Chasing the Scream: The First and Last Days of the War on Drugs

by Johann Hari

I think Bruce Alexander’s breakthrough may hold the answer. “Human beings only become addicted when they cannot find anything better to live for and when they desperately need to fill the emptiness that threatens to destroy them,” Bruce explained in a lecture in London in 2011. “The need to fill an inner void is not limited to people who become drug addicts, but afflicts the vast majority of people of the late modern era, to a greater or lesser degree.” A sense of dislocation has been spreading through our societies like a bone cancer throughout the twentieth century. We all feel it: we have become richer, but less connected to one another. Countless studies prove this is more than a hunch, but here’s just one: the average number of close friends a person has has been steadily falling. We are increasingly alone, so we are increasingly addicted. “We’re talking about learning to deal with the modern age,” Bruce believes. The modern world has many incredible benefits, but it also brings with it a source of deep stress that is unique: dislocation. “Being atomized and fragmented and all on [your] own—that’s no part of human evolution and it’s no part of the evolution of any society,” he told me.

Gabor tells me: “The whole economy is based around appealing to and heightening every false need and desire, for the purpose of selling products. So people are always trying to find satisfaction and fulfillment in products.” This is a key reason why, he says, “we live in a highly addicted society.” We have separated from one another and turned instead to things for happiness—but things can only ever offer us the thinnest of satisfactions. This is where the drug war comes in. These processes began in the early twentieth century—and the drug war followed soon after. The drug war wasn’t just driven, then, by a race panic. It was driven by an addiction panic—and it had a real cause. But the cause wasn’t a growth in drugs. It was a growth in dislocation. The drug war began when it did because we were afraid of our own addictive impulses, rising all around us because we were so alone. So, like an evangelical preacher who rages against gays because he is afraid of his own desire to have sex with men, are we raging against addicts because we are afraid of our own growing vulnerability to addiction?

Bruce says that at the moment, when we think about recovery from addiction, we see it through only one lens—the individual. We believe the problem is in the addict and she has to sort it out for herself, or in a circle of her fellow addicts.

Stop thinking only about individual recovery, he argues, and start thinking about “social recovery.” If we think like this, the question we need to answer with our drug policy shifts. It is no longer: How do we stop addiction through threats and force, and scare people away from drugs in the first place? It becomes: How do we start to rebuild a society where we don’t feel so alone and afraid, and where we can form healthier bonds? How do we build a society where we look for happiness in one another rather than in consumption? These are radical questions, with implications far beyond the drug war, and bigger than this book. But they have to be asked. We haven’t been able to reduce addiction, it occurs to me, because we have been asking the wrong questions.

Cut off from one another, isolated, we are all becoming addicts—and our biggest addiction, as a culture, is buying and consuming stuff we don’t need and don’t even really want. We all know deep down it doesn’t make us happy, to be endlessly working to buy shiny consumer objects we have seen in advertisements. But we keep doing it, day after day. It in fact occupies most of our time on earth. We could slow down. We could work less and buy less. It would prevent the environment—our habitat—from being systematically destroyed. But we don’t do it, because we are isolated in our individual cages. In that environment, the idea of consuming less, in fact, fills us with panic. All this stuff, Bruce believes, is filling the hole where normal human connection should be.

When nicotine patches were invented in the early 1990s, public health officials were thrilled. They believed in the theory of addiction that almost everyone believes in: addiction is caused by chemical hooks that are hidden in the drug. You use a drug for a while, and your body starts to crave and need the chemical in a physical way. This isn’t hard to grasp. Anybody

The wonder of nicotine patches, then, is that they can meet a smoker’s physical need—the real in-your-gut craving—while bypassing some of the really dangerous effects of smoking tobacco. So if the idea of addiction we all have in our heads is right, nicotine patches will have a very high success rate. Your body is hooked on the chemical; it gets the chemical from the nicotine patch; therefore, you won’t need to smoke anymore.

them, so that chemical craving is gone. There is just one problem: even with a nicotine patch on, you still want to smoke. The Office of the Surgeon General has found that just 17.7 percent of nicotine patch wearers were able to stop smoking.

This point is worth underscoring. With the most powerful and deadly drug in our culture, the actual chemicals account for only 17.7 percent of the compulsion to use. The rest can only be explained by the factors Gabor and Bruce have discovered.

But addiction is different. Addiction is the psychological state of feeling you need the drug to give you the sensation of feeling calmer, or manic, or numbed, or whatever it does for you. My coffee withdrawal pains will have totally passed in two days—but two weeks from now, I might feel the urgent need to get my mind focused again, and I will convince myself I can’t do it without caffeine.

craving in the body has long since gone. They are no longer physically dependent—but they are addicted. As a culture, for one hundred years, we have convinced ourselves that a real but fairly small aspect of addiction—physical dependence—is the whole show. “It’s really like,” Gabor told me one night, “we’re still operating out of Newtonian physics in an age of quantum physics. Newtonian physics is very valuable, of course. It deals with a lot of things—but it doesn’t deal with the heart of things.”

You could immediately see the difference between the street addicts stumbling into the clinic for help for the first time, and the patients who had been on legal prescriptions for a while. The street addicts would often stagger in with abscesses that looked like hard-boiled eggs rotting under their skin, and with open wounds on their hands and legs that looked, as Parry recalls, “like a pizza of infection. It’s mushy, and the cheese you get on it is pus. And it just gets bigger and bigger.”

You have that on both legs and your body’s not strong enough—it’ll cut right through. You had situations where people were walking and their legs snapped.” They often looked like survivors of a war, with amputated limbs and flesh that looked charred and scarred. The addicts on prescriptions, by contrast, looked like the nurses, or the receptionists, or John himself. You couldn’t tell them apart. Harry Anslinger thought this contamination of drugs was a good thing, because it would discourage people from using. By 1942, he was boasting: “The addict is now using heroin which is over 99 percent adulterated.” But Allan Parry saw the effects in this clinic. “These shitty drugs—when you try to inject them they block up [your veins] and they really make a mess of you,” he tells me. “The trouble is, with dirty heroin, one vein more or less goes with one hit.”

Faced with this evidence, John Marks was beginning to believe that many “of the harms of drugs are to do with the laws around them, not the drugs themselves.” In the clinic, they started to call the infections and abscesses and amputations “drug war wounds.” So he “slowly got,” he told me, “that this clinic was working wonders” by bypassing criminality and providing safer forms of the drug. John began to wonder: If prescription is so effective, why don’t we do it more?

He knew that, like alcohol, cocaine is harmful to your health over time, but he explained: “If you were an alcoholic in the Chicago of the 1930s, and had just stolen your grandmother’s purse to buy a tot of adulterated methylated spirits at an exorbitant price from Mr. Capone, I would have a clean conscience in prescribing for you a dram of the best Scotch whisky.”

other words: there was a 93 percent drop in theft and burglary. “You could see them transform in front of your own eyes,” Lofts told a newspaper, amazed. “They came in in outrageous condition, stealing daily to pay for illegal drugs; and became, most of them, very amiable, reasonable law-abiding people.” It was just as Henry Smith Williams had said, all those years before.

I’m not a bleeding heart, and I don’t think there’s anything glamorous about drugs; I try to make my clients realize that what they are doing is boring, boring, boring.”

He wanted Julia to be bored, not terrified and in danger—so he wrote her a prescription. “I stopped straightaway,” she said later to Ed Bradley of CBS’s 60 Minutes when they came to report on the Liverpool experiment. “I went back once just to see, and I was almost physically sick just to see these girls doing what I used to do.” Now she was working as a waitress, and able to be a mother to her little girl. As Julia pushed her daughter on a swing, Bradley asked her: “Without that prescription, where do you think you’d be today?” “I’d probably be dead by now,” she said. “I need heroin to live.”

But John Marks differed from Henry Smith Williams in one important way. Henry thought that drug addicts would need to be given their prescription for the rest of their lives. That was the part of his story that most disconcerted me. It seemed that the only alternative to the drug war forever was being prescribed a drug forever. But since then, a discovery had been made about addiction—one that Henry Smith Williams couldn’t have foreseen.

addicted musicians in New York in the 1950s. Winick, like everyone else, used to believe that once you were a heroin addict, you were a heroin addict until you died, but what he found was something very different. “Heroin use was concentrated in the 25 to 39 group, after which it tapered to very little,” he wrote. Most addicts simply stopped of their own accord. They “mature out of addiction . . . possibly because the stresses and strains of life are becoming stabilized for them and because the major challenges of adulthood have passed.” This process—the fancy names for it are “maturing out” or “natural recovery”—is not the exception: it’s what happens to almost all of the addicts around you.

There was one obvious reason why people were worried by John’s experiment. If there is no punishment—if you give people drugs for free—surely they will use them more? This was one of Harry Anslinger’s most reasonable objections.

It seems like common sense. But John, by contrast, thought the rate of use would hold steady: If being ostracized by your family, riven with disease, and plunged into poverty didn’t affect your decision to use, how would a few free heroin reefers make a difference? It turns out both sides were wrong. Drug use didn’t rise, and it didn’t hold steady. It actually fell—including among the people who weren’t being given a prescription.

Imagine you are a street heroin addict. You have to raise a large sum of money every day for your habit: £100 a day for heroin at that time in the Wirral. How are you going to get it? You can rob. You can prostitute. But there is another way, and it’s a lot less unpleasant than either of them. You can buy your drugs, take what you need, and then cut the rest with talcum powder and sell it to other people. But to do that, you need to persuade somebody else to take the drugs too. You need to become a salesman, promoting the experience. So heroin under prohibition becomes, in effect, a pyramid selling scheme. “Insurance companies would love to have salesmen like drug addicts,” with that level of motivation, John remarked. Here’s why drug use went into reverse in John Marks’s clinic. Prescription, it turns out, kills the pyramid selling scheme,

You don’t have to sell smack to get smack. This explains why when you prescribe heroin, fewer people are recruited to use heroin, and why when you prescribe cocaine, fewer people are recruited to use cocaine.

Harry Anslinger always said drug addiction was infectious. It isn’t, in normal circumstances—but the system of prohibition he built makes it so after all.

At this time, Liverpool was run by a Communist group called Militant Tendency, who believed in establishing an immediate socialist revolution in Britain. John Marks, they declared, was preventing that revolution by tranquilizing the working classes with heroin. The opiate of the masses turned out to be . . . opiates, literally. Marks was blocking Marx.

John Marks expected that the news of these results would spur people across the country, and across the world, to do the same. Who would turn down a policy that saves the lives of drug users and leads to less drug use and causes dealers to gradually disperse? At last, this ripple effect seemed to have begun.

Clearly, we must reach injectors and get them the help that they require, but in the meantime we must try and keep them healthy, for we are their police as well.” But John was about to whack into the same wall as Henry Smith Williams.

With a few of his colleagues, John was invited to tour the United States to explain how this policy could save American lives. Everywhere they went, at the end of the meeting, they were told the same thing—that the Republican congressman Jesse Helms had been pressuring the organizers to shut them down and shut them up. Helms didn’t want anybody to interfere with the war on drugs. A few years later, on a CNN phone-in show, a caller thanked him for “everything you’ve done to help keep down the niggers,” and he replied by saluting the camera and saying: “Well, thank you, I think.”

The Conservative government decided to “merge” John’s clinic with a new health trust, run by evangelical Christians who opposed prescription on principle. The patients panicked, because they knew what being cut off would mean—a return to abscesses and overdoses and scrambling for drugs from gangsters. John was powerless to help them. The results came quickly. In all the time Dr. Marks had been prescribing, from 1982 to 1995, he never had a drug-related death among his patients. Now Sydney, the Liverpool docker, went back to buying adulterated crap on the streets and died.

Dr. Russell Newcombe, who had worked in the clinic, tells me the survivors “were immediately forced back onto the street . . . People who had jobs lost them. It split relationships up. People rapidly went back into debt and crime. The average person thrown off John Marks’s prescription regime would have been back in acquisitive crime within a month.” Whenever he’d see one of them in the street, he’d ask them what they were doing now. “Grafting,” they’d say—the local word for stealing to support your habit.

John found he was blacklisted within his own country. He ended up literally at the other end of the earth, in Gisborne, the farthest corner of New Zealand, the place from which he told me his side of the story by telephone in 2012. “I was exiled,” John Marks told me. One day, the Royal Astronomical Society asked him to play Galileo at an open day. He had to playact being burned at the stake. His voice softened at the irony. But when I said to him this story made me angry, he replied, flatly: “Whatever gave [you] the idea folk in authority operate according to reason? Your trouble is you’re being rational.”

Switzerland has always been the place on earth where it is easiest to pretend nothing ever changes, and everything makes sense. My father is a mountain boy from the Swiss Alps, and in his village, you were raised to believe that the country’s last major upset was when Hannibal invaded the mountains with his elephants in 221 b.c. All the country’s symbols are about order and cleanliness and permanence. Swiss watches will tick-tock with scientific precision even after a nuclear

Even more significant, she would become the first president in the world since the 1930s who decided to run not away from drug reform, but toward it. She dedicated her presidency to sitting with addicts,

When Billie Holiday was in prison for heroin possession in the United States, the only people who tried to help her were Swiss. “A wonderful couple in Zurich, Switzerland, sent me a thousand dollars,” she wrote, “and a telegram telling me that America would never accept me when I got out, so I should come to them in Europe.”

This country has no ghettoes where addiction could be hidden away. There are no Us and Them in Swiss chalets: if chaotic drug use is happening, it happens where everyone can see. So she gathered into her office representatives of the country’s most despised minorities—gays, prostitutes, and junkies—because she suspected that they held not only the problem but also the solution to the AIDS crisis. She found that sex workers, if you arm them with condoms and information, are actually “very good public health agents. But you have to trust them. You have to accept their job. So prevention begins with respect.”

Still the disease raged. It turned out that many addicts loathe methadone: they compare it to a flavorless lump of dough when you have a ravenous craving for steak. One day, some of the street doctors Ruth talked to all the time told her that they had been to visit an experiment in Liverpool, England—a program with startling results, even though the ideologues were shutting its doors.

We have to reinvent the imagination.” The heroin program is built around helping the patients to slowly rebuild: to get therapy, to get a home, and to get a job. One of Jean’s fellow patients, for example, owns a gas station, while another works in a bank. He discovered that “once you have stability, the speed of events decreases, and you come back into a normal life, and you say—okay, what am I going to do now?”

Harry Anslinger believed he had spotted the crucial flaw in heroin prescription programs like this. Addicts’ bodies gradually develop a tolerance for their drug, so he said they would need higher and higher doses over time to achieve the same effect. “The addict is never satisfied with his dose; he always tries to get more,” he explained. He praised two of his officers who laid out what they called the First Law of Addiction: “A person in the condition of opiate addiction, with free access to opiates, will continue in that condition at an accelerated rate of consumption unless the course of addiction is deterred by some extraneous force.”

That observation seems to make sense. Yet at this clinic, they tell me, they have discovered something that contradicts it. If you are an addict here and you want a higher dose of heroin, you can ask for it, and they’ll give it to you. So at first, most addicts demand more and more, just as Anslinger and his agents predicted. But within a few months, most addicts stop asking for more and choose, of their own free will, to stabilize their doses.

that that isn’t the real choice. If you give hard-core addicts the option of a safe legal prescription and allow them to control the dose, the vast majority will stabilize and then slowly reduce their drug consumption over time. Prescription isn’t an alternative to stopping your drug use. It is—for many people—a path to it.

The purpose of this program is to gradually build a life for the addict so they can put something else into that empty glass: a social network, a job, some daily pleasures. If you can do that, it will mean that even as the heroin drains, you are not left totally empty. Over time, as your life has more in it, the glass will contain more and more, so it will take less and less heroin to fill it up. And in the end, there may be enough within you that you feel full without any heroin at all.

once again. The streets became safer. The people on heroin prescriptions carry out 55 percent fewer vehicle thefts and 80 percent fewer muggings and burglaries. This fall in crime was “almost immediate,” the most detailed academic study found. The HIV epidemic among drug users stopped. In 1985, some 68 percent of new HIV infections in Switzerland were caused by injection drug use, but by 2009, it was down to approximately 5 percent. The number of addicts dying every year fell dramatically, the proportion with permanent jobs tripled, and every single one had a home. A third of all addicts who had been on welfare came off it altogether. And just as in Liverpool, the pyramid selling by addicts crumbled to sand: people on the heroin prescription program for a sustained period were 94.7 percent less likely to sell drugs than before their treatment. Jean tells me the drug dealers he used to work for are “completely against this program. They

The program costs thirty-five Swiss francs per patient per day, but it spares the taxpayer from having to spend forty-four francs a day arresting, trying, and convicting the drug user.

In the late 1990s, a conservative group triggered a national referendum on heroin prescription, and there was a rowdy national debate—or as rowdy as Switzerland ever gets.

Ever since Anslinger, the drug warriors had presented themselves as the forces of order ranged against the chaos that would inevitably be brought by any relaxation in the drug laws. But, in a political jujitsu move, Ruth reversed that argument. Swiss citizens could see now that U.S.-style drug crackdowns had brought chaos to their streets—and after the government provided a legal route to heroin, the chaos vanished. So they argued that the drug war means disorder, while ending the drug war means slowly restoring order. This argument won. In 1997, some 70 percent of Swiss electors voted to keep the reforms. In 2008, the conservative forces regrouped and called another referendum. The campaign supported by Ruth ran posters of a young mother with her baby, saying: “I want to keep our public parks free of syringes.” Another poster showed a couple in their fifties saying: “Thanks to treatment, our son could quit drugs.” This time, 68 percent backed the policy. These campaigns showed, in embryo, the

Those of us who believe in ending the drug war already pretty much have the liberals and leftists on our side. It’s the moderates and the conservatives we need to win over—and the way to do it may be heard in a distant yodel from the mountaintops of Switzerland.

Yet the same forces that had pressured Britain into locking down John Marks tried to intimidate the Swiss. The International Narcotics Control Board declared: “Anyone who plays with fire loses control over it,” and said Switzerland was “send[ing] a disastrous signal to countries in which the drugs were produced.” But Ruth Dreifuss was not going to be intimidated by anyone. When the U.S. drug czar, General Barry McCaffrey, visited Europe, he went to the Netherlands and held a press conference at which—like a colonial governor addressing the natives—he berated the Dutch government for their wickedness. He was scheduled to come to Switzerland shortly after. “It was terrible what he said in the Netherlands [about] the cannabis shops,” Ruth says.

Land of the Free—and they often came back with a response that threw me. But we already prescribe powerful opiates, they said. We prescribe Oxycontin and Vicodin and other painkillers—and, far from having the effect you are describing, it has caused a disaster. Look, they said, at the headlines any day of the week. More people are becoming addicted every year to prescription drugs that they were given at first for pain relief. More people are overdosing.

This narrative was everywhere—including in liberal outlets normally receptive to drug policy reform, like Rolling Stone. The conclusion seemed obvious: for some reason, in this country, prescription doesn’t reduce problems—it metastasizes them. This seemed to blast a hole in the case for providing legal access to the most potent drugs in the United States, and I was sent into a spiral of confusion. I looked over the evidence, and these critics seemed to be right. Oxycontin and Vicodin addictions are indeed spreading in the United States, and they are causing more criminality and overdose. The cause, everyone seems to agree, is that doctors have prescribed the drugs too freely. How could it be, I asked myself, that opiate prescription worked so well