Chronicle Book Review: "The Cult of Pharmacology: How America Became the World's Most Troubled Drug Culture," by Richard De Grandpre (2007, Duke University Press, 294 pp., $24.95 HB)

Phillip S. Smith, Writer Editor
Phil Smith
Ritalin is a popular stimulant used to control the behavior of hyperactive children. It is legal, widely prescribed, and much adored by many parents and educators. Cocaine is an illegal stimulant, harshly penalized, and is reviled by the guardians of the common good. Yet Ritalin and cocaine act on the brain in a very similar fashion. In laboratory experiments, subjects -- human and animal -- do not differentiate between the two. So why is one legal and accepted and the other illegal and proscribed?

In other lab experiments, heroin users falsely told that their doses were being reduced reported withdrawal symptoms. Conversely, heroin users told their doses were being maintained when they were really being reduced showed no withdrawal symptoms. What's up with that?

In "The Cult of Pharmacology," drug researcher, former fellow at the National Institute on Drug Abuse, and author of "Ritalin Nation" Richard De Grandpre takes a serious crack at answering those questions. In a fascinating and provocative read, De Grandpre provides an illuminating social history of drug use in America, an eye-opening window into the legal drug industry, and a harsh, Szaszian critique of the increasingly popular disease model of addiction.

With American politicians poised to make the disease model of addiction official dogma by congressional fiat -- Sen. Joe Biden's (D-DE) bill that would define addiction as a brain disease is moving on Capitol Hill -- De Grandpre's intervention into the never-ending drug debate in America couldn't be more timely. Biden, along with a large portion of the biopharmacological research community and the American public in general are what De Grandpre would call victims of "the cult of pharmacology."
What is that? While in days of yore, drug actions were considered the work of spirits or demons, we have advanced beyond such silliness through science, right? We know that psychoactive drugs affect the brain in certain ways, right? Well, maybe not. In De Grandpre's own words:

"As a drug ideology derived from the eternal notion that psychoactive compounds contain a unique spirit or essence, the cult of pharmacology legitimized the belief that these spirits bypassed all social conditioning of the mind and by themselves transform human thought and action. Unlike other worldly modes of influence on mind and human experience, and despite many advances in the pharmacological sciences in the twentieth century, psychoactive substances continue to be treated in the main as spirits that could enter into a body and take possession of it. Yes, soul was transformed into mind and spirit into biochemistry, giving the appearance that science and medicine had done away with the myths surrounding what had come to be called 'drugs.' Drugs were not demythologized, however, but rather remythologized. Psychobabble and biobabble replaced magical explanations of drug action, creating what had become by the end of the century a new, molecular pharmacologism."

As De Grandpre illustrates with the heroin experiments, among many others, neither people nor lab animals necessarily respond to drugs in the predictable manner expected by the disease model. One of the most striking and well-known lab animal experiments gave monkeys unfettered access to cocaine, which some used until they killed themselves. But a much lesser known and remarked upon follow-up found that when the animals were given a chance to select another stimulus -- sugared water -- their cocaine use dropped dramatically.

I can't help thinking of the current wave of methamphetamine use and its destructive consequences in this context. As De Grandpre points out, Americans gobbled down billions of amphetamine tablets from the 1940s through the 1970s (when they were restricted, only to be replaced a few years later by Ritalin) without the horrid consequences that seem to obtain among tweakers these days. It's not the drugs that have changed -- amphetamines are amphetamines, and methamphetamine is an amphetamine -- but the social context and what De Grandpre calls the "placebo text" -- the set of beliefs one carries about how the drug is supposed to affect you -- that have changed.

Like lab rats in a sterile environment with no stimulus except cocaine, today's tweakers, and I'm speaking of the stereotypical Western and Midwestern poor, rural, white users (who as a South Dakotan I know well), may be so tweaked out not because of the pharmacological properties of the demon drug meth, but because of their sterile social environment and dim prospects… and because that's how meth's placebo text tells them to respond to the drug.

My mother and millions of women like her, on the other hand, took methamphetamines in the 1960s as a diet aid -- not a recreational drug -- and responded quite differently. Yes, she cleaned house like crazy and got pretty chatty, but she did not become "addicted" to the drug, nor did she engage in the kind of pathological behaviors associated with tweakers. Instead, she quit using it because she didn't like the fact that it kept her up at night.

Perhaps, as De Grandpre concedes, it is not only set and setting that make the difference. While he doesn’t directly discuss the pharmacodynamics of meth, in his discussion of Ritalin and cocaine, he notes studies suggesting that the manner of ingestion of the drug (oral, say, versus injected or smoked) can have an effect on the drug user's experience. My mother wasn't shooting up or smoking speed, she was popping little yellow pills.

Was it the placebo context that kept my mother from tweekerdom? Was it the fact that she swallowed pills instead of injecting powders? Or that she took small doses instead of large ones? We don't know. What De Grandpre convincingly argues is that we do (or should) know that it is not something deterministically inherent in the methamphetamine molecule that caused her (and millions of other slightly overweight women in the 1960s and 1970s) to walk away from it, but made poor, rural, white people into tweakers in the 1990s and 2000s.

My mother was fortunate. Her drug use was sanctioned. If she had been taking the same drugs illegally, she would have faced prison. As De Grandpre notes, that's because the last century saw a bifurcation in dealing with drugs: Some drugs -- notably heroin, cocaine, and marijuana -- are "demon drugs," full of pharmaceutical malice, ready to enslave the unwary user, while others, notably the prescription pharmaceuticals, are "angel drugs," here to save us from the troubles of the day with their molecular magic.

We can thank the American Medical Association and the pharmaceutical industry for that, according to De Grandpre. Rather than being rivals for market share, as was the case in the era of patent medicines before the Food and Drug Act of 1906, the two groups decided to split the booty. The pharmaceutical companies would develop and market psychoactive drugs and the doctors would sanction and prescribe them as "ethical medicines" as opposed to dangerous drugs.

This historical process gave rise to "differential prohibition," or the demonizing of some drugs and the sanctifying of others -- even if, like Ritalin and cocaine, they are essentially the same thing -- as well as to the two faces of an authoritarian state: the therapeutic state that classifies drug taking as a disease and wants to treat it, often with other drugs and the prohibitionist state that sees drug use as immoral and wishes to punish it.

There is much, much more to "The Cult of Pharmacology." Even as a wizened veteran of the drug scene, there is much that challenges my beliefs and preconceptions about drugs and their interactions with humans. De Grandpre's theses may be controversial and even unpopular in this period when much of the mainstream political discourse seems to consist of calling for treatment instead of prison and for dealing with drug "addicts" as victims instead of miscreants. But he should definitely be read by anyone concerned with drug policy in America and why it's gone so terribly awry.

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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Book review

As Mr. Smith comments in the last paragraph of his review, the analysis presented in De Grandpre's book challenges some of the long-held assumptions common to both recreational drug users and prohibitionists. It is not unusual for heads to transmit myths and unfounded information as given truths, as in the fable that still circulates concerning the naming of Dolophine by Nazi chemists in honor of Adolph Hitler. That of course is not true but no one is harmed by such an outlandish claim. What is destructive, however, is the avalanch of legislation emanating from governing bodies from the federal down to the local legislatures without informed consent. Let's not kid ourselves, anyone trying to unravel the thicket presented by human responses without careful thought will only perpetuate the old destructive myths and nothing will change except the amount of money extracted from the situation by legalistic predation.

Ritalin vs. Cocaine

Maybe they are the same. Having done both at different times I can only conclude that the route of administration makes all the difference. Ritalin seems "easier" and not as speedy as coke.

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