed unsuccessful will always be tempted to alight on drug-taking as a pursuit (in the original sense of the word, as a flight from reality). Many of them will use drugs as part of a compulsive quest for some imagined state of grace; and some will use them in greater quantities as they realize the ultimate futility of the quest.
I asked Ted who he thought was most likely to develop problems with drugs. ‘Stockbrokers basically play Monopoly for a living. Most people past the age of seven find that boring. If you’re a guy with a healthy Wall Street income, you almost certainly have no emotional or psychological ce
ntre, so when you plug into the main circuit of pleasure, you’re fucked. Brokers are a drug dealer’s dream customers. They value things that are expensive and showy. Big tits! Porsche! Coke! So of course they get all fucked up on cocaine and are out selling pencils six months later. But to extrapolate from that sample something about the substance? No. I would certainly be in favour of criminalizing stupidity, but criminalizing something because stupid people might like it is not a very productive approach, is it?’
Dealing with other people’s stupidity, as well as their depression, means facing up to the destructive qualities inherent in personality traits that we prefer to celebrate, such as competition, individualism and self-denial. It requires that we accept drug abuse as an attempt to self-medicate conditions beyond the aegis of most doctors, who are trained to focus on physical well-being. Regular, compulsive crack use is symptomatic of deeply rooted obsessive or compulsive psychological disorders. Such disorders can also manifest themselves through torturous relations with other substances (like alcohol) or activities (like sex, or even the internet). The pharmacological properties of cocaine can only go a short way in explaining why there are so many compulsive crack users in America’s inner cities. Far more telling is the price and wide availability of drugs like cocaine in communities of deeply troubled people.
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