International Aspects of Drugs Research Paper

1. Psychoactive Drugs And How They Are Used

There are a wide variety of psychoactive substances, naturally occurring and synthesized, including tobacco, alcoholic beverages, coffee, tea, chocolate, and some spices, as well as substances legally available only through medical channels such as benzodiazepides, cannabinols (including marijuana), opiates (including heroin), and cocaine. Such substances often have other use values, along with their psychoactive properties (Makela 1983). Users may like the taste, or the image of themselves that the use conveys. Use may be a medium of sociability, or part of a religious ritual. Some substances have other useful properties; alcohol, for example, is a source of calories, and is the solvent in many tinctures and medicines.

Psychoactive drugs differ in their metabolic pathways and mechanisms of action in the human body, in the strength of their effects, and in the states of mind and feelings they induce. In particular, it is easy to become intoxicated with some substances— alcohol is a prominent example—while it is much less likely with others. But the effects of drug use are also powerfully dependent on the pattern of use, and on set and setting—this is, the expectations of the user and of others present, and the context of use (Zinberg 1984). While the psychoactive effect of tobacco may not even register in the consciousness of a habituated cigarette smoker, in other circumstances the effect of tobacco use may be so strong that the user is rendered unconscious, as early Spanish observers reported concerning native South Americans.

Three social patternings of psychoactive drug use can be distinguished as prototypical: medicinal use, customary regular use, and intermittent use. In many traditional societies, particular drugs or formulations have been confined to medicinal use—that is, to use under the supervision of a healer to alleviate mental or physical illness or distress. For several centuries after the technique for distilling alcoholic spirits had diffused from China through the Arab world to Europe, for instance, spirits-based drinks were regarded primarily as medicines. This way of framing drug use has been routinized in the modern state through a prescription system, with physicians writing the prescriptions and pharmacists filling them. Drugs included in the prescription system are usually forbidden for nonmedicinal use.

Where a drug becomes a regular accompaniment of everyday life, its psychoactivity is often muted and even unnoticed, as is often the case for a habitual cigarette smoker. Likewise, in southern European wine cultures, wine is differentiated from intoxicating ‘alcohol’; wine drinkers are expected to maintain the same comportment after drinking as before. We may call this a pattern of ‘banalized use’: a potentially powerful psychoactive agent is domesticated into a mundane article of daily life, available relatively freely on the consumer market.

Intermittent use—for instance, on sacred occasions, at festivals, or only on weekends—minimizes the build-up of tolerance to the drug. It is in the context of such patterns that the greatest attention is likely to be paid to the drug’s psychoactive properties. The drug may be understood by both the user and others as having temporarily taken over control of the user’s behavior, and thus to explain otherwise unexpected behavior (Room and Collins 1983). Given the power attributed to the substance, access to it may be limited: in traditional societies by sumptuary rules keyed to social differentiations, in industrial societies by other forms of market restriction.

In industrial societies, a fourth pattern of use is commonly recognized for certain drugs: addicted or dependent use, marked by regular use, often of large doses. Since the pattern of use of the drug in question is not defined in the society as banalized, addiction is defined as an individual failing rather than as a social pattern. While attention is paid to physical factors sustaining regular use, such as use to relieve withdrawal symptoms, most formulations of addiction focus on psychological aspects, including an apparent commitment to drug use to the exclusion of other activities and despite default of major social roles. An addiction concept thus also focuses on loss of normal self-control, but the emphasis is not so much on the immediate effects of the drug as on a repeated or continuing pattern of an apparent inability to control or refrain from use, despite adverse consequences.

Among the attractions of psychoactive substances is that, at least up to a certain point, they potentially enhance one or another kind of performance by the user: For instance, coffee or a cigarette may modestly improve mental performance, a limited amount of alcohol may improve dancing or other expressive activity, amphetamines may improve wakefulness on a long watch. There are also nonpsychoactive substances (steroids, beta-blockers, etc.) which can potentially improve one or another kind of performance. In particular, in the context of competitive sports, international attention has been focused on a wide variety of substances which can improve some aspect of athletic performance.

2. Problems From Drug Use, And Systems Of Control

From ancient times, it has been recognized that problems can result from drug use. Formerly, the main concerns were with social and political problems seen as associated with drug use. In medieval England, the government’s main concern in controlling alcohol sales was with enforcing discipline in the labor force. Violence, disturbances of the peace, and harm to dependent family members would also be commonly recognized, particularly in relation to alcohol consumption. Often it was rebellious or countercultural elements of a society which introduced or became associated with new drugs. Reacting to this, political establishments in Europe tried at first to control coffee houses, and in Turkey and elsewhere imposed severe punishments on tobacco use (Austin 1978).

New social concerns about problems from drug use entered the scene in the modern era. Concerns about the physical health of the drinker were a factor in responses to the English ‘gin epidemic’ of the eighteenth century. In the early nineteenth century, the idea of addiction became established, at first for alcohol and in the USA (Levine 1978). By the late nineteenth century the idea had spread to other societies, and was applied also to other psychoactive drugs. As safety became identified as a social problem in the late nineteenth century, attention was also directed to the potential effects of drinking in degrading performance of mechanical tasks. In recent decades, as the automobile became a central part of daily life, this concern became much stronger, and was extended too to other drugs.

Social concerns about problems from drug use have resulted in a variety of kinds of efforts to control availability (MacCoun et al. 1996, Room 2000). One option has been a flat prohibition on use, or at least on recreational use. Combined with this, sometimes, has been a system for use of the substance as a medication. The prescription system in modern states is essentially a state-sanctioned form of rationing of availability, with doctors and pharmacists delegated to serve as the gatekeepers on access. A third option has been a system of state control or licensing of sales, such as the systems of alcohol control through state monopolies and licenses in North American states and provinces. Such a structure can be combined with other discouragements for use, such as excise taxes and restricted opening hours. A fourth option, applicable for instance nearly everywhere for tea and coffee, is that the psychoactive substance is treated as an ordinary commodity, with no special controls. For intoxicating substances, choice of the third or fourth option is often accompanied by ‘harm reduction’ measures (in the terminology of the illicit drug field), since the options involve official acceptance of the fact of recreational drug use.

Where a psychoactive substance is seen as causing great problems, prohibition of use has been a fairly common societal response. Such a prohibition on alcohol had long been imposed on all faithful Muslims by the Koran. Legal prohibition of alcohol, initially on a local basis or for special population categories such as indigenous peoples, became a feature of some Christian societies in the late nineteenth and early twentieth centuries. Prohibition of alcohol sales extended to the national level around the time of World War I in the USA, Canada (briefly), Iceland, Norway, Finland, and Russia. The USA, in particular, had some success in gaining international cooperation with its prohibition through bilateral treaties (Tyrrell 1994). A flourishing worldwide temperance movement succeeded in pushing the European powers with colonies in Africa into adopting treaties prohibiting aspects of the distilled spirits trade in Africa (Bruun et al. 1975). These fell into disuse by the 1940s.

The alternative to prohibition in the early twentieth century was ‘state control’, and comprehensive systems of alcohol control were eventually adopted, not only in the societies which had tried prohibition, but also in many other nations. These systems have been gradually weakened, particularly since 1950 (Makela et al. 1981). On the other hand, in a broad range of societies there has been a steady strengthening of controls over drinking in specific circumstances, in particular over drinking and driving (Gusfield 1981).

In the early twentieth century, the idea of a prohibitory regime was extended from alcohol to other psychoactive substances. In the realm of ‘narcotics’, which came to refer to opiates, cocaine, and marijuana, the first international treaty was signed in 1906, and extended globally as part of the treaties concluding World War I (McAllister 1992). The agreement on narcotics can be seen as part of an emergent tradition of such regimes for social problems defined as international in scope (Nadelmann 1990). A series of subsequent international agreements were codified in the 1961 Single Convention on Narcotic Drugs (amended 1972). While the system had always included provision for a legal market in narcotic medications under a prescription system, in a 1971 convention its scope was broadened to extend international control to other synthesized medications such as amphetamines, barbiturates, and benzodiazepines. A 1988 convention extended control also to ‘precursor chemicals’ used in manufacturing controlled drugs. By 1996, more than 240 substances were in principle under the system’s control (Room and Paglia 1999).

In the mid-1990s, the international narcotics control system included the United Nations Drug Control Program (UNDCP), with about 200 staff, headquartered in Vienna. The political organ of the system is the Commission on Narcotic Drugs, with an elected membership of 53 nations. The International Narcotics Control Board (INCB) serves as the control board for the legal (pharmaceutical) markets in controlled drugs. Alongside this international effort is a substantial global antidrug effort by the USA, including over 400 Drug Enforcement Agency staff stationed in 50 countries in 1993, and an annual certification process to the US Congress on the extent of cooperation by each other country with antidrug actions.

Although effective action has been taken to diminish use of prescribed drugs like barbiturates, the system has by most accounts been relatively ineffective in suppressing illicit international traffic in drugs. The system’s own summation, in the World Drug Report (UNDCP 1997), is that the ‘outcome is undoubtedly less than satisfactory’ in terms of the decreased availability of drugs.

At the end of the 1990s, two other international systems for the control of psychoactive drugs were in formation. In late 1999, in the wake of a World Conference on Doping in Sport, a World Anti-Doping Agency started operation in Lausanne, as a joint venture between governments and the International Olympic Committee (WADA 2000). Prior to this, in 1989 the Council of Europe had put forward an Anti-Doping Convention which by 2000 had been signed by 40 European countries and other countries such as Australia and Canada (COE 2000).

In October 2000, the World Health Organization began negotiations on a global Framework Convention on Tobacco Control. Among topics discussed for inclusion in the Convention were the harmonization of taxes, cooperation against smuggling, elimination of duty-free sales, and control of advertising and sponsorship (Joossens 2000). Unlike the international narcotics control system and the nascent anti-doping system, the tobacco control effort is thus not prohibitory of use, at least by adults.

In the meantime, in 2000 there is no prospect of any international agreement on alcohol control. For tobacco and alcohol, as well as other psychoactive substances not under international control, international treaties have operated in the opposite direction. The World Trade Organization and related treaties, and regional free trade agreements, have been used to weaken national and local alcohol controls (Holder et al. 1998, Jernigan et al. 2000).

3. Traditions Of Social Science Analysis

Dominant patterns of use of a drug in a society, and shifting conceptions about its use, greatly affect the size and shape of the social science literature concerning that drug. In particular, the very different sociocultural positions of ‘illicit drugs’, benzodiazepines, alcohol, tobacco, and coffee in most developed societies means that the literatures about these different psychoactive substances are often quite separate.

Novel substances have proved a potent catalyst in many societies in crystallizing free-floating fears about the younger generation and the future. Culturally accepted psychoactive substances, on the other hand, become deeply entrenched in the culture, although often with the potential to again become contested. Social concerns about drugs have thus often ensured substantial funding for social scientists to work in the area. For instance, a substantial part of Polish sociology was financed to work on alcohol problems in the difficult days of martial law there in the 1980s. But while much social science work has been funded and expected to proceed within the parameters of official frames, the work of sociologists and other social scientists has also played a key role in broadening the base of scholarship and understanding.

In the first place, alcohol and drug issues have proved fertile grounds for constructivist analyses by sociologists. Historical and comparative work has identified a number of alternative governing images or models of alcohol and drug problems, and shown that these governing images change over time (Bruun 1971, Gusfield 1967). Constructivist perspectives have often been combined with a positivist concern about measuring and comparing social and health problems associated with drug use, and about distinguishing problems attributable to the drug use from problems that are secondary to societal reactions (e.g., Fischer et al. 1997). Some analyses point to a function for illicit drugs of providing ‘suitable enemies’ for the modern state, in comparison with the ‘unsuitable enemies’ of tobacco, alcohol, and pharmaceuticals (Christie and Bruun 1996).

In the second place, there is a long sociological tradition of critical analysis of the concepts of alcoholism or addiction as a disease (Room 1983), concepts which were the dominant discourse in the last half of the twentieth century. The alcohol and drug arenas have thus figured prominently in sociological analyses of the ‘medicalization of deviance’— and its demedicalization (Conrad and Schneider 1992). Applying perspectives from Foucault and Rothman, Levine (1978) showed that the addiction concept has a history, first coming to the fore in the early nineteenth century USA, as an explanation of the mystery of continued drinking by the drunkard, even after pledging to abstinence. Analyses in this tradition point to the centrality to addiction concepts of the focus on self-control (Valverde 1998). The economist’s concept of ‘rational addiction’ has also contributed to the ferment in the late 1990s in thinking about addiction concepts (Elster and Skog 1999).

There are as yet few social science analyses of the burgeoning international systems for control of psychoactive substances. Bruun et al (1975) studied the development of the international drug control system until the early 1970s, but arms-length analysis of the expansion of this system’s scope after then has been sparse (Room and Paglia 1999), and analyses of the development of new international instruments and agencies around doping in sports (Houlihan 1999) and around tobacco (Taylor 1996) as yet come primarily from those involved in building the systems. The issues of why the three systems are developing separately, of the nature and practicability of their goals, and of their place in the developing international system, are still important topics for future work.

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