ROUTLEDGE HANDBOOK OF

INTOXICANTS AND INTOXICATION

Bringing together scholars from diferent disciplines in the humanities and social sciences,
this multidisciplinary Handbook ofers a comprehensive critical overview of intoxicants and
intoxication.
The Handbook is divided into 34 chapters across eight thematic sections covering a wide
range of issues, including the meanings of intoxicants; the social life of intoxicants; intox-
ication settings; intoxication practices; alternative approaches to the study of intoxication;
scapegoated intoxicants; discourses shaping intoxication; and changing notions of excess. It
explores a range of diferent intoxicants, including alcohol, tobacco, cofee, tea, and legal
and illicit drugs, including amphetamine, cannabis, ecstasy, khat, methadone, and opiates.
Chapter length case studies explore these intoxicants in a variety of countries, including
the USA, the UK, Australia, Bosnia & Herzegovina, Brazil, Denmark, Ireland, Japan, Kyr-
gyzstan, Nigeria, Singapore, and Sweden, across a broad timespan covering the nineteenth
century to the present day.
This wide-ranging Handbook will be of great interest to researchers, students, and in-
structors within the humanities and social sciences with an interest in a wide range of difer-
ent intoxicants and diferent intoxication practices.

Geofrey Hunt is a Professor at the Centre for Alcohol and Drugs Research at Aarhus Uni-
versity, Denmark, and Director of the Institute for Scientifc Analysis in San Francisco, USA.

Tamar M.J. Antin is the Founder and Director of the Center for Critical Public Health
and a Senior Research Scientist at the Institute for Scientifc Analysis in San Francisco, USA.

Vibeke Asmussen Frank is a Professor at the Centre for Alcohol and Drug Research at
Aarhus University, Denmark.
ROUTLEDGE HANDBOOK
OF INTOXICANTS
AND INTOXICATION

Edited by
Geofrey Hunt, Tamar M.J. Antin
and Vibeke Asmussen Frank
 Cover image: Christopher G Schultz, Adelaide, South Australia,
Australia
First published 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an Informa business
© 2023 selection and editorial matter, Geofrey Hunt, Tamar M.J. Antin
and Vibeke Asmussen Frank; individual chapters, the contributors
The right of Geofrey Hunt, Tamar M.J. Antin and Vibeke Asmussen
Frank to be identifed as author of the editorial material, and of the
authors for their individual chapters, has been asserted in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other
means, now known or hereafter invented, including photocopying and
recording, or in any information storage or retrieval system, without
permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks
or registered trademarks, and are used only for identifcation and
explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library

ISBN: 978-0-367-17870-3 (hbk)

ISBN: 978-1-032-32148-6 (pbk)
ISBN: 978-0-429-05814-1 (ebk)
DOI: 10.4324/9780429058141
Typeset in Bembo
by codeMantra
 CONTENTS

List of fgures x
List of tables xi
List of contributors xii
Acknowledgements xxii

Introduction 1
Geofrey Hunt, Tamar Antin and Vibeke Asmussen Frank

PART I
Te Terrain of Intoxication 17

1 Intoxications and their meanings 19

Craig Reinarman

2 Nic’d up: a practice theory approach to understanding vaping

nicotine as intoxication 33
Ruth Lewis, Emily Kaner and Tamar M.J. Antin

3 Recreational drug use as everyday life: explorations of young adults’

gendered motivations for taking drugs in Nigeria 51
Emeka W. Dumbili, MaryJane Nnajiofor and Emmanuel C. Ezekwe

4 When the clock takes over: hangovers in twentieth-century

British and American fction and poetry 69
Jonathon Shears

v
 Contents

PART II
Social life of intoxicants 87

5 Intoxicating consumption: Capitalism and the commodifcation

of pleasure 89
Gerda Reith

6 Producing planned hedonism among opiate users in an online

drug market 101
Angus Bancroft

7 Craft drinks, connoisseurship and intoxication 113

Thomas Thurnell-Read

8 Ecstasy: A synthetic history of MDMA 127

Peder Clark

PART III
Intoxicating Settings 141

9 The social work of cofee: cofee consumption in bosnia and

herzegovina and the bosnian diaspora 143
Ana Croegaert

10 Expanding intoxication: what can drinking places (c. 1850–1950) tell

us about other intoxicants and other sites? 159
James Kneale

11 Join us for drinks: intoxication, work and academic conferences 178

Helen Keane

12 Exploring the motivations and social organisation of intoxication in

prison settings 191
Torsten Kolind and Karen Duke

13 How methadone becomes an intoxicant: the making of methadone

within prisons in the Kyrgyz Republic 203
Lyu Azbel and Frederick L. Altice

14 Trade-ofs between intoxication, safety, and sociability within a

drug-consumption facility 221
Esben Houborg and Siv Schjøll Berge

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 Contents

15 Intoxicants in warfare 239

Łukasz Kamie ński

PART IV
Intoxication Practices 259

16 Engaging with drug, set, and setting to understand nicotine use

experiences and practices 261
Julia McQuoid

17 ‘Uninhibited play’: the political and pragmatic dimensions of

intoxication within queer cultures 272
Kane Race, Kiran Pienaar, Dean Murphy and Toby Lea

18 Ritual to reflexivity – from promotion and problematisation of

intoxication to proportionality 290
John O’Brien

PART V
Alternative Approaches for Studying Intoxication 307

19 Intoxication made visible: the sober sciences of intoxication,

euphoria, and overdose in the laboratory 309
Nancy D. Campbell

20 Trip reports: exploring the experience of psychedelic intoxication 328

Jonas Bååth and Johan Nordgren

21 Passion, reason and the politics of intoxication: ontopolitically-

oriented approaches to alcohol and other drug intoxication 342
Suzanne Fraser, David Moore, Adrian Farrugia and Renae Fomiatti

PART VI
Scapegoated Substances 359

22 Alcohol, slavery and race in Brazil during the long nineteenth century 361
Lucas Brunozi Avelar and Deborah Toner

23 Street-level policing, structural violence and habitus: accounts of

street-involved cannabis users in Nigeria 382
Ediomo-Ubong E. Nelson

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 Contents

24 Ethnifed intoxication – khat use and the Somali community in Sweden 400
Johan Nordgren

25 Symbolic meaning of the amphetamine-type stimulant problem

throughout the restoration of Japanese society after WWII: drug
control and the construction of the other 412
Akihiko Sato

PART VII
Discourses shaping intoxication and people who use intoxicants 435

26 Risk, intoxication and death: contemporary media framing of drug-

related deaths 437
Susanne MacGregor and Betsy Thom

27 Clearing the air: Toxic healthism and cigarette(s) (smoke) as (in)toxicant(s) 457
Qian Hui Tan

28 Fighting intoxication and addiction: international drug control as a

self-perpetuating social system 468
Axel Klein

29 Handling complexity: constituting the relationship between

intoxication and violence in Australian alcohol policy discourse 484
David Moore, Helen Keane, Duane Duncan and Emily Lenton

PART VIII
Notions of Excess 499

30 Altered states: changing conditions of excess in European drinking

cultures 501
Dorota Dias-Lewandowska, Laura Fenton, Sam Goodman and Beat Kümin

31 From ‘Pledge’ to ‘Public Health’: medical Responses to Ireland’s

Drinking Culture, c. 1890–2018 523
Alice Mauger

32 ‘Drinking Himself to Death’: the Chronic Drunkard in British

Mid-Victorian Fiction and Culture 542
Pam Lock

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 Contents

33 Tea, addiction and late Victorian narratives of degeneration,

c. 1860–1900 564
Ian Miller

34 Conceiving addiction: historical constructions of chronic

intoxicant use 581
David Clemis

Index 601

ix
 FIGURES

8.1 Central Ofce of Information ‘Drugs: sometimes the after efects never
wear of’, 1990 128
9.1 Ismeta Bufet Display Qur’an Bosnian landscape painting džezva
fldžan šešerluk 144
9.2 Tatjana and Mahira interview 148
9.3 Mostar market stall with džezve, mlinovi, and souvenirs 149
9.4 ŠTO TE NEMA Chicago installation 2017 154
22.1 Carte du Brésil 363
22.2 HARRO-HARING, Paul. Scene at a tavern: sailors trade with black
women. Tropical sketches of Brazil, 1840. Available in: Paul
Harro-Harring - Instituto Moreira Salles (ims.com.br) 368
22.3 Brahma Bull-Bock Advertisement 375
22.4 Brahma-Porter Advertisement 376
22.5 Companhia Cervejaria Brahma Advertisement 376
22.6 Bock-Ale Teutonia Advertisement 377
25.1 Number of arrests for violation of drug laws in Japan 1951–2019 414
27.1 Interior of a designated smoking point in Yishun, Singapore 460
27.2 A designated smoking point in Yishun, Singapore 461
27.3 Inside a designated smoking point in Yishun, Singapore 462
30.1 Extract from Barthel Beham, ‘Country Fair’ (woodcut, c. 1530) 505
30.2 Aleksander Orłowski, ‘Uczta u Radziwiłłów’, frst half of the
nineteenth century 507
30.3 Aleksander Orłowski, ‘Zabawa w karczmie’, 1800 509

x
 TABLES

2.1 Pathways of nicotine product use among participants in each study 36

2.2 Practice elements identifed within young adults’ accounts of vaping
nicotine via second- and third-generation devices (i.e. pre-pod-based
systems) in California in 2016–2017 38
3.1 Sociodemographic data of the participants 54
23.1 Cannabis seizure and arrest of trafckers by the NDLEA (2010–2015) 384
23.2 Socio-demographic characteristics of the participants (n = 97) 388
25.1 Rate of prosecution (The White Paper on Crime 1960: 110) 425
25.2 Number of violent and crime syndicates 1963–1972 (made by the author
based on The White Paper on Police 1973) 427
26.1 Examples of estimated DRDs by country and date 439
26.2 Themes and evidence sources in UK newspapers 448
26.3 Illustrations of coverage in national newspapers 449
26.4 Illustrations of coverage in local newspapers 451

xi
 CONTRIBUTORS

Frederick L. Altice is a Professor of Medicine, Epidemiology and Public Health at Yale

University where he serves as the Director of Clinical and Community Research, the
Community Health Care Van and the HIV in Prisons Program. His research training is
in implementation science, decision science, behavioral interventions with expertise on
intervention adaptation implementation science, including development and adaption
of HIV prevention and treatment interventions and expanding evidence-based practices
into real-world community settings. He is interested in the creation of novel prevention
and treatment programs for the treatment of HIV, viral hepatitis, tuberculosis, and sub-
stance use disorders in vulnerable populations, including people who inject drugs, crim-
inal justice populations, men who have sex with men and both female and transgender
sex workers. Dr. Altice has spent considerable time devoted to developing and studying
integrated systems of care, including integrating medication-assisted therapies such as
methadone, buprenorphine, and extended-release naltrexone into managing co-morbid
conditions, including people living with or at risk for HIV, HCV, tuberculosis, and men-
tal illness. As the time from evidence to dissemination often exceeds 17 years, his recent
interests have been on how to work with individuals and systems to shorten this gap. Dr.
Altice is currently leading studies in Ukraine, Eastern Europe, Central Asia, Malaysia,
Indonesia, Peru, and the United States.

Tamar M.J. Antin is the Founder and Director of the Center for Critical Public Health
and a Senior Research Scientist at the Institute for Scientifc Analysis in San Francisco,
USA. An applied anthropologist, her research focuses on the social and cultural meanings
of alcohol, tobacco, and other drug use for groups of people typically left at the margins in
mainstream public health research, including youth of color, LGBTQ+ adults, and people
living in rural communities. Her work explores the role of stigma in public health practice
and policy-making and draws attention to the structures within which health practices are
embedded and highlights the social processes that lead to inequities in health. She conducts
primarily large-scale qualitative research studies and has received funding from the National
Institutes of Health, the California Tobacco-Related Disease Research Program, and the
Substance Abuse and Mental Health Services Administration.

xii
 Contributors

Lucas Brunozi Avelar is a Social and Cultural Historian of alcohol, drugs and taverns in
the Americas. His current research examines the origins and development of tavern culture
in Brazil, and the history of cachaça in a global perspective. His recent publication is ‘Bebi-
das: conceitos fundamentais’ (Senac, 2020).

Lyu Azbel is a Public Health Sociologist exploring how medical interventions translate
into new settings. As a postdoctoral fellow at Yale University, they use qualitative methods
to unpack the social relations of treatment, especially where drug use, infectious diseases,
and incarceration intersect. Their work tackles some of the most stubborn impasses to im-
plementing harm reduction interventions at the heart of the world's fastest growing HIV
epidemic in Eastern Europe and Central Asia. The theoretical takeaways from their research
generate a space where new forms of treatment are possible.

Jonas Bååth is an assistant professor at the Department of People and Society at SLU Al-
narp and a researcher afliated to the Department of Service Studies and CIRCLE – Center
for Innovation Research, both at Lund University. He holds a doctorate in sociology from
Uppsala University. His research draws on qualitative methods to connect economic sociol-
ogy with agri-food and intoxicants research. Current projects study the role of alcohol policy
in everyday service work on licensed premises and how customers and suppliers co-create
alternative markets. His work has appeared in journals such as Journal of Rural Studies, Food
Culture & Society, and Socio-Economic Review.

Angus Bancroft is a Lecturer in Sociology at the University of Edinburgh. He teaches on

illicit markets, intoxication and criminology. He blogs about teaching and research at https://
blogs.ed.ac.uk/darkmatters/. His most recent book is Angus Bancroft, The Darknet and Smarter
Crime: Methods for Investigating Criminal Entrepreneurs and the Illicit Drug Economy (2020), Palgrave
Macmillan and he also published a novel of sociological ideas with Ralph Fevre: Angus Ban-
croft and Ralph Fevre (2016) Dead White Men and Other Important People, 2nd edition.

Siv Schjøll Berge has an MA in cross cultural studies from the University of Copenhagen,
Denmark. Her area of interest lies within the felds of social processes and identity, especially
what constitutes possible roles for individuals, but also organizations. Through her previous
work at the Center for Alcohol and Drug Research, she focused at the area of drug treatment
and harm reduction. A knowledge she has brought into her current job as a development
consultant in The Coordinating Unit in Drug Treatment Copenhagen in The Municipality
of Copenhagen.

Nancy D. Campbell is a Professor and Department Head of Science and Technology

Studies at Rensselaer Polytechnic Institute in Troy, New York, where she has taught for
over two decades. Her most recent book is OD: Naloxone and the Politics of Overdose Prevention
(MIT Press, 2020). She was a FRIAS Senior Fellow and Marie Curie Fellow of the Euro-
pean Union at the Freiburg Institute for Advanced Studies (FRIAS) in 2017–2018. She is
one of three editors of the Journal of the Social History of Alcohol and Drugs. Her books include
Discovering Addiction: The Science and Politics of Substance Abuse Research (University of Mich-
igan Press, 2007); Gendering Addiction: The Politics of Drug Treatment in a Neurochemical World
(co-authored with Elizabeth Ettorre; Palgrave, 2011); The Narcotic Farm: The Rise and Fall of
America’s First Prison for Drug Addicts (co-authored with JP Olsen and Luke Walden; Abrams,
2008); and Using Women: Gender, Drug Policy, and Social Justice (Routledge, 2000).

xiii
 Contributors

Peder Clark is a Historian of health and drugs in modern Britain, based at the University of
Strathclyde, Glasgow. He started his Wellcome Trust funded Research Fellowship “‘The Ef-
fects Can Last Forever’: Ecstasy’s Risks and Pleasures in Britain, 1985–2000” in October 2021.

David Clemis is an Associate Professor of history at Mount Royal University, Calgary,

Canada. His research focuses on understandings of alcohol intoxication and conceptions of
craving, habit and addiction in the seventeenth and eighteenth centuries. He is the author of
“‘Great Annoyance to Their Mindes’: the Humours, Intoxication, and Addiction in English
Medical and Moral Discourses, 1550–1730,” in Kaara L. Peterson and Amy Kenny, eds., Hu-
morality in Early Modern Art, Material Culture, and Performance (London: Palgrave/Macmillan,
2021); “Medical Expertise and the Understandings of Intoxication in Britain, 1660 to 1830,”
in Jonathan Herring, Ciaran Regan, Darin Weinberg, and Phil Withington, eds., Intoxication
and Society: Problematic Pleasures, (London: Palgrave, 2013); and “The History and Culture
of Alcohol and Drinking: 18th Century” and “The History of Addiction and Alcoholism”
in Scott C. Martin, ed., “Alcohol: Social, Cultural, and Historical Perspectives” (Thousand Oaks,
CA: SAGE, 2015).

Ana Croegaert received her PhD in Cultural Anthropology from Northwestern Uni-
versity and conducts research focused on gender, material and expressive culture, and in-
equality. She has published on a range of topics, including refugee migration, cofee rituals,
contested public space, street parades, monuments and memorials, and racism in Chicago,
New Orleans, and Bosnia-Herzegovina. Croegaert is a research afliate with the Field Mu-
seum of Natural History in Chicago.

Dorota Dias-Lewandowska is an Anthropologist and Historian, Assistant Professor at the

Institute of Archaeology and Anthropology, Polish Academy of Science in Warsaw. Her re-
search interest evolved from the early modern history of alcohol and Polish culinary recipes
to drinking cultures, and discourses concerning sobriety and drunkenness among women
in the 19th century.

Karen Duke is a Professor of Criminology and Co-Director of the Drug and Alcohol Re-
search Centre at Middlesex University, UK. She is a Criminologist and Policy Analyst, spe-
cialising in research on drugs policy and the interfaces with the criminal justice system. She
has conducted research and consultancy for the European Commission, UNODC, Home
Ofce, Department of Health, the former Central Drugs Co-ordination Unit (Cabinet Of-
fce) and the Royal Society for the Arts. She is one of the Editors-in-Chief of the journal,
Drugs: Education, Prevention and Policy.

Emeka W. Dumbili is a Lecturer in Sociology working at the Nnamdi Azikiwe Univer-

sity. Emeka is currently an Alexander von Humboldt Research Fellow at the Institute for
Therapy and Health Research, Kiel, Germany. His research focuses on the sociology of drug
use, gender and sexuality, social theory, qualitative methodology, and public health.

Duane Duncan is a Lecturer in Sociology at the University of New England. His research
interests include gender, sexuality and men’s health, including a recent role as a Research
Fellow at the Australian Research Centre in Sex, Health and Society at La Trobe University
on an Australian Research Council-funded project analysing the handling of gender in al-
cohol research and policy.

xiv
 Contributors

Emmanuel C. Ezekwe is currently a Research Assistant at the Department of Sociology

and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria. His research interests are
in the areas of Alcohol, Drugs, Health Policies and Development.

Adrian Farrugia is a Research Fellow in the Drugs, Gender and Sexuality (DruGS) pro-
gram at the Australian Research Centre in Sex, Health and Society at La Trobe University.
He specialises in the sociological analysis of health initiatives such as hepatitis C treatment
uptake, health education for young people and take-home naloxone for people who consume
opioids.

Laura Fenton is a Sociologist. Her PhD investigated the drinking biographies of three
generations of British women against the backdrop of changes in the role of alcohol in wom-
en’s lives. She is currently working as a Research Associate at the Universities of Shefeld
and Manchester. Her research interests include youth, gender, alcohol, the life course, and
biographical methods.

Renae Fomiatti is a Research Ofcer in the Drugs, Gender and Sexuality (DruGS) pro-
gram at the Australian Research Centre in Sex, Health and Society at La Trobe University.
She conducts qualitative research on alcohol and other drug consumption and recovery,
health and gender. Her research is informed by contemporary feminist theory and Science
and Technology Studies. She previously held an appointment at the National Drug Research
Institute, Curtin University.

Vibeke Asmussen Frank is a Professor at the Centre for Alcohol and Drug Research at
Aarhus University, Denmark. She has been working within the social science drug and alco-
hol research feld for over 20 years. Her main areas of research include user perspectives on
diferent kinds of drug consumption, policy processes related to drug control, drug-reducing
interventions and harm reduction initiatives, and young people’s alcohol intoxication as well
as use of N2O for intoxication. She is the author of numerous articles and co-editor of Drug
Policy: History, Theory & Consequences (Aarhus University Press, 2009) and Markets, Methods
and Messages: Dynamics in European Drug Research (Pabst, 2011).

Suzanne Fraser is a Professor and Director of the Australian Research Centre in Sex,
Health and Society, at La Trobe University. She has published widely on drug use and related
issues, and is currently working on research projects on hepatitis C treatment and stigma in
healthcare.

Sam Goodman is an Associate Professor in English & Communications at Bournemouth

University, UK. His research interests centre around productions of Britishness and identity
across literature, culture and society, the relationship between alcohol and medicine, and the
medical humanities.

Esben Houborg is an Associate Professor at the Centre for Alcohol and Drug Research,
School of Business and Social Sciences, Aarhus University, Denmark. His main areas of
research include drug policy in a historical and contemporary perspective, criminological
research particularly concerning law enforcement, sociological research in the areas of drug
treatment and harm reduction and urban studies of drug-related issues.

xv
 Contributors

Geofrey Hunt is a Professor at the Centre for Alcohol and Drugs Research at Aarhus
University, Denmark, and Director of the Institute for Scientifc Analysis in San Francisco,
USA. He is also the Principal Investigator on a US National Institute of Health-funded
project on rural drinking and intoxication amongst young adults as well as two research
projects in Denmark. A social and cultural anthropologist, he has published extensively on
substance abuse, especially alcohol and drug use and evaluating community prevention and
intervention programs. He is the co-author of Youth, Drugs, and Nightlife (Routledge, 2010)
and the co-editor of Drugs and Culture: Knowledge, Consumption and Policy (Routledge, 2011)
and Handbook of Drug and Alcohol Studies (Sage, 2016).

Łukasz Kamieński is a Professor at the Faculty of International and Political Studies,

Jagiellonian University, Kraków, Poland. His work concentrates on military technology
and military transformation, the history and the future of war, the military profession, and
biotechnology and military human enhancement. He is an author of Shooting Up. A Short
History of Drugs and War (OUP, 2016).

Emily Kaner is a Research Associate at the Center for Critical for Public Health and an
MPH/MCP candidate at the University of California, Berkeley. Her research explores the
meanings and social environmental contexts of substance use with adolescents and young
adults. She is interested in the structural determinants of health, the intersection of health
and place and the use of mixed methods in research.

Helen Keane is a Professor in the School of Sociology at the Australian National University
in Canberra, Australia. She works on critical and qualitative approaches to drug use, with
a current focus on tobacco and alcohol. She has a particular interest in concepts of addic-
tion and critical addiction studies, with additional expertise in feminist theory. She is the
co-author of Habits: Remaking Addiction (Palgrave Macmillan, 2014) with Suzanne Fraser and
David Moore. This book builds on her earlier work What’s Wrong with Addiction? (New York
University Press, 2002).

Torsten Kolind is trained as an anthropologist. He is a Professor in drug and alcohol

research and also the Director of Centre of Alcohol and Drug Research, Aarhus Univer-
sity, Denmark. He has a long experience in planning, conducting and managing research
within the drug and alcohol feld. He has published widely in the felds of criminal justice,
prisons, ethnicity, young people, drug treatment, alcohol and drugs. He is one of the Ed-
itors-in-Chief of the journal Drug: Education, Prevention and Policy. He is the editor of The
SAGE Handbook of Drug and Alcohol Studies from 2017.

Axel Klein is a Social Anthropologist with a longstanding interest in altered states and
institutional eforts to gain beneft in some shape and form. Successive studies of ‘drug com-
plexes’, be this cannabis in the Caribbean (Caribbean Drugs, 2004) or khat in Eastern Africa
(The khat Controversy, 2007), have confrmed his viewpoint that altered states perform
critical socio-cultural functions, and that prohibition is a policy perversity pursued solely for
institutional and professional beneft (Drugs and the World, 2009; Collapse of the Global
Order on Drugs, 2018). He is currently working in West Africa and a Fellow of the Global
Drug Policy Observatory at the University of Swansea, UK.

xvi
 Contributors

James Kneale is a Cultural and Historical Geographer at UCL. He has longstanding inter-
ests in histories and geographies of drinking and temperance, and is currently working on
the connections between life assurance, temperance, and medicine in Britain between 1840
and 1918. He is a co-editor of Journal of Victorian Studies.

Beat Kümin is a Professor of Early Modern European History at the University of War-
wick, UK. His research interests focus on social, religious and political exchange in local
communities, particularly in the German lands. Publications include the monograph Drink-
ing Matters: Public Houses and Social Exchange in Early Modern Central Europe (2007) and the
edited collection A Cultural History of Food in the Early Modern Age (2012). Alongside, he leads
the ‘Food & Drink Cultures’ theme of Warwick’s research priority on ‘Food’ and co-edits
the book series ‘Cultures of Early Modern Europe’ for Bloomsbury.

Toby Lea is an Adjunct Lecturer in the Centre for Social Research in Health, the Uni-
versity of New South Wales (UNSW) Sydney, Australia. He is an applied social health re-
searcher focused on the use of psychedelics as novel therapies for mental health, and substance
use and harm reduction among sexual and gender minority people.

Emily Lenton is a Research and Project Ofcer at the Australian Research Centre in Sex,
Health and Society, La Trobe University. She works on projects in both the Gender, Law
and Drugs, and Drugs, Gender and Sexuality research programs, and the BBV Sector De-
velopment Program.

Ruth Lewis is a public health sociologist based at the MRC/CSO Social and Public Health
Sciences Unit, at the University of Glasgow. Her research aims to explore how social rela-
tionships and identities shape health and wellbeing, and how to translate these understand-
ings into interventions to improve population health. Much of her work focuses on young
people, often using qualitative methodologies and participatory approaches to co-produce
knowledge and expertise. Ruth holds degrees from the University of Leeds (BA Hons, Ge-
ography) and the University of Edinburgh (MSc Social Research; PhD Sociology). Prior to
joining the University of Glasgow, Ruth worked at the University of Edinburgh, the Lon-
don School of Hygiene and Tropical Medicine, and the University of the Pacifc.

Pam Lock is a Lecturer at the University of Bristol. She has published a number of ar-
ticles and chapters on the representation of drinking in British Victorian fction and her
monograph entitled The Drunkard in Victorian Fiction and Culture will be out with Edinburgh
University Press in 2023. Pam is a co-Director of the Drinking Studies Network, co-lead
with Dorota Dias-Lewandowska on the NCN-funded project ‘Hidden Representations of
Women’s Drinking in Polish and British Public Discourses in the second half of the 19th
Century’, and Associate Editor for the ADHS Journal, The Social History of Alcohol and Drugs.

Alice Mauger is a UCD Wellcome Trust Postdoctoral Fellow at the Centre for the History
of Medicine in Ireland, School of History, University College Dublin. Her current research
explores “Patient Narratives of Alcohol Addiction in Ireland, c. 1960–2020”. Prior to this,
she completed a Wellcome Trust funded postdoctoral project entitled “Alcohol, Medicine
and Irish Society, 1890–1970”. She has published and taught on the history of medicine,
psychiatry and alcohol(ism). Her frst monograph, The Cost of Insanity: Public, Voluntary and
Private Asylum Care in Nineteenth-Century Ireland, was published by Palgrave Macmillan in

xvii
 Contributors

2018. She completed a PhD at the UCD Centre for the History of Medicine in Ireland on
this topic.

Susanne MacGregor is a Fellow of the Academy of Social Sciences. She is an Honorary

Professor at the London School of Hygiene and Tropical Medicine, University of Lon-
don, attached to the Centre for History in Public Health. She is also a Professor Emerita
at Middlesex University London, attached to the Drug and Alcohol Research Centre. Her
frst degree was in Social Anthropology and her second in Politics, both from the Univer-
sity of Edinburgh. She has researched and taught in humanities and social sciences in De-
partments of Social Anthropology, Politics, Social Psychiatry, Sociology, Social Policy and
Public Health. Her research has focused on social issues and political and policy responses,
especially poverty, homelessness, unemployment, drug and alcohol use, and urban change.
Her recent publications include The Politics of Drugs: Perceptions, Power and Policies Palgrave
Macmillan 2017 and Risk and Substance Use: Framing Dangerous People and Dangerous Places
(edited with Betsy Thom) Routledge Studies in the Sociology of Health and Illness 2020.
She is currently researching drug-related deaths in English prisons.

Julia McQuoid is an Assistant Professor at the TSET Health Promotion Research Center
and the Department of Family and Preventive Medicine at the University of Oklahoma
Health Sciences Center (OUHSC). She is a health geographer interested in creative ap-
proaches to understanding relationships between people’s everyday environments and health
behaviors. Her research examines the everyday patterns, contexts, and motivations linked
to tobacco and other substance use for priority groups. Her work has contributed to under-
standing and explaining sexual and gender minority tobacco use disparities. She recently re-
ceived an American Cancer Society Institutional Research Grant to integrate mobile health
and qualitative mapping methods to study multiple substance use in rural Oklahoma. Julia
was a California Tobacco-Related Disease Research Program Fellow while completing her
postdoctoral fellowship at the University of California, San Francisco. She co-founded and
co-directs the OUHSC Qualitative Methods Community of Practice.

Ian Miller is a Lecturer in Medical History at Ulster University and PI on the project www.
epidemic-belfast.com. He has published a medical history textbook with Palgrave Macmillan.
Earlier books include A Modern History of the Stomach: Medicine, Gastric Illness and British Society, c.
1800–1945 (2011), Reforming Food in Post-Famine Ireland: Medicine, Science and Improvement (2014)
and Water: A Global History (2015). He has been awarded the Distinguished Research Fellowship
at Ulster University and is a book review editor for Social History of Medicine journal.

David Moore is a Professorial Research Fellow in the Australian Research Centre in Sex,
Health and Society at La Trobe University. He has published extensively in key sociological
and health journals on youth, gender, alcohol and other drug use, addiction concepts and
drug policy. David is the author of The Lads in Action: Social Process in an Urban Youth Subcul-
ture (Arena, 1994), and (with Suzanne Fraser and Helen Keane) Habits: Remaking Addiction
(Palgrave, 2014). He also edited (with Paul Dietze) Drugs and Public Health: Australian Per-
spectives on Policy and Practice (Oxford University Press, 2008) and (with Suzanne Fraser) The
Drug Efect: Health, Crime and Society (Cambridge University Press, 2011).

Dean Murphy is a Research Fellow at The Kirby Institute UNSW, and the Department
of Infectious Diseases, Alfred Hospital. His work focuses on biomedical HIV prevention

xviii
 Contributors

technologies, stigma, HIV diagnosis, experiences of sexual health and well-being, and the
meanings of drug consumption. His book, Gay Men Pursuing Parenthood through Surrogacy:
Reconfguring Kinship, was published in 2015.

Ediomo-Ubong E. Nelson, trained as a health sociologist, is the African research project

lead for the Global Drug Policy Observatory, based at Swansea University, United King-
dom. He is also an associate researcher with the Centre for Research and Information on
Substance Abuse in Nigeria. His research explores how criminal justice and public health
intersects, with a focus on socially marginalized populations (e.g. sex workers and people
who use drugs). His latest research investigates the structural and health system drivers of
prescription opioid misuse among socially marginalized women with chronic pain. Besides
research, he is actively involved in advocacy for evidence-based, public health-centered drug
policies in Africa. In this capacity, he currently serves as the alcohol and other drug policy
advisor to the International Blue Cross, based in Bern, Switzerland.

MaryJane Nnajiofor is a Sociologist with interests in alcohol and other drug use, gender,
and sexuality. She served as a Research Assistant at the Centre for Alcohol and Other Drug
Research (CfADR), Department of Sociology/Anthropology, Nnamdi Azikiwe University,
Awka, Nigeria, in 2018–2019.

Johan Nordgren is a Senior Lecturer at the Department of Social Work, Malmö University,
Sweden. He has conducted research about khat use, synthetic cannabinoids, codependency,
drug law enforcement and online drug dealing. His current research project concerns urban
drug scenes in Malmö, Sweden and how people who use drugs experience everyday life and
how social work- and health care professionals and the police may afect marginalization. He
teaches social work practice and theories in the feld of problematic drug use.

John O’Brien is a Lecturer in Sociology at Waterford Institute of Technology. He received

his PhD from the Department of Sociology in University College Cork. His research inter-
ests focus on historical sociology, the use and regulation of alcohol, alcohol and crime, socia-
bility, and classical and contemporary sociological theory. His recent research has looked at
the role of alcohol in the construction of public problems and how the Covid-19 Pandemic
has afected sociability and drinking culture. He is the author of ‘States of Intoxication’
(Routledge), which looks at the role of alcohol in state formation processes. He is the Presi-
dent of the Sociological Association of Ireland.

Kiran Pienaar is a Lecturer in Sociology at Deakin University, Melbourne, Australia.

Kiran’s research explores connections between health, gender, sexuality and the body, with
a particular interest in drug consumption and sexual cultures, and the sociopolitical dimen-
sions of health. She has published on topics related to drugs, addiction and the self; the bio-
politics of disease; public health and drug policy; and drug experiences in LGBTQ cultures.
Her frst book Politics in the Making of HIV/AIDS in South Africa was published with Palgrave
Macmillan.

Kane Race is a Professor of Gender and Cultural Studies at the University of Sydney. His
work has explored embodied engagements with medicine in the context of sexual stigma,
as well as changing forms of sexual sociability in the digital context. He is the author of The
Gay Science: Intimate Experiments with the Problem of HIV (Routledge, 2018); Plastic Water: The

xix
 Contributors

Social and Material Life of Bottled Water (MIT Press, 2015), co-authored with Gay Hawkins
and Emily Potter, and Pleasure Consuming Medicine: The Queer Politics of Drugs (Duke Uni-
versity Press, 2009).

Craig Reinarman is a Professor Emeritus of Sociology and Legal Studies at the University
of California, Santa Cruz. He was a Post-Doctoral Fellow at the Alcohol Research Group in
the School of Public Health at the University of California, Berkeley. He has been a visiting
professor at the University of Amsterdam and the University of Utrecht, a visiting scholar at
the Center for Drug Research at the University of Amsterdam, and a principal investigator
on research grants from the National Institute of Drug Abuse and the National Institute of
Justice. He has also been a consultant to the World Health Organization’s Substance Abuse
Program and a member of the Board of Directors of the College on Problems of Drug De-
pendence. Dr. Reinarman is the author of American States of Mind (Yale University Press,
1987) and co-author of Cocaine Changes (Temple University Press, 1991) and Crack in America
(University of California Press, 1997). His most recent book is a co-edited anthology of
critical addiction studies called Expanding Addiction (Routledge 2015).

Gerda Reith is a Professor of Social Science at the University of Glasgow. She conducts
research and writes on issues relating to addiction, risk and excess, and their relation to
wider issues of behaviour and governance in global consumer societies. Gerda is particularly
interested in the factors infuencing gambling behaviour and its regulation, and has carried
out numerous projects exploring the ways that behaviour changes over time, and the role
of the social, physical and commercial environment on those changes. Gerda’s research has
been funded by a variety of academic, governmental and charitable organisations, including
the Economic and Social Research Council, the Medical Research Council, the Australian
Research Council, the British Academy and the National Institute for Health Research
(NIHR). She has published extensively on these topics, and her work has been translated
into a number of languages, including Korean, Chinese, Spanish and Hungarian. Her book,
The Age of Chance: Gambling in Western Culture, won the Philip Abrams Prize in 2000. Her
latest book is Addictive Consumption: Capitalism, Modernity and Excess, and is published by
Routledge.

Akihiko Sato is a Professor of Sociology, School of Sociology at Kwansei Gakuin Uni-

versity, Japan. He has been studying both legal and illegal drug problems for thirty years.
He is the author of Drug and Discourse: Methamphetamine in Japan (Kakuseizai no Shakaishi,
Toshindo, Tokyo, Japan, published in Japanese, Japanese Association of Social Problems Aca-
demic Promotion Award (2007) and 7th Japanese Association of Sociological Criminology
Promotion Award (2008)), and Sociology of Drugs: Psychoactive substances and social order (Drug
no Shakaigaku, Sekaishisosha, Kyoto, Japan, published in Japanese). He has published many ar-
ticles and book chapters on drug problems and drug policies, including “Methamphetamine
use in Japan after the Second World War: Transformation of narratives”, Contemporary Drug
Problems, 35/Winter 2008, 717–746, 2009, and “Methamphetamine users and the process of
condemnation in Japan: framing and infuence” in S. MacGregor and B. Thom eds., Risk
and Substance Use: Framing Dangerous Places and Dangerous People, Routledge, 2020. He is a
member of the editorial board of Japanese Sociological Review.

Jonathon Shears is a Senior Lecturer in English Literature at Keele University, UK. He

is the author of The Hangover: A Literary and Cultural History (Liverpool University Press,

xx
 Contributors

2020). Besides the representation of alcohol and drinking cultures, he has research interests
in poetic infuence, ageing in literature, and material culture in the nineteenth century. He
specialises in literature of the Romantic period and has published books and many essays on
the Romantic poets, especially Lord Byron. From 2012 to 2019, he was the Editor of The
Byron Journal.

Qian Hui Tan is a PhD student at the Department of Geography, National University of
Singapore. Her MA thesis attended to the complexities of smoking spaces and subjectivities
in Singapore.

Betsy Thom is a Professor of Health Policy and Co-Director of the Drug and Alcohol Re-
search Centre at Middlesex University. She is also an honorary professor in the Department
of Psychology and Behavioural Sciences, Aarhus University, Denmark. She has degrees in
modern languages and sociology and has completed certifcates in education and in public
health. Her doctorate, from the London School of Hygiene and Tropical Medicine, was on
the history of alcohol treatment. Her research includes drug and alcohol policy and practice,
with current focus on young people, drug-related deaths and co-production approaches
to research. She has managed European, national and local research projects and led the
development of a cross-national master’s programme on drug and alcohol studies. Recent
publications include Risk and Substance Use: Framing Dangerous People and Dangerous Places
(edited with Susanne MacGregor) (2020), Routledge; and Alcohol, Power and Public Health:
A Comparative Study of Alcohol Policy (co-authored with Butler, Elmeland, Nicholls) (2017),
Routledge.

Thomas Thurnell-Read is a Senior Lecturer in Sociology in the School of Social Sciences

and Humanities, Loughborough University, UK. His research focuses on the social and
cultural aspects of alcohol, drinking and drunkenness. He is the editor of Drinking Dilemmas:
Space, culture and identity (Routledge, 2015) and co-editor (with Dr Laura Fenton) of Alcohol,
Age, Generation and the Life Course (Palgrave, 2022).

Deborah Toner is a Social and Cultural Historian of alcohol, food and identity in the
Americas. Her current research examines the development and interaction of racial ste-
reotypes about drinking in the United States and Mexico, and the history of substance
use disorders in Guyana. She has been the Co-Director of the Drinking Studies Network
since 2010, an interdisciplinary research community exploring alcohol and drinking cultures
across diferent societies and time periods.

xxi
 ACKNOWLEDGEMENTS

The completion of this Handbook would not have been possible without all of the con-
tributors who volunteered their time and expertise to put together a great collection of
works that expand our understanding of intoxication and intoxicants. The papers in the
Handbook are written by a wide-range of well-known scholars in the feld of intoxicant
research, and we are delighted to present the insights and data from so many expert
scholars. We especially appreciate their patience during the rather long process of com-
pleting this Handbook.
We would also like to thank the generosity and commitment of the 67 peer reviewers,
who reviewed the 34 chapters. These reviewers donated their valuable time and critical re-
fections on each chapter within this Handbook in order to help the authors produce their
best work. Without their expertise, guidance, and hard work, we would have been unable
to produce a Handbook that integrates the critical component of critique in the production
of knowledge on intoxication and intoxicants. We would like to thank the following distin-
guished reviewers for their invaluable contributions to our Handbook:
Angus Bancroft, David Beckingham, Kirsten Bell, Virgina Berridge, David Bewley-Tay-
lor, Mie Birk Haller, Alexandra Bogren, Marie Bræmer, Martin Bruegel, Nancy Campbell,
Nate Chapman, Yuet-wah Cheung, Jakob Demant, Fay Dennis, Molly Doane, Tristan Dun-
can, Erika Dyck, Steve Earnshaw, Bryce Evans, Laura Fenton, Simon Flacks, Joao Florencio,
Vibeke Frank, Suzanne Fraser, Pekka Hakkarainen, Marie Jaufret Roustide, Helen Keane,
Axel Klein, Philip Lalander, Chris Land, Susanne MacGregor, Sarah MacLean, Elisabeth
Malcolm, Scott Martin, Annemarie McAllister, Julia McQuoid, Brett Millier, Tamar M.J.
Antin, Kristian Mjåland, Alex Mold, David Moore, Maddy Novich, John O’Brien, Aileen
O’Gormann, Jennifer Patico, Craig Reinarman, Lucy Robinson, Sara Rolando, Thomas
Søgaard, Bill Sanders, Robert Shaw, Blaine Stohard, Scott Taylor, Lorne Tepperman, Betsy
Thom, Thomas Thurnell-Read, Tobias Kammersgaard, Debora Toner, Jukka Törrönen,
Torsten Kolind, Birgitte Tylstrup, Marie Van Hout, Jennifer Wallis, Takuya Watanabe, Da-
rin Weinberg, Bernd Werse, and Lisa Williams.
Other people we wish to thank include K.C. McNaughton, our research assistant, who
had the task of ensuring that the fnal manuscript was complete and ftted the requirements
of our publisher Routledge, and Gerhard Boomgaarden who, as a commissioning editor,

xxii
 Acknowledgements

initially approved the Handbook proposal. When Gerhard left Routledge, his position was
flled by Rebecca Brennan, who has been both supportive and patient in waiting for us to
complete the manuscript. Finally, we would like to acknowledge our families and friends,
who have been tremendously supportive during the many months that it took to complete
the Handbook. They have all been both sources of support and balance in our lives.

xxiii
 INTRODUCTION
Geofrey Hunt, Tamar Antin and Vibeke Asmussen Frank

While the topic of intoxication continues today to be a contentious issue between research-
ers, who trace its endemic and often positive qualities and those, who emphasize its trans-
gressive and pathological nature, an increasing number of scholars have begun to situate
contemporary debates on intoxication within a broader context that considers “the lon-
ger, more variegated, encompassing and ambiguous history” of intoxications (Withington
2014:20), as well as the contemporary social, cultural, political and economic elements that
infuence intoxication and the use and practices of intoxicants. Given growing interest in
intoxicants and intoxication, it is not surprising that since 2017, when we initially decided
to produce this Handbook, new and important contributions have appeared. For example,
in 2020 and 2021, the following have been published: Cultures of Intoxication (Hutton 2020),
Alcohol and Humans (Hockings and Dunbar 2020), Drunk (Slingerland 2021) and the Hang-
over (Shears 2020; see also Chapter 4). This continuing fow of books on intoxication and
related topics does not lessen the importance of our Handbook. Instead, collectively, these
contributions highlight one important aim of our Handbook, which is to illustrate the ex-
tensive interest in intoxicants and intoxication and similarities in approaches that exist across
multiple disciplines, but that so often fail to speak to one another.
The Handbook on intoxicants and intoxication emphasizes the wide-ranging nature of
intoxication, providing a perspective that challenges the “silo” approach to the study of in-
toxicants and intoxication – an aim inspired by the work of Goodman et al. (2005), Bancroft
(2009) and Withington and McShane (2014). As a result, we have intentionally avoided
concentrating solely on alcohol and illicit drugs – the focus of many previous works – and
instead sought to incorporate chapters which highlight various intoxicants, including cofee,
tea and prescription drugs, that all, despite their various intoxicants of focus, nevertheless
emphasize common themes related to the socio-cultural, contextual, situated, historical and
comparative nature of intoxicants and intoxication.
In addition to providing an alternative to the silo approach, we also sought to bring
together contributions that avoided a problem perspective, instead examining the multi-
plicity of intoxicant use among people of diferent ages, from totally diferent social back-
grounds, in many diferent cultures, and at so many diferent times in history. As Rudgley
(1993) has documented, people since prehistoric times have sought not only to achieve the
happiness, freedom and/or euphoria from psychoactive drugs, but also, like the romantic

DOI: 10.4324/9780429058141-1 1
 Geoffrey Hunt et al.

writers – Coleridge, De Quincy, Byron and Walter Scott – sought to open up new avenues of
poetic inspiration ofering “dreams that money can buy” and allowing the transportation “to
the realms of imagination” (Boon 2002:37). Hence, our goal was to encourage contributions
that adopted a more universal approach which, instead of viewing intoxication as inherently
problematic, attempted to map out why the authorities have too often viewed intoxica-
tion as “the most harmful of …behaviors with a signifcant negative impact on individual
and community safety and well-being” (Keane 2009:135), or had adopted an approach,
which viewed “the goal of artifcially inducing a change in one’s consciousness” as immoral
(Becker, 1967:164), viewing intoxication, from whatever substances, as “at best tolerated …
often stigmatized or even criminalized” (Yardley 2012:1). Therefore, the overall purpose of
the Handbook was to produce a compendium in which the contributions would locate an
understanding of intoxication within the relationships between culture, consumption, poli-
tics and society (Sherratt 1995).
With this in mind, we began to contact a number of researchers and scholars, from a
wide-range of diferent social science disciplines, to examine both the historical and con-
temporary theoretical paradigms and provide an overview of the key elements that social
science researchers have identifed as important for our understanding of intoxicants and in-
toxication. In bringing together these researchers from diferent social science disciplines to
discuss a range of diferent intoxicants, from diferent parts of the globe, in diferent histori-
cal periods, our aim was to provide the reader with a critical and comprehensive sense of the
range of issues, both established and emerging, that scholars have explored. We also hoped
that in mapping out this arena, within an international and multi-social science approach,
students, junior researchers, as well as established scholars would be encouraged and inspired
to explore and develop new research interests.

Finding Contributors
Recruiting a wide-range of contributors conducting research on diferent intoxicants in dif-
ferent parts of the globe proved to be more challenging than we had initially expected. Hav-
ing identifed and contacted potential contributors, we discovered that while our attempts
to recruit alcohol, illicit drugs and tobacco researchers proved to be very successful, fnding
scholars to write about cofee, tea and other ingested intoxicants was less successful, and we
are grateful for those few contributors to our Handbook. The reasons for this may partly be
because the three editors themselves are involved in alcohol, illicit drugs and tobacco re-
search and hence less connected with other research arenas looking at other intoxicants. Or
it could be that while research funding has been somewhat more plentiful for those of us in
drug, alcohol and tobacco research, funding to study other intoxicants is less available. One
fnal additional aim had been to ensure that scholars from diferent countries, other than the
U.S., Europe or Australia, were fully represented in the pages of the Handbook to ensure
that “northern theorizing” did not dominate (Connell 2007). While more chapters from the
Global South would have been welcome, we nevertheless were able to recruit six excellent
contributions focusing on Brazil, Japan, the Kyrgyz Republic, Nigeria and Singapore.
Having identifed our contributors, and accepted their initial abstracts, we then waited for
the papers to start rolling in. This process always takes much longer than initially planned, in
spite of target dates and deadlines being specifed. However, we did not expect that the pro-
cess would be further derailed by the COVID-19 pandemic. As news of the pandemic began
to flter in, and as universities and research centers started to close down, we and our contrib-
utors began to face new challenges. Many of our potential contributors found themselves,

2
 Introduction

not only needing to learn how to teach their students online while working at home, but also
balancing the pressures of their professional lives with the needs of their personal lives, such
as managing children while fnding time to write. Some of our contributors also fell ill from
COVID-19 and then dealt with the slow process of recovery. While some were able to keep
the initial deadlines, others fell behind. Consequently, we, as editors, had to adopt a much
more fexible and encouraging approach to help all our contributors handle their personal/
professional needs, while completing their chapters. Being in contact with our contributors,
also meant that we began to learn more about their personal and professional journeys and
the various and often competing duties that they were attempting to juggle. During that
time, one or two e-mails struck us as accurately portraying the situation that many of our
contributors were confronting and the difculties they faced on a daily basis. For example,
one contributor writing to us at the start of pandemic, in explaining their situation, noted:

I was already behind with my schedule, when the epidemic broke out and for more than
two weeks now it has not been possible for me to work on my chapter. I have been con-
fned at home for a week and with my two year old boy around, I am not able to focus
on the many things I have to do.

At the end of this e-mail, the contributor forecasts somewhat pessimistically, the future, a pre-
diction which we all discovered was far too optimistic. “It is also clear this situation will last for
several weeks and when this period is over, we will have to deal with many complicated issues.”
As the pandemic continued, and the situation got increasingly dire, this contributor, like many
others, began to tell us that their ability to handle their work commitments had worsened, and
yet at the same time also expressed the fact that they should not complain:

we can’t really complain, our place is pleasant and not small. However, working is very
complicated though, our kid is two and a half years old, it is not easy for him and he
requires a lot of attention of course. It is clear he is feeling out of sorts…. Overall, the
general atmosphere is uncomfortable, the epidemic is an obsession, the only topic you
hear about and the fact that we don’t know how long it will last and how violent will
the consequences be. That is a gloomy atmosphere.

Another contributor, having asked for a short extension to our latest deadline for the chapter,
described their daily lives in the following ways:

Sorry, for not being in touch…but as you can imagine, things are weird, stressful, un-
certain and chaotic, in about equal measure. The University is closed, so it is very
strange trying to work at home, often with 3 anxious and demanding kids. Even as I
type this e-mail, they’re arguing and running around the kitchen, where I work.

This was followed a few months later with another e-mail which again described their sit-
uation at home:

We’re deep into another lock-down. The schools are closed again, so it is back to herd-
ing the kids. I gave up on home-schooling almost immediately. It’s just impossible with
the 3 of them all at very diferent stages, and trying to work at the same time. It is a real
challenge trying to balance everything. I try to work early morning and late evening,
the rest is just treading water. Hoping things will eventually get back to normal.

3
 Geoffrey Hunt et al.

Other contributors faced other obstacles in completing their papers. For example, one of
them, while completing their chapter, had to deal with helping his aged parents, whose
house had been struck by a typhoon and was covered in mud. Visiting his parents every week
to restore their house and ensure that his parents were safe and comfortable was certainly
more important than a Handbook chapter and eventually the house was restored. Given an
extension to the deadline, our contributor completed the chapter, even while dealing with
this catastrophe. Nevertheless, instead of receiving the chapters all around one deadline date,
they drifted in slowly but always one or two every couple of weeks. Having then received the
papers, we faced the next problem: fnding two and sometimes three reviewers. Again, given
the turmoil brought about by the pandemic, we searched for fellow academics and specialists
in specifc areas, who were willing to devote some time to reading and commenting on the
individual papers, while handling their already burdensome workload. At times, fnding
willing reviewers was difcult, many either refusing or in some cases never replying to our
requests. In fact, one potential reviewer, while expressing her willingness to review, told us
that unfortunately she was locked down in a hotel in Southern China without her laptop
computer and did not know how long the situation would continue. Nevertheless, the ma-
jority of researchers we approached were more than willing to review the papers and ofered
us their best wishes in completing the Handbook. These reviewers (a list of all the reviewers
can be found in Section??) played an important role in the production of this Handbook.
Their insightful comments guided the authors’ revisions, enabling them to produce a high
standard of chapters. This is the background and the momentous historical period in which
this Handbook was produced.

Te Field of Intoxicants and Intoxication Research

The available published research on intoxicants and intoxication, in addition to its wide-rang-
ing nature, is quite fragmented, and only a few of the available books or collected editions
on intoxication are comprehensive in terms of the social sciences, examining diferent in-
toxicants, or covering diferent historical periods. For example, Hutton’s recent “Cultures of
Intoxication” (2020) provides an excellent overview of the main intoxicants: alcohol, illicit
drugs and tobacco, as well as considering important social science issues such as the impact
of sexuality, gender and ethnicity on intoxicant use. While her book is intentionally focused
on contemporary issues, our own Handbook sought to include both contemporary accounts
and historical discussions. Bancroft’s stimulating book Drugs, Intoxication and Society (2000) is
an exemplar of a wide-ranging approach, which includes cofee, tea, prescription drugs and
a short section on nicotine as well as alcohol and illegal drugs. Other compendiums, such as
Davenport-Hines (2002), have also produced wonderful global histories of narcotics, unfor-
tunately however, given both the specifcity of the topic and the use of the word “narcotics,”
his coverage is somewhat limited. Finally, Withington and McShane’s supplement to Past and
Present (2014), based on the proceedings of a conference on the “Cultures of Intoxication”
at Cambridge University in 2010, is also a good example of the wide-ranging approach to
the feld, an approach we sought to emulate. It covers both a wide-range of intoxicants not
only in diferent historical periods, including, for example, ancient Greece and contempo-
rary Hong Kong, but also in diferent parts of the globe, including Taiwan, South and West
Africa and the Middle East.
These books are just a few examples of the available works that have examined intoxicants
and intoxication against a broad backcloth. There are of course many, many other examples
that we could have mentioned, including, to name but a few, Jay (2010), Siegal (2005), Grob

4
 Introduction

(2002), Dobkin de Rios (1990), Rudgley (1993), Walton (2001) and MacAndrew and Edg-
erton (1969). All of these books and compendiums, and many that we have not mentioned,
have added to our overall knowledge about diferent intoxicants and intoxication in many
diferent societies, in diferent historical periods, and you will see these important contribu-
tions cited throughout the subsequent pages of this Handbook.
Although our aim in producing the Handbook was to correct some of the shortcomings of
contemporary compendiums, contributions within the Handbook owe an enormous debt to
all these studies, which have enriched our appreciation of these topics and have provided to
those of us, who conduct research within these areas, a rich and detailed reference literature.

Outline of the Handbook

Having briefy outlined the background to our Handbook, and the processes by which we
assembled all the contributions, what is it that the reader can expect to fnd in its???? pages.
One aspect, that is largely absent from the Handbook, is an opening section that sets out to
accurately defne either diferent intoxicants or diferent forms of intoxication. Other works
have begun their examination of the topic by defning their use of intoxication or intoxi-
cants. For example, Slingerland (2021) informs his readers that in using the term intoxica-
tion, he intends to include both “dramatic states of inebriation” (p. 6) and the mellow and
happy buzz that one feels after “the frst couple of sips of wine.” Others, for example Hutton
(2020), adopt Mary Douglas’ (1987) defnition in which intoxication is “viewed as a set of so-
cial and cultural practices, norms and values” (2020:3). Some writers, instead of attempting
to defne or precisely specify either intoxication or intoxicants, have detailed why they have
adopted the term intoxication. For example, Withington (2014) in his introduction to “Cul-
tures of Intoxication” argues that the vocabulary of intoxication “is etymologically and se-
mantically precise” (p. 12) and is relatively “neutral… without the ideological connotations
of drugs” (ibid.). He argues “that it depicts a cognitive and social condition (intoxication)
as well as the substances that induces it (intoxicants)” (ibid.). We have implicitly followed
Withington’s lead, using similar terms as he does, hence the title of the Handbook, and de-
cided not to specifcally defne the precise terrain for our contributors, thereby avoiding any
attempt to pre-determine how they should approach the topic. Instead, we allowed them to
determine themselves what constituted intoxication and which intoxicants they wished to
focus on. We assumed, in general, given our choice of contributors, that their focus would be
broad and wide-ranging and would cover issues they believed were signifcant, whether that
be examining diferent conceptions of addiction across a wide-range of historical periods
(for example, Chapter 34), investigating societal-level discourses about Ireland’s drinking
cultures (Chapter 31), exploring the interplay between the defnition, regulation and prac-
tices of excess (Chapter 30) or examining the symbolic role of cofee and cofee shops among
Bosnian refugees (Chapter 9).
However, while we as editors refrained from specifcally defning either intoxication or
intoxicants, this is not to say that some of our individual contributors have done likewise.
For example, Craig Reinarman (Chapter 1), having traced the lexicographical origins of the
term intoxication in Greek and Latin, argues, somewhat in opposition to Withington (2014),
that the term intoxication, as referring to a “state of being poisoned,” narrows the potential
range of possible meanings. Instead, he suggests that, “we need a lexicon with a wider ap-
erture so that the phenomena we refer to, with the term intoxication, do not imply a false
binary, drunk or sober, but rather capture the broad array of altered states in between.” In
Chapter 21, Suzanne Fraser and colleagues begin their chapter by noting the extent to which

5
 Geoffrey Hunt et al.

intoxication is a “multivalent term” “that invokes a range of experiences – from joy and plea-
sure to chaos and impairment – and applies diferently across diferent drugs and diferent
settings of drug consumption.” These characteristics, they argue, “can carry highly variable
political implications and efects, entailing varying governance measures and practices.” Fi-
nally, John O’Brien (Chapter 18) suggests that intoxication is a “compromised term” because
of its roots in nineteenth-century medical science.
Having stayed away from pre-determining the ways in which our contributors should
handle their discussion of individual intoxicants and types of intoxication, we nevertheless
have had to organize all the disparate chapters into sections. In designing the Handbook
initially, we had decided on possible themes under which the diferent contributions could
potentially be grouped. However, as the papers trickled in, it became clear that some of them
did not ft our initial thematic plan and hence a revised thematic plan was required. Yet, this
process was not entirely clear due to the broad-ranging nature of each of the chapters, which
easily ftted into more than one theme. Nevertheless, we have grouped the 34 chapters into
eight diferent headings, which can operate as a road map to guide you, the reader, through
the Handbook. Keep in mind, however, that in classifying chapters under one particular
section, it became all too clear that certain chapters could easily have been listed under a dif-
ferent section. We believe, however, that the reality of this challenge only further provides
evidence of the remarkable overlap among studies of various intoxicants and intoxication
which focus on disparate settings, countries, cultures, age groups and historical periods and
which are considered through the lens of diferent social science disciplines.

Teme 1: Te Terrain of Intoxication

The aim of this initial theme is to bring together those chapters, which have examined the
diferent social meanings of individual intoxicants and the way in which diferent social and
cultural infuences have worked to construct those diferent meanings. Under this heading,
we have grouped four papers that we feel specifcally highlight this theme. The opening
chapter by Craig Reinarman seeks to explore the diferent meanings of intoxication and
examine why not only certain forms of intoxication are “socially approved and unproblem-
atic,” while others are “feared and punished,” but also why these forms change over time.
Reinarman argues that intoxication as a category of behavior “warrants” further investi-
gation, arguing that it cannot be the simple fact of producing an altered consciousness that
solely infuences why certain forms of intoxication are acceptable or unacceptable at diferent
times. Instead, he suggests that we must examine “the conditions under which intoxication
gets defned as troubling or not troubling, which often depends on who is intoxicated, by
what means, when, and where.” In this opening chapter, Reinarman sets the scene for other
contributors to question and examine what all the diferent circumstances and factors are
that infuence how the authorities defne, judge and control diferent intoxicants and difer-
ent states of intoxication.
The second chapter by Ruth Lewis and colleagues, while unlike the broad nature of the
frst chapter, examines the diferent meanings ascribed to nicotine vaping by young adults.
Using practice theory, they explore the shared meanings and processes that young people
attach to vaping nicotine, emphasizing the extent to which these meanings are infuenced
by social inequities, based on race, class, gender and sexuality. In the third chapter, Emeka
Dumbili and colleagues present a very diferent situation than described by the previous
chapter. Instead of vaping in California, this chapter examines the intoxication practices
among young adults in South-Eastern Nigeria. In tracing the meanings of drug use and

6
 Introduction

specifcally, cannabis and tramadol, among these young adults, clear gendered diferences
emerge where notions of masculinity and femininity play a signifcant role in the ways in
which intoxication practices take place. The fnal chapter by Jonathon Shears, which we
have grouped under this initial heading, is an unusual chapter in the sense that it does not
discuss a specifc form of intoxication but instead explores the consequences of intoxication.
While many researchers have produced studies of intoxication, few have explored the some-
what forgotten topic of the hangover, as Shears has done in his contribution. Our reason for
placing this chapter here is because the author examines how the symptoms of the hangover
arise not solely as a result of imbibing too much alcohol but instead from the diferent psy-
chosocial consequences of using alcohol. In other words, the meanings of the hangover are
far more complex than the pharmacological properties of alcohol itself.

Teme 2: Social Life of Intoxicants

As Appadurai noted many years ago, intoxicants can be viewed primarily as commodities
operating and circulating in specifc spheres of diferent value. The values ascribed to each
intoxicant are based not upon any intrinsic properties but instead depend upon “judgements
made about them by subjects” (Appadurai 1986:3). Given the fact that substances circulate in
specifc cultural and historical milieus where they are produced, exchanged and consumed,
they acquire diferent values as they pass from one sphere to another. Consequently, in ex-
amining the social and cultural life of individual substances, he suggests that we examine the
social history of things, in order to trace the ways in which intoxicants move through difer-
ent historical periods and “through diferent hands, contexts and uses” (Appadurai 1986:34).
Infuenced by this approach, we have grouped together four papers, which examine the
social life of diferent intoxicants. In Chapter 5, Gerda Reith examines two contempo-
rary trends: frst, the “commodifcation of intoxicants” and, second, the expansion of the
“concept of intoxication.” In examining these trends, she considers three diferent types of
intoxicating consumption – drugs, food and gambling. By examining the discourses that
operate around them, she argues, that until recently, drugs were viewed as the “paradigmatic
example of intoxicating consumption.” However, today, an increasingly “wide range of
both substances and experiences” have been described in terms similar to those previously
confned to descriptions of drug use and addiction. Moreover, it is not merely the case that
new substances and experiences have become defned as intoxicating, but also that the com-
mercial potential of these substances has become increasingly realized. Examining the ways
in which corporate interests have adopted many of the scientifc discoveries on how the brain
operates when exposed to stimulating pleasurable experiences, such as heroin and cocaine,
she highlights how these corporations have used these discoveries in marketing other com-
modities and experiences.
The second chapter by Angus Bancroft again examines the social life of drugs by showing
how drugs become diferent substances in diferent “consumption regimes.” More specif-
cally, he explores notions of potency within drug distribution markets and the ways that these
markets infuence both “intoxication subjectivities” and drugs as specifc types “of object[s]
with tangible characteristics.” Drugs as useable commodities are shaped by “the relation-
ship between dealer, user, market and consumption context.” Within these settings, drugs
become interchangeable commodities, and users become consumers. In the third chapter,
intoxicants as commodities take on a diferent shape, this time in the form of craft drinks
and craft drinks culture. Thurnell-Reed examines the changing discourses and practices
that have framed the consumption of craft drinks. Unlike many other alcoholic beverages,

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 Geoffrey Hunt et al.

he argues that discussions surrounding craft drinks rarely deal with notions of drunkenness
and disorder and instead focus on notions of cultural capital, including “discernment, taste
and studied cultural appreciation.” Within this context, consumers can drink “as an expres-
sion of pride and community” rather than simply drinking to intoxication. By showing the
fuctuations in the cultural values and social status of individual intoxicants, he highlights
the extent to which craft drinks and the discussions around them have successfully distanced
themselves from being viewed as an intoxicant capable of producing intoxication.
The fnal chapter in this section is by Peder Clark, who examines the diferent meanings
of ecstasy in diferent cultural, temporal and spatial settings. In tracing the history of ecstasy
from its beginnings in 1912, with its discovery by the Merck company; its re-discovery in
California by Alexander Shulgin in the mid-1960s; through its use in the 1970s and 1980s
becoming an important commodity associated with the club scene, he highlights the “ten-
sion at the heart of many cultures of intoxication” between the costs to health versus the
escape from the mundane. However, while noting this tension, Clark also encourages histo-
rians and other researchers “to look beyond these binaries of harm and hedonism to develop
more nuanced perspectives on ecstasy.”

Teme 3: Intoxicating Settings

In 1989, Ray Oldenburg wrote a book called “the Great Good Place” where he extolled
the virtues of informal public gathering places. These places included the pub, the café, the
tavern, beer gardens and the cofee house. While these sociable meeting places are important
to examine in terms of their relationship to specifc intoxicants, our aim was to broaden our
approach and include settings, not normally examined under the heading of intoxicating
geographies. Included under this heading are chapters that have examined intoxication set-
tings not as static, peripheral or an “impassive backdrop to situated human activity” (Thrift
1996:3) but instead specifc settings which contribute their “own constitutive and active
rhythms, forces and energies” (Duf 2007:506). With this in mind, we have included dis-
cussions of cofee bars and drinking places, as well as chapters, which have examined the
impact of informal drinking settings, such as drinking at academic conferences, as well as the
impact of institutionalized settings, in this case prisons, on the use of intoxicants. Finally, we
consider how intoxicants are used in warfare.
In Chapter 9, Ana Croegaert examines the practices and culture of Bosnian cofee
drinking and specifcally the role of cofee houses. However, her aim is not merely to
trace the role of cofee or cofee houses in diferent historical periods within Bosnian
society, but also to examine the “spatial elements associated with cofee drinking” and
to explore what these elements might tell us about human relations. She shows how
the practices of drinking cofee play an important symbolic role in connecting globally
dispersed Bosnians with their homeland. In the next chapter, James Kneale seeks to
highlight the extent to which drinking places, such as public houses in England, were
not only sites for consuming alcohol, but important places for the consumption of other
intoxicants and especially tobacco. Furthermore, in a similar way to that suggested by
Duf and Thrift above, Kneale examines intoxication, within these drinking places, not
solely as something resulting from the physiological and neurological efects of specifc
beverages, but instead “something that emerges out of the interaction of consumers,
intoxicants, songs, light and visual spectacles, and a wider afective atmosphere.” In so
doing, he suggests that adopting a broader examination of drinking places “may well
generate entirely new questions for researchers interested in intoxication.”

8
 Introduction

The importance of setting in examining the practices and cultures of individual intox-
icants is further developed by Helen Keane (Chapter 11), who examines drinking and net-
working practices at academic conferences. She argues that minor intoxication can itself be
viewed not as a symbolic marker between work and play (Gusfeld 2003) but instead as a
form of work. Drinking and intoxication “can be interpreted as an intensifcation and ex-
tension of expected attachments to work.” In general, psychoactive substances, alcohol and
cofee (cofee at regular points during the day and alcohol in the evening) are “normalized”
features of the conference schedule. However, given the fact that drinking in nighttime
venues results in individuals loosening social constraints and conventions, drinking at a
conference involves people still inhabiting their “professional identities.” These potentially
conficting situations and norms may result in experiences of ambiguity and tension. The
fourth chapter in this section, by Torsten Kolind and Karen Duke, examines the issue of
intoxication in prison settings, considering both how intoxication is experienced and orga-
nized within the prison environment and the relationship between intoxication and pleasure
among those who are imprisoned. More specifcally, they argue that the prison context
creates an environment that is diferent than the outside world in that it determines the kind
of drug use that is possible and also how intoxication is experienced and socially organized.
Following on the theme of custodial institutions, Lyuba Azbel and Frederick Altice ex-
amine the case of methadone in prisons in the Kyrgyz Republic comparing its use with that
of heroin. While noting the extent to which the medical and clinical literatures distinguish
methadone from other illicit drugs, they show how the use of these substances, by the pris-
oners, turns this distinction on its head. Instead of methadone being viewed as a substance to
be used to reduce harm, the prisoners view methadone as a “compulsive drug of addiction.”
In contrast to this, they view heroin, often portrayed within addiction literature as the epit-
ome of an addictive substance, as a benefcial substance that can be used for harm reduction.
In highlighting this case, the authors show the extent to which an intoxicant, previously de-
fned in one way within public health writing, can under diferent circumstances be viewed
in a totally diferent way, even producing benefcial health outcomes.
Continuing the theme of setting and intoxicant use, Houborg and Berge explore how
drug users in a drug consumption room (DCR) in Copenhagen, Denmark, narrate both
“modes of use” and “trade-ofs” in relation to intoxication experiences. Using narrative
data from in-depth interviews with drug users, they show how users consider benefts and
drawbacks when using drugs in the DCR. The narratives include how to get a desired intox-
icating efect of a drug and how the particular setting inside or outside DCRs can promote
these efects. These “trade-ofs,” promoted by diferent settings, are also analyzed in relation
to modes of use which can include intoxication, self-medication or removal of withdrawal
symptoms. Houborg and Berge’s study show that drug users have a variety of reasons for
using or not using DCRs, compared to the overall purpose of DCRs, which are intended as
ways of preventing overdose deaths and securing healthy drug taking.
Finally, in this section on intoxicated settings, we have included a chapter by Lukasz
Kamienski, who examines a much broader intoxicated setting than the other papers, by
considering what he calls the “weaponization of intoxicants.” By considering intoxicants in
diferent historical periods, in diferent societies, he shows how intoxicants and warfare are
intertwined. He also, in passing, highlights the irony that while much literature has been
spent on examining the “war on drugs,” the analysis and examination of the use of intoxi-
cants in armed confict have been neglected, especially by military historians. In correcting
this oversight, he shows how intoxicants are not only used to inspire courage and enhance
performance by counteracting fatigue, but are also used to mitigate the long-term efects of

9
 Geoffrey Hunt et al.

battle experience after soldiers have been removed from the feld. This last example is par-
ticularly relevant, given the very recent debate on the use of psychedelics for the treatment
of PTSD, especially for soldiers.

Teme 4: Intoxication Practices

In the last section, we discussed the importance of considering the wider setting in under-
standing the importance of the socio-cultural context for understanding the role and culture
of intoxicants. In the fourth thematic section, following on from this previous theme, we
examine those chapters that have focused more specifcally on the practices that have been
adopted in using particular substances. In Chapter 16, Julia McQuoid argues that in con-
sidering nicotine use practices, it is important that the social context be examined to un-
derstand these practices. To do this, she suggests that building upon Zinberg’s (1984) model
of drug set and setting, a model used extensively in the drug feld, could be fruitful when
examining nicotine use practices and experiences. Furthermore, she argues that research
which examines the day-to-day and lived practices of those who use nicotine is sparse “when
compared to the large body of literature examining trends in prevalence of and ‘risk factors’
for tobacco use.” Highlighting the available qualitative research studies and also exploring
more contemporary theories beyond Zinberg’s important work, she examines how “smok-
ing experience” is not an isolated relationship between the individual and the substance, but
instead a dynamic practice that operates within specifc settings and contexts. Following
the notion of practices, Kane Race and colleagues examine in Chapter 17 the practices of
intoxication for LGBTQ users. Historically, research on LGBTQ drinking, drug use and in-
toxication have tended to view their use of intoxicants primarily from a problem perspective.
Consequently, their drinking, drug using practices and intoxication were viewed as a re-
sponse to the social and health problems they confront, including stigma and minority stress.
In contrast to this perspective, Kane and colleagues ask the unusual question: What if intox-
ication were viewed not “as a plaster [band-aid] for the wound of sexual stigmatization,” but
instead as a “pragmatic means of carrying out certain discredited activities.” By reverting the
focus, the authors are able to portray their research participants not as “damaged and static
identities” or submissive actors involved in pathological self-medication, driven by societal
forces, but instead as active agents. Using narrative data, they show how their participants
“reject the concept of intoxication” as inadequate because of its negative connotations, such
as notions of toxicity. Instead, their own practices of psychoactive consumption are viewed
as pleasurable and transformative and as a “practical strategy that grapples” with the situation
they fnd themselves in.
Finally, in this thematic section, Chapter 18 by John O’Brien considers the practice of
drinking proportionately. Examining the schizoid quality of the discourse on alcohol intox-
ication, which, on the one hand, viewed alcohol consumption as an element of modernity
encompassing freedom, choice and involvement in the public sphere. On the other hand,
drinking is the subject of “problematisation” and a practice that must be governed. Within
this discourse, O’Brien asks the question: how do people learn to drink proportionately, a
feature of every drinking culture? How do they learn the rules of the game and how do they
learn what constitutes excess and the ideal forms of “drunken comportment?” In answering
these questions, he argues that a process of deritualization is a major aspect of moderniza-
tion. Unlike more traditional societies, in which ritual plays a central role in determining
the diference between moderation and excess, control today in the context of deritual-
ization “comes less from ritual as an aspect of the social structure and more from refexivity,

10
 Introduction

involving a more individualised navigating of risk,” and it is these practices of the self that
shape consumption.

Teme 5: Alternative Approaches for Studying Intoxication

Critical studies of intoxicants and intoxication have long challenged mainstream, positivistic
approaches that search for a singular, unyielding truth about intoxicants and their efects.
They critique the tendency to produce a single pharmacological explanation for the efects
of drugs on the body and brain, while ignoring either the diferent modes of administration
or the social and cultural contexts within which intoxicant use takes place. These studies
also investigate how particular scientifc methods are themselves social and cultural con-
structs built on particular assumptions that shape drugs in particular ways, which change
over time. This approach can be seen in Nancy Campbell’s chapter, in which she delineates
how, over time, intoxicants and their efects have been defned and operationalized by “ex-
perimental, clinical, and behavioral scientists” as singular static entities that are considered
easily observable in the laboratory. Her account critiques the ability of such positivistic and
“sober” approaches to studies of intoxicants and intoxication to fully attend to the “plea-
sure and desire [that] stubbornly reside within intoxication,” and she not only makes room
for, but champions the need for post-positivistic social scientifc approaches that “disrupt”
mainstream studies of intoxicants and intoxication. Campbell’s chapter is nicely followed by
a chapter by Jonas Bååth and Johan Nordgren which provides a counter approach to neuro-
psychological studies of drug intoxication. They assert that conventional scientifc methods,
especially those employed in pharmacological and neurological research, cannot sufciently
grasp a person’s experiences with intoxication and, therefore, they argue for the use of online
trip reports for understanding the subjectivities of people who use intoxicants. Finally, this
section concludes with a chapter by Susanne Fraser and colleagues who draw upon an “onto-
politically-oriented” approach to research, further developed in Fraser (2020), that acknowl-
edges that drug consumption realities emerge from diferent “contexts and discourses…
[which] co-produce culturally and politically specifc intoxication experiences and efects”
(p#). Using two separate research projects as case studies, they illustrate the ways in which
intoxication is a political designation reliant on a range of assumptions about drug-consum-
ing subjects and practices. In making this case, the chapter sets out methodological resources
for new approaches to researching politically multiple concepts such as intoxication.

Teme 6: Scapegoated Substances

As Craig Reinarman succinctly states in Chapter 1,

whether a form of intoxication is seen as problematic is contingent on many things, not

least whose consciousness is being altered and in front of whom. Narratives of ‘irrespon-
sibility’ and ‘danger’ stick to some groups more easily than others; certain groups are
depicted as prone to drug abuse, others to abstinence.
(p.6)

The history of intoxicants and intoxication has been intimately intertwined with certain
groups at the margins within many diferent societies. This section in the Handbook il-
lustrates the ways in which the association of particular intoxicants with particular groups
around the world ultimately shapes the meaning of the intoxicant use and of intoxication,

11
 Geoffrey Hunt et al.

not to mention stigmatizes the people who use. The frst chapter, by Lucas Brunozi Avelar
and Deborah Toner, highlights the ways in which meanings of drunkenness shifted over-
time through the racialization of drinking behaviors from colonial Brazil to the twentieth
century. In particular, they argue that racial discrimination in Brazil was enacted, in part,
through the stigmatization of alcohol use, specifcally cachaça (i.e., Brazilian rum), and the
alcohol practices there were associated with Africans, who were enslaved. In the next chap-
ter by Ediomo-Ubong E. Nelson, we are introduced to the experiences of street-involved
youths in Nigeria who use cannabis and the ways in which cannabis serves as a scapegoat
for police surveillance and violence. Through a large-scale qualitative data collection efort,
Nelson examines the context in which cannabis use emerges among these youth and de-
scribes youths’ unjust and inhumane encounters with the police, illustrating the structural
violence and harmful consequences that can result in zero-tolerance approaches to drugs.
In the following chapter, Johan Nordgren takes us to Sweden describing how khat use
became “ethnifed” through its association with Somali communities in Malmö, thus ren-
dering, in societal-level discourse, khat use a “Somali problem.” However, his study empha-
sizes that there are multiple constructions of ethnicity and argues that an excessive reliance
on ethnicity as it relates to drugs ends up obscuring other, and arguably far more relevant,
structural conditions that contribute to the use of intoxicants. From Sweden, the reader is
then taken to Japan, where Akihiko Sato presents a fnal chapter on the history of the control
of amphetamine-type stimulants (ATSs) in post-war Japan. He challenges the conventional
narrative in Japan that ATS control was solely due to its addictive properties and psycholog-
ical harms, and instead suggests that the symbolic meaning of ATS has changed drastically
overtime, frst as a symbol to establish political and ethnic boundaries, then as an economic
marker establishing what constitutes legitimate business activity, and fnally as a way to draw
the psychological and social boundaries of Japanese society. In all of these moments in time,
Sato argues that ATS sets up boundaries between deserving citizens and scapegoated others.

Teme 7: Discourses Shaping Intoxication and Intoxicant Users

In the frst chapter, in this section, Susanne MacGregor and Betsy Thom consider changes
in how the issues of death from drug intoxication/drug overdoses have changed in recent
years. Drug overdoses have increased in many countries, and become a concern for a range of
actors, including policy makers and health professionals. However, as MacGregor and Thom
show, the framing of the problem has altered along with associated proposed solutions, and
the media’s role in these shifts in framing was signifcant. They emphasize how the framing
of drug-related deaths is underpinned by implicit assumptions and values, such as what con-
stitutes acceptable or risky behavior; who is a “worthy” person; the nature of responsibility
and blame for negative consequences. The media provide a key means through which the
understanding of risk, the links between risk and behavior and the adoption of “appropriate”
responses to drug intoxication are refected and disseminated.
In the next chapter by Qian Hui Tan, we are introduced to discourses on cigarette intox-
ication. Tan shows how cigarette smoking is constructed as a(n) (in)toxic(ating) practice that
resists spatial containment. Because of the “airy” character of cigarette smoking, smoking is
not confned to the smoker, but also to non-smokers, who can become second/third-hand
smokers. The toxicity and risks of cigarette smoking are thus not only related to the smoker,
but is reported to be potentially even more toxic to non-smokers. Taking as her point of de-
parture the situation in Singapore, Tan examines how the ever-extending geographical reach
of public smoking bans, “fueled by paternalistic public health institutions,” de-normalizes

12
 Introduction

smoking. Her chapter critically investigates what she calls the “medicalization of smoking”
and “healthist” discourses and advocates instead for a diversity of “not-so-toxic” or “not-so-
healthist” discourses on smoking, thereby taking into account the complexities of smoking,
such that smoking can be both life-enhancing and detrimental to health.
Continuing the critical tone of this section in the analysis of discourses, Axel Klein in
Chapter 28, using Niklas Luhmann’s systemic theory, discusses the international drug con-
trol system, arguing that it is “run as a social system, the primary concern [of which] is not
resolving the world drug problem, but to perpetuate itself.” As such, this self-perpetuating
drug control system is argued to perpetuate the very risks that they purport to attempt to
alleviate. Consequently, this confguration of the drug control system leaves the develop-
ment of alternative and practice-based solutions, like measures to reduce harm or redefning
the problem as “social” or “medical” instead of “criminal,” to “heretics” outside the system.
Klein concludes by arguing that the system needs to be “defunded, deconstructed and dis-
mantled” in order to change to allow for diferent problematizations and less harmful solu-
tions to the “drug problem” to fourish.
The last chapter in this section by David Moore and colleagues introduces us to the notion
of intoxication in alcohol policy discourse and practices in Australia. They argue that intox-
ication, generally in alcohol and other drugs policies, is presented as a universal and singular
state and is constituted as a threat to health and social order. Taking as their point of depar-
ture diferent Australian alcohol policy documents, the authors show how the relationship
between alcohol intoxication and violence is linked in a simplistic way whereby (excessive)
alcohol intoxication is considered to cause violence. However, when interviewing alcohol
policy stakeholders, they identifed various modes of explanations in which discussions of
the alcohol intoxication and violence nexus became much more complex, yet nevertheless
conclude with simplistic causal explanations. Drawing on the work of Annemarie Mol and
John Law (2002), the authors provide an analysis of the relationship between alcohol intoxi-
cation and violence that takes into account both the interview participants’ insistence on the
complexity and multitude factors that make up both the problem and the solution, as well as
their tendency to provide more simplistic explanations of alcohol intoxication and violence.

Teme 8: Notions of Excess

This section explores intoxication and the changing boundaries of excess for diferent in-
toxicants, while considering the continual interplay between the defnition, regulation and
practice of excess in a range of contexts. In this way, the papers in this section identify how
defnitions, regulations and practices of excess exist in a state of changing reciprocation, and
re-inscription over time; how notions of excess associated with intoxicants have been repre-
sented over time, and how the boundaries between “acceptable” and “excessive” constantly
change. In the frst chapter, Dias-Lewandowska and colleagues “provide a historically and
culturally comparative perspective on the socially contested boundary between excess and
moderation in relation to alcohol by drawing on four distinct, yet complementary, cases.”
The four cases include late medieval and early modern Western Europe; sixteenth- to nine-
teenth-century Poland; twentieth-century Britain and fnally contemporary Britain. By
exploring these four cases, the chapter explores “how various religious, state and cultural
authorities have sought to defne excessive and moderate drinking, and how a diverse set of
actors has negotiated their drinking in relation to these textual and visual discourses.” By
drawing on such diferent cases in diferent times and in diferent places, the authors show
how defnitions of excessive and moderate drinking are not constant, but fuctuating.

13
 Geoffrey Hunt et al.

In the next chapter, Alice Mauger explores shifting representations of Ireland’s drinking
culture and how competing discourses have infuenced changes in the perception of Irish
(excessive) drinking. Her analysis examines the period from 1890 to 2018 and is based on the
author’s own research on medico-scientifc and state responses to (excessive) alcohol consump-
tion and addiction combined with a historiographical survey of existing work. In the chapter,
she traces three distinct phases in which medico-scientifc, voluntary and state responses have
converged. She shows how the disease concept is accepted in Ireland in an era when, among
other things, Irish nationalism and a temperance association were gaining a foothold; how in
the 1960s, the interest in alcoholism intersects with attempts to reinvent Ireland’s international
profle; and how most recently Ireland adopts a public health approach to alcohol, including
an alcohol policy on pricing, health warnings and restriction on marketing and advertising.
While this chapter focuses on Ireland and gives us insights into changes in responses to the Irish
alcohol culture, it also provides an important example of how it is possible to examine changes
in national (policy) as possible responses to (excessive) alcohol consumption.
The alcohol theme is continued in the next chapter by Pamela Lock, who introduces
us to the fgure of the “chronic drunkard” in nineteenth-century British literature. Lock
examines a particular fgure, the “chronic drunkard,” and relates the representation and
understanding of this fgure to broader societal and cultural discourses. The chapter gives
an overview of the most infuential representations of the drunkard in literary, popular and
temperance fction. These representations, despite the diferences in genres, are related to
anxieties, while at the same time having a didactic purpose. Lock writes:

The fctional drunkard, usually broken and repulsive, not only warns its nineteenth-cen-
tury audience to drink ‘well’ or not at all for their own bodily and mental health, but
reminds the reader of their duties to family, community, and country by demonstrating
‘Victorian’ values such as moral rectitude and industry.

The chapter, however, not only explores how the representations of the fctional “chronic
drunkard” relates to norms and values in an era where social hierarchies and gender roles
are in a process of change, but also how it relates to medical developments; theories of how
alcohol afects body and mind; and new ideas on how to treat the “chronic drunkard.” Lock
thus highlights the way a fctional fgure relates to societal, cultural and scientifc norms and
values that are present, and yet changing, in nineteenth-century Britain.
While concerns about excess of alcohol have often been examined, the issue of excessive
tea consumption has rarely been explored. However, in the chapter by Ian Miller, he exam-
ines the issue of tea intoxication from 1860 to 1900. In this period, tea began to be consumed
at all levels of society, including the working class both in Britain and in Ireland. The chapter
explores how tea drinking became viewed as excessive, addictive and intoxicating, especially
for the working class and specifcally working-class mothers. Miller shows how “excessive”
tea drinking was considered a trigger for severe mental illness such as hysteria and concerns
about “excessive tea drinking” ultimately became class- and gender-based. “Working-class
mothers were accused of over-consuming strong concoctions of tea (with white bread) at the
expense of more nutritious food items.” Yet rather than recognizing “excessive tea drinking”
as a symptom of poverty and food insecurity for working-class families, tea drinking be-
comes viewed solely as addictive, transgressive and pathological. The “moral panic” (Cohen
2002) that Miller describes in this period in relation to “excessive tea drinking” can also be
seen in more recent times with other intoxicants, thereby emphasizing the importance of
historical research and discussion.

14
 Introduction

In the fnal chapter, both in this section and in the Handbook, David Clemis introduces
us to the diferent ways in which “chronic intoxicant use” – an extreme form of excess – has
been framed across history. He explores how chronic use, particularly of alcohol, has been
understood throughout history, chronologically considering particular eras as points of im-
pact related to the Western world, including “The ancient West,” “Early Modern Galenism,”
“Seventeenth Century Empiricism and Eighteenth Century Neurology,” “The Nineteenth
Century: Disease and Alcoholism” and “The Twentieth Century: The Meanings of Dis-
ease.” By choosing diferent points of impact, Clemis is able to explore how particular factors
have been instrumental in changing ideas about chronic intoxicant use and highlight how
understandings of the self are both consistent yet varying and contested throughout history.
This chapter reminds us that concepts and understandings of chronic intoxicant use or ad-
diction as the preferred term are not constant, but changing, and rely on broader societal,
cultural and medical understandings of intoxication.

Conclusion
This Handbook, and the chapters within, was crafted over many hours, days, weeks
and months by so many scholars around the world, including the authors and editors
themselves, as well as the 73 reviewers, who provided excellent peer-reviewed support
to assist each contributor to produce their highest quality of work. We, the editors, are
grateful to each contribution made by every person, who put their labor into this Hand-
book. The result, we believe, is a book that explores the contributions of critical studies
of intoxication across disciplines, intoxicants and places. Such critical contributions so
often elude the mainstream literature and yet arguably pave the way for creativity in
knowledge production, innovation in research and practice and challenges to main-
stream approaches in the feld of public health. Using Klein’s label (Chapter 29), it is left
to the “heretics,” those who are willing to dig deeper into innovative theory, methods
and analysis, to challenge the status quo in an efort to shed light on the complexity of
the human experience, the structures that constrain and disenfranchise certain groups of
people, and the role of power and privilege in shaping social and cultural meanings, the
production of knowledge and precedents of policy. We hope that the readers will fnd
our “heretical” accounts as challenging and as stimulating as we do.

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Social Life of Things: Commodities in Cultural Perspective (pp. 3–63). Cambridge: Cambridge Univer-
sity Press.
Bancroft, A. 2009. Drugs, Intoxication and Society. Cambridge: Polity Press.
Becker, H. S. 1967. Becoming a marijuana user. American Journal of Sociology, 59:3235–242.
Boon, M. 2002. The Road of Excess: A History of Writers on Drugs. Cambridge, MA: Harvard University
Press.
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Davenport-Hines, R. 2002. The Pursuit of Oblivion: A Global History of Narcotics. London: Weidenfeld.
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University Press.

16
 PART I

Te Terrain of Intoxication
 1
INTOXICATIONS AND
THEIR MEANINGS1
Craig Reinarman

Intoxication was not born in sin. Animals apparently got high before human civilization
(Siegel 1989; Rudgley 1993; Lenson 1995; Slingerland 2021). Humans fermented grapes and
grain as soon as they figured out settled agriculture, perhaps before. History is strewn with
luminaries who saw great value in periodically “drowning Apollonian reason in Dionysian
abandon” (Lescaze 2021). Drunkenness was a normal pleasure in popular celebrations from
antiquity through the Middle Ages.
And yet, in much of the Western world since the end of the eighteenth century, in-
toxication has carried the presumption of guilt. If something bad happens and alcohol or
other drugs are found in the vicinity, a “malevolence assumption” tends to kick in and a
causal connection gets implied (Hamilton and Collins 1981:261; Gusfield 1996). Blaming
booze, recurring drug scares and drug wars, and a lurking “tyranny of abstinence” ( Jamison
2018:452) are all common in cultures that fear intoxication. The wellsprings and conse-
quences of such fears are vital parts of the puzzle of intoxication’s complex history.
I begin this chapter by making the case that the concept of intoxication is too pinched to
do justice to the multitude of altered states that are typically lumped under it. Intoxications
vary far more widely than we think; some don’t even involve ingesting a toxin at all. I argue
that intoxication is an unstable category with blurred boundaries. I then trace the fluctuating
moral careers of common intoxicants to show how such boundaries have been drawn and re-
drawn. Based on these cases, I outline some tentative propositions about the characteristics
and conditions that inform the cultural and legal status of intoxicants. The chapter closes
with a Coda on the relationship between intoxicants and social change.

A Troubled Category
The idea of “intoxication” is haunted by its genealogy. The root of “intoxication” is the
Greek word “toxon,” for bow, the adjectival form meaning “of or for the bow,” which refers
to the poison in which arrows were dipped during antiquity (as in the Latin “toxicum”).2
The Oxford English Dictionary (OED) defines the noun “intoxication” as “1. the action of poi-
soning; administration of poison; killing by poison; the state of being poisoned.” The verb
“intoxicate” means “to poison.” All variations of the term have poison in the first mean-
ing. I suggest that the denotation of intoxication as a state of being poisoned constricts the

DOI: 10.4324/9780429058141-3 19
 Craig Reinarman

connotations available to us, unnecessarily narrowing the range of meanings of intoxication.

This results in a shortage of names that conceptualize the much more prevalent altered states
of consciousness that fall short of the extreme of poisoning, names that are not made to carry
the baggage of intoxication’s semantic history.
We need a lexicon with a wider aperture so that the phenomena we refer to with the term
intoxication do not imply a false binary, drunk or sober, but rather capture the broad array
of altered states in between. After all, milder varieties of intoxication are a quotidian cultural
practice, with cocktails or cannabis commonly deployed as a means of shifting one’s psychic
gears, signaling the end of the workday and the beginning of leisure time (Walker 2017).
As alcohol was the earliest and most common means of achieving an altered state, the
word “drunk” stood as the initial template for subsequent intoxications, literal and fgurative
(“drunk on power”). In 1981, Levine compiled the rich “vocabulary of drunkenness.” He
reported that Benjamin Franklin found 228 terms for drunk in 1737, and that the Dictionary
of American Slang listed 353 such terms, noting that “the concept having the most slang syn-
onyms is ‘drunk’” (1981:1038). Curiously, most such terms connote the destruction of ordi-
nary consciousness – bombed, blitzed, hammered, shit-faced, wrecked – without implying
there’s anything wrong with that. For most of Western history, the term “drunk” did not
necessarily carry a negative connotation. Early ascetic Protestants helped link drunkenness
to poison by using the term “intoxication” to stigmatize drinking as transgressive. Since
then, the word intoxication has come to cover a multitude of sins.
Marking of the territory of intoxication as a province of meaning is a tricky endeavor; its
boundaries are a good deal more blurry than we usually imagine. Intoxications vary along
numerous continua: in their duration, their intensity, and their degree of transgressivity.
There are distinct types, depths, registers, and shades of altered state, to say nothing of the
diverse meanings attached to these by diferent groups at diferent times. There is a wide
expanse of terrain between a beer after work and an alcoholic blackout, or between “a little
buzz” and “totally wasted.” Intoxications or high states are context-specifc. The same quan-
tum of drink yields diferent behavioral efects at a wake than at a wedding. The experience
of MDMA or ecstasy is diferent at a dance club than during a couple’s romantic evening at
home by the fre.
Other contributors to this handbook ably document culturally specifc repertoires of in-
toxication. Such repertoires become thinkable and articulable within specifc conjunctures
of time/space/culture (MacAndrew and Edgerton 1969; Alasuutari 1992; Withington 2014).
Learning more of their histories will enrich our understanding of the phenomena we refer
to as intoxication. What structural forces and historical exigencies have shaped the systems
of thought and genres of discourse that have produced and reproduced “intoxication” as a
recognizable realm of meaning? For all the ink that has been spilled on intoxication over the
centuries, its topography remains sketchy, perhaps rightly so.
“Intoxication,” then, is a category that invites interrogation. The World Health Organi-
zation defnes it as “a condition that follows the administration of a psychoactive substance
and results in disturbances in consciousness, cognition perception, judgment, afect, or be-
havior” (2020). If we leave aside the pejorative term “disturbances,” the core idea in this
defnition is an altered state of consciousness. But altered compared to what? Compared to ordi-
nary waking consciousness without having ingested a psychoactive drug, the WHO implies.
This defnition has some limitations.
The distinction between altered/not-altered consciousness is most legible at opposite ends
of a continuum. In many places for much of history, ordinary waking consciousness did
not necessarily mean “drug-free.” In parts of medieval Europe, beer-laden porridge was

20
 Intoxications and their meanings

consumed for breakfast. A petition against brandy submitted to the English Parliament in
1673 argued that “all labor[ing] people (the greater part of the Kingdom)” need, deserve, and
indeed benefit from “a pot of ale or a flagon of strong beer,” which they drank “every morn-
ing and evening” (Schivelbusch 1992:159). Contrary to the mythical imagery of abstemious
Puritans, colonial Americans carried rum, hard cider, and whiskey into their fields and
shops for work breaks (Levine 2014) and consumed far more alcohol per capita than modern
Americans (Levine and Reinarman 1991:468). Frederick the Great of Prussia felt that coffee
drinking among his soldiers “must be prevented” because beer was so superior for purposes
of bonding and morale (Slingerland 2021:135). In past centuries, widespread diseases, fevers,
injuries, backaches, and tooth decay routinely put people in pain, in response to which they
invented consciousness-altering potions containing alcohol or opium for pain relief. If a
substantial proportion of the population was in some sort of altered state for a substantial
proportion of the time, then at least moderate varieties of what is called intoxication were
not considered aberrant.
The tobacco industry worked tirelessly to normalize smoking so that it was until recently
considered just part of everyday life. Recall the ash trays that once graced all restaurant tables
and were built into every automobile and airplane seat. By taking a 100 or more drags across
their day, smokers alter their consciousness by mobilizing neurotransmitters to “fine-tune
their arousal and mood state” to fit their situations (Krogh 1991:51). True, smoking tobacco
does not lead to the crazed abandon conventionally associated with the term intoxication,
but this does not change the fact that it is a drug-induced alteration of consciousness – a
difference of degree, not of kind.
The same may be said for the tens of millions who take Prozac and other serotonin-based
anti-depressants. Millions more (mostly Americans) ingest amphetamine-type drugs such as
Ritalin to soothe attention deficit disorders and improve their ability to focus and function.
These practices are considered medical treatment rather than intoxication, but they, too, en-
tail the use of psychoactive drugs to alter consciousness and thus occupy a point on the same
continuum as more extreme and obvious forms of intoxication. So, by asking “altered com-
pared to what?,” I am suggesting that the category of intoxication itself, as well as the com-
parative states of consciousness against which it is defined, are moving targets – v­ ariegated,
permeable, and ultimately unstable.
The word intoxication is misleading in a second sense: there are common varieties of ex-
perience and behavior that bear the marks of intoxication and yet involve no “toxin” at all.
Years ago on a visit to the Van Gogh Museum in Amsterdam, I saw his early masterpiece,
“The Potato Eaters.” Unlike the blazing colors of his more well-known work, this is a dark
portrait of peasants huddled around a small table over a pot of potatoes in their low-ceiling
shack. A few days later, I visited Delft and stopped at the fourteenth-century church in which
the great Golden Age painter Johannes Vermeer is buried. As I sat in a back pew taking it all
in, it occurred to me that medieval ancestors of Van Gogh’s potato eaters could have been
congregants in that church, and I tried to imagine what such people must have felt entering
it for the first time:
The grand tower lofting high above graceful stone arches; sunlight streaming kaleido-
scopically through stained-glass windows, colors cascading across the stone floor. Alter boys
carrying candles in a solemn procession of costumed clergy spraying drops of holy water
onto the bowed heads of the faithful. The air tinged with incense. Reverent silence broken
only by the choir sending hymns and Gregorian chants wafting through the nave and by the
priest’s Latin incantations. Listening to tales from the Bible, kneeling with others to pray, in-
gesting the body and blood of Christ from implements of gold. All of it concocting a majesty

21
 Craig Reinarman

unlike anything else in the peasant world, inducing a state of awe. All their senses mobi-
lized to bring alive the divine, to glimpse God, I’d wager those early potato eaters found
themselves in an altered state, intoxicated by the sights and sounds of the spiritual sublime.
Compared to their lives of trudging labor in turbulent times,3 they needed no drug for it all
to feel positively psychedelic, avant la lettre.4
Moving from the sacred to the profane, consider the pandemonium surrounding the
arrival of The Beatles in the USA in the 1960s. Thousands of teenagers screamed and
jumped in uncontrollable spasms, some to the point of passing out, before a single song
was played. News reports framed this as a worrying new form of mass hysteria, but be-
fore The Beatles, there was similar mania around Elvis Presley and before him among
fans of Frank Sinatra. Neither alcohol nor other drugs were necessary for these altered
states. Subsequent rock concerts famously involved plenty of drug use, but anyone who
has attended a live concert of a favorite band can attest to the contagious eruption of an
altered state of pleasure in being with thousands of others moved by the same music, with
or without intoxicants. 5 When Dizzy Gillespie and Louis Armstrong brought American
jazz to Africa for the first time in the 1950s, audiences were literally ecstatic. When, after
decades in exile and Soviet suppression, Vladimir Horowitz returned to the USSR to
play Rachmaninoff and Tchaikovsky, he was mobbed by admirers. His concerts sold out
in minutes. Hundreds stood in silence squeezed together in the back of the concert hall,
some in tears, overwhelmed to be in the presence of such beauty, such genius. The Cold
War context added an extra measure of meaning, but the intoxicant producing those
altered states was music.
Gambling casinos are designed without windows to ensure their patrons focus on the
flashing lights, the flying dice, the whirring roulette wheels, the quick clicking of the cards,
and the drama of big money won and lost in a blink. Hard-core gamblers describe ups and
downs of adrenaline in a language of addiction that is similar to the accounts of crack cocaine
users (cf. Waldorf et al. 1991:103–126; DeCaria et al. 1998). Commodities markets and stock
exchanges from “Tulipmania” in seventeenth-century Holland to contemporary Wall Street
also flicker with the speculative possibility of fast riches and often produce the same sort of
affective roller coaster of risk, rush, and ruin. Computer games and virtual reality devices
are engineered to maintain their grip on participants with their own genre of attentional
intoxication.
Beyond religious rituals, rock concerts, casinos, whirling Dervishes and other ­d ance-
induced trances,6 there is the frenzied elation found in ordinary sporting spectacles. Amer-
ican and global versions of football have in common tens of thousands of fans screaming in
fevered states of ecstasy (or agony) about moves on the field barely visible from most stadium
seats. Certainly, beer is often involved, but I submit that no drug is necessary for the intense
intoxications sparked by a goal, a touchdown, a 9th-inning home run, a game-winning
3-point basket at the buzzer, or any hard-fought home team victory. And like some other
intoxications, sporting events, too, are occasionally followed by violence.
I offer these examples to suggest that there are many modes of intoxication in which
the “toxin” involved is not a drug ingested but rather one produced internally by the
­a lchemical-cultural interaction of self and situation. If, therefore, it is neither a psychoactive
substance nor the mere fact of altered consciousness that define the meaning province of
intoxication, then what does? If intoxications are so varied and common, and may not even
entail intoxicants, then how is it that the use of certain consciousness-altering chemicals has
come to define what we mean by “intoxication,” and to carry such moral freight? More than
molecules are involved.

22
 Intoxications and their meanings

The Undulating Moral Careers of Intoxicants

As regards drink, I can only say that in Dublin, during the Depression when I was growing up,
drunkenness was not regarded as a social disgrace. To get enough to eat was regarded as an accom-
plishment. To get drunk was a victory.
– Brendan Behan

While intoxication in one form or another has been ubiquitous across time and space, dif-
ferent intoxicants have had distinct moral careers, including some vertiginous shifts in how
they are perceived by various publics and defined by governments. Certain intoxicants have
been feared and punished, others accepted or even esteemed. Most interesting are those that
have moved from one status to the other and sometimes back again, for these make visible
the brushstrokes of their social construction.
Writing of the sixteenth-century Mediterranean world, historian Fernand Braudel found
“lands of wine and vineyards” (1972:236) where wine was understood more as food than
intoxicant and considered an intrinsic part of family meals. He noted that for centuries, wine
had been an essential “provision,” stored in cellars for the winter along with firewood and
grains. “Throughout the Mediterranean the grape harvest was an occasion for merrymak-
ing and license, a time of madness,” he wrote. This form of intoxication entailed “various
abuses” and some authorities tried stern measures to suppress such “pagan customs,” but
Braudel offered no evidence these ever succeeded. “Is there any way of fighting the combi-
nation of summer and new wine, of preventing collective revelry?” (1972:256–259).
Yet, preventing just that sort of revelry was what American anti-alcohol activists set out to
do in the early nineteenth century. Their self-proclaimed temperance crusade was then the
largest and longest social movement in the USA and culminated in national alcohol Prohibi-
tion in 1919. The crusaders blamed booze for a long list of personal and public problems, as if
immediate intoxication and eventual ruin were inevitable consequences of drinking. Trou-
bles associated with drink came to be defined as more threatening in a context of wrenching
social change – the transformation of an agrarian to an industrial market economy, a civil
war over slavery, large-scale immigration, urbanization, and class conflict (Sellers 1991).
Gusfield (1963) described the “status politics” around alcohol in the nineteenth- and early
twentieth-century USA as a battle between native-born, middle-class Protestants, mostly
from small towns, and immigrant, working-class Catholics who lived mostly in cities. On
the surface, it was “dry” vs. “wet,” but the broader question animating the conflict was
which groups would be dominant and whose values would stand as the law of the land.
Tobacco was the largest export in early colonial America, but its spread in England was
initially greeted with royal condemnation. At the start of the seventeenth century, King
James demonized this genre of intoxication as religiously offensive, casting tobacco users as
immoral “fume suckers.” But despite attempts to ban its use, tobacco was vindicated, largely
on financial grounds. The King discovered to his chagrin that his continued reign was de-
pendent on tobacco tax revenues, and the commercial interests whose support he needed
were keen to protect their profits from the European tobacco trade (Best 1979). Modern
tobacco merchants marketed their wares relentlessly, expanding the spaces in which tobacco
could be smoked. By inventing cigarettes and later providing free matchbooks with each
pack, they made smoking easy to do almost anywhere.
But following the 1964 U.S. Surgeon General’s report documenting the deleterious
health effects of smoking, a powerful anti-smoking movement began to reverse the tobacco
industry’s strategy. Anti-smoking activists argued forcefully on public health grounds for

23
 Craig Reinarman

restricting the spheres in which smoking is allowed. They won various partial prohibitions
and huge lawsuits. In the USA and increasingly other Western countries, the movement has
de-normalized and re-stigmatized smoking, cutting its prevalence in half.
The moral career of cannabis provides a contrasting case. Cannabis was consumed and
used as a medicine for centuries in parts of Asia and Africa. In the nineteenth and early twen-
tieth centuries, it was commonly prescribed in medicines in the USA, listed in the Pharmaco-
poeia and the United States Dispensatory (Grinspoon and Bakalar 1997). But in the 1930s it was
condemned as immoral and dangerous by the Bureau of Narcotics. In a report to the League
of Nations, for example, the Bureau’s director, Harry Anslinger, claimed that marijuana had
“toxic effects,” including “willful violence” and “complete loss of judgment and restraint.”
“Cannabis acts quickly and effectively to cut off inhibitions,” which he took as a self-evident
evil. He invoked racist fears, citing unsourced “estimates” that “fifty percent of the violent
crimes committed in districts occupied by Mexicans, Turks, Filipinos, Greeks, Spaniards,
Latin-Americans and Negroes, may be traced to the abuse of marijuana.” Anslinger quoted
a narcotics officer: “Marihuana has a worse effect than heroin. It gives men the lust to kill,
unreasonably, without motive – for the sheer sake of murder itself ” (League of Nations 1934;
cited in Bonnie and Whitebread 1974:146–147).
The result of Anslinger’s moral entrepreneurship was the “Reefer Madness” era in which
the Marijuana Tax Act of 1937 first criminalized cannabis under federal law (Becker 1963).
As marijuana use spread across U.S. college campuses in the 1960s, however, the argument
against it shape-shifted. Earlier claims that marijuana caused crime and violence proved false,
and for users, cutting off inhibitions and loss of restraint was the point. So then anti-drug
forces claimed that marijuana caused an “a-motivational syndrome” that sapped users of
ambition (Himmelstein 1983).
Marijuana remained a potent political symbol, associated with the counterculture and
the anti-war movement and attacked by conservatives for that reason (Baum 2016, 1996).
In 1970, President Nixon signed the Comprehensive Drug Control Act, which classified
marijuana as a Schedule I narcotic, defined as a drug having “no currently accepted medical
use and a high potential for abuse,” neither of which turned out to be true. He soon declared
“drugs” to be “public enemy #1,” formally launching the War on Drugs. Lifetime preva-
lence of cannabis consumption, however, continued to spread from small subcultures like
Beatniks and jazz musicians c. 1950 to nearly half the adult population by 2000 (SAMHSA
2012). But with the rise of the New Right and the election of Reagan in 1980, the War on
Drugs expanded exponentially (Reinarman and Levine 1997:36–46), including the arrest of
millions of Americans for marijuana possession, disproportionately people of color (see, e.g.,
King and Mauer 2005; Levine and Small 2008; Alexander 2010).
This repression, along with growing scientific evidence of the relative safety and medical
utility of cannabis, sparked a growing drug policy reform movement. Between 1996 and
2020, the movement succeeded in getting 36 states to pass medical marijuana laws and 18
states and the District of Columbia to legalize adult use. There is now a burgeoning cannabis
industry in many states, providing tens of thousands of jobs and millions in tax revenues
(Yakowicz 2021). For the first time, the U.S. Congress is considering re-scheduling and
even legalization (Edmondson 2020), moving the USA toward the Netherlands, Portugal,
Switzerland, Uruguay, Canada, and other nations in the moral vindication of cannabis (The
Economist 2021).
Troy Duster describes a “remarkable transformation in the moral interpretation of nar-
cotics usage.” In the late nineteenth century, opiate addiction was roughly eight times more
prevalent than now. The addicted population was predominantly white middle-class women,

24
 Intoxications and their meanings

most remaining unnoticed or considered patients. These included “the most respectable citi-
zens … pillars of middle-class morality.” Opiate use was a matter between patients and their
doctors. As Duster notes, “It was acknowledged in medical journals that a morphine addict
would not be detected as an addict so long as he maintained his supply” (1970:9). But that
supply began to dry up after the Harrison Narcotic Act of 1914, the first federal law against
opiates. As the addict population began to shift, from mostly “respectable” middle-aged,
middle-class women in 1900 to more “disreputable” young, working-class males in 1920,
opiate addiction was reinterpreted. Medical journals wrote of two classes of addicts: “phys-
ical, mental and moral defectives, the tramps, hoboes, idlers, irresponsibles, criminals …
These are the drug fiends” in whom “morphine addiction is a vice.” Others were “good
citizens who have become addicted … innocently,” who were “victims” (Swaine 1918:611,
in Duster 1970:11).
Armed with the Harrison Act, agents from the new Bureau of Narcotics pursued a policy
of criminalization. They prosecuted a series of cases that resulted in Supreme Court deci-
sions interpreting the Harrison Act narrowly, so that “legitimate medical use” could no lon-
ger mean maintaining opiate-dependent patients. They forced the closure of 44 morphine
maintenance clinics and began arresting physicians who prescribed opiates for their patients
(see, e.g., Waldorf et al. 1974). This choked off legal supplies and set up a self-fulfilling
prophecy in which “drug fiends” were pushed into a growing criminal underworld (Duster
1970; Musto 1987). Opiates were criminalized not on the basis of pharmacology or addictive
liability but rather on who was seen as their primary consumers.
At the same time in England, the spread of cocaine use stoked a moral panic on similar
logic. British cultural historian Marek Kohn summarized it this way:

Strongly associated with women – prostitutes, actresses, nightclub dancers, ‘flappers’ –

[cocaine] was at the center of a discourse that used anxiety about delinquent drug use
as a means of articulating deeper fears about the transformations Britain was undergo-
ing; particularly those involving female emancipation, pleasure, morality, and perceived
threats from the outside world, symbolized by drug-dealing ‘men of color.’ The drug
panic was a spasm of reaction, as Britain struggled to come to terms with modernity…
[p]art of a moral sea change, which embraced the pursuit of pleasure for its own sake.

As with alcohol, cannabis, and opiates in the USA, Kohn notes that in England, “cocaine was
damned by the company it kept.” The Dangerous Drugs Act of 1920 was animated by anxi-
eties about “the jazz craze … This, the British apprehensively realized, was the sound of the
new world; chaotic, Dionysian, American, African, and altogether Other” (1999:105–106;
118–119).
Lastly, the class of intoxicants known as psychedelics has had its own checkered career.
Some psychedelic substances like peyote, psilocybin mushrooms, and ayahuasca have been
part of longstanding indigenous rituals in Central and South America (Rudgley 1995). LSD
was discovered in the course of pharmaceutical research and initially thought to have poten-
tial in psychotherapy. The CIA soon explored its potential as a chemical weapon. But LSD,
too, was damned by the company it kept. It was criminalized after being linked to Timothy
Leary, Aldous Huxley, and other counterculture figures who advocated psychedelic intoxi-
cations for pleasure and exploration of the mind (Stevens 1987).
Under official stigma, scientific research on the therapeutic potential of LSD and other
psychedelics ground to a halt for decades, but is now having a renaissance. Giffort (2020)
documents how scientists “performed” their expertise so as to construct “boundaries of

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 Craig Reinarman

credibility” to distance their research on the therapeutic potentials of LSD from the “mes-
sianic” approach of Leary et al. Drug policy reformers pushed for new studies which even-
tually showed what was suspected long ago: psychedelics hold real promise in the treatment
of PTSD, depression, trauma, addiction, and in end-of-life care (Tullis 2021). Scientific
and public opinions are shifting (Pollan 2018). Johns Hopkins University has established
the Center for Psychedelic and Consciousness Research where controlled trials have shown
favorable results. The Netherlands allows the sale of psilocybin mushrooms. In 2020, Wash-
ington, DC, voters passed a law to de-criminalize them and Oregon voters legalized their
medical use (Chang 2020; Smith 2021). Pharmaceutical companies are busy planning.

Controlling Intoxicants: Common Themes

Intoxicants have seen shifts in their moral-legal status under different political, economic,
and cultural conditions. It follows that there is nothing natural or inevitable about the label
attached to an intoxicant at any point, a historical fact that should confer some humility
about drug controls. Beyond this, however, the examples above all have unique features that
make generalization difficult. In each case, such shifts seem to be the result of a contingent
conjuncture of actors, institutions, and contexts, so it seems best to speak a language of like-
lihoods and tendencies. Mark Twain famously quipped that “history doesn’t repeat itself but
it does often rhyme.” Are there at least “rhymes” to be found across the histories of intoxi-
cants, themes that are marbled through these cases?
Let me suggest five recurring themes. First, intoxicants and forms of intoxication are usu-
ally bound up with symbolic and identity interests that shape their uses, effects, and mean-
ings. For example, Alasuutari’s case studies of working-class drinking in Finnish taverns
identify a “cultural grammar” in which drunkenness is a purposively transgressive expres-
sion of desire for personal freedom, beyond all self- or social control (1992:5). Rosenzweig
makes a related case for the centrality of drinking and saloons in creating autonomous spaces
in American working-class culture (1983). The use of cannabis and other illicit drugs was
embraced as a badge of honor among members of the 1960s counterculture, a symbol of re-
sistance to the established order that was central to their identity. That such intoxications had
an oppositional valence is an important part of why defenders of the social order feared and tried
to suppress them, which, in turn, often helped suffuse them with still greater transgressive
value for their adherents.
Second, whether a form of intoxication is seen as problematic is contingent on many
things, not least whose consciousness is being altered and in front of whom. Narratives of
“irresponsibility” and “danger” stick to some groups more easily than others; certain groups
are depicted as prone to drug abuse, others to abstinence. The more disreputable the users
of an intoxicant in terms of class, ethnicity, status, and power, the more likely that form of
intoxication is to be defined as dangerous by the state. Conversely, the higher the status of
the intoxicated – the more cultural capital they have, the greater their ability to conceal or
recover from problematic use and resist stigma – the lower the likelihood that their intoxi-
cation will be deemed dangerous. In some cases, there is a tendency toward reciprocal demon-
ization: an intoxicant is thought dangerous in part because it is associated with a “dangerous
class,” and that class is thought dangerous in part because they ingest a “dangerous drug”
(Himmelstein 1978).
Third, and corollary to the above, altered states or intoxications that help people trans-
gress or loosen the grip of social control are more likely to be feared and defined as deviant
or criminal. Conversely, intoxications that help people adapt to or function more smoothly

26
 Intoxications and their meanings

within the existing social order are less likely to be defined as deviant or criminal. High
states that cut against the dominant cultural grain tend to invite sanctions. Guardians of that
culture worry that under the influence, the structure of social control and social order will
break down, and that intoxicated individuals will slip beyond customary constraints. Slaves
might cast off their chains. Workers could break the bounds of their class position to confront
their “betters.” Youth might rebel against their parents’ world. Sober citizens in the public
square can’t predict what an intoxicated person will say or do, disrupting what Goffman
(1983) called the interaction order. By contrast, chemically managing one’s troubles with
Valium, Prozac, Ritalin, or methadone tends to be supported by organized medicine and
the state.
Fourth, the moral vindication of a stigmatized intoxicant is more likely if there is a con-
stellation of businesses, an “industry,” to claim that the production and distribution of the
intoxicant are legitimate forms of commerce. The histories of alcohol, tobacco, cannabis,
and pharmaceutical drugs suggest that industries that create jobs, profits, and taxes are better
able to mitigate evidence of health harms associated with their products. Industry lobbyists
have always found ways to get their views across to policy makers so as to prevent, forestall,
or weaken laws to eliminate or regulate their products. This seems most obvious with the
tobacco and pharmaceutical industries, but the theme has broader salience. In the Nether-
lands, for example, representatives from the retail cannabis industry are treated like any other
business group and invited to testify in Parliament regarding regulations that affect them.
The same is increasingly true in many states in the USA.
Finally, laws and policies designed to control intoxicants are inextricably part of the ma-
trix of problems associated with their use. Drug laws and policies influence both the social
settings in which intoxicants are ingested and the psychology of those ingesting them (Zin-
berg 1984). These, in turn, bear upon the patterns of use and the behavioral consequences
thought to flow from them. Alcohol prohibition was designed to eliminate drinking but
gave rise to bathtub gin, speakeasies, increased consumption of liquor, organized crime, and
so many other negative consequences that some key prohibitionists soon reversed course and
pushed for its repeal (McGirr 2016). Elimination of legal supplies of opiates after 1914 helped
create the black market and criminal drug subculture.
It is still taken as common sense that certain intoxicants cause crime, disease, and over-
dose deaths, but such claims are partly self-fulfilling. A substantial portion of “drug-related
crime” is caused as much by the dehumanizing “funnel” of narrowing options (Rosenbaum
1981) shaped by prohibition as by addiction per se. The spread of HIV/AIDS and Hepatitis
C among people who inject drugs stems from syringe sharing, which has more to do with
the criminalized context of use than with drugs themselves. Overdose deaths are largely a
function of the lack of potency labeling and quality controls in illicit markets. In short, the
dangers citizens have been led to fear most about illicit intoxicants are as much the predict-
able effects of drug policy as the effects of drugs. In this sense, punishment-based prohibitions
tend to be self-ontologizing; they helped create the conditions under which intoxicant use is
more likely to be problematic, and thus helped create the consequences that appear to con-
firm the need for prohibition.

CODA: Politics and Pleasures

The way we think about intoxicants and intoxication is evolving. Pleasure is a central goal
of intoxicant use and a core reason for its persistence as a cultural practice. But all types of
nation states have found it functional to draw cordons sanitaires around certain intoxicants

27
 Craig Reinarman

(Levine 2003) – as if to say “these forms of pleasure are just too dangerous to our health to
allow.” The case histories summarized above suggest, however, that the cordons keep getting
re-drawn. Such state actions have their own genealogies and logics, but they are always more
than mere governmental responses to health risks (see, e.g., McGirr (2016) on the impor-
tance of state building in the war on alcohol; Frydl (2013) on the influence of foreign policy
in drug wars; and Reinarman and Levine (1997) on the political functions of drug scares).
In his book about state formation in early modern Europe, Philip Gorski argues that the
Protestant Reformation, Calvinism in particular, “unleashed a profound and far-reaching
process of disciplining – a disciplinary revolution – that greatly enhanced the power of early
modern states.” This led to “new mechanisms for the production of social and political or-
der.” He shows how “the technology of observation – self-observation, mutual observation,
hierarchical observation” created an “infrastructure of governance” whose object was the
“control of behavior and the shaping of subjectivity.” This slowly resulted in “a more disci-
plined polity” with “more obedient and industrious subjects” (2003:x–xvi; cf. Elias 1978).
This disciplinary revolution began, however, in what historians call the “early modern”
period (see, e.g., Burke 1978), and therein lies the rub; for modernity has turned out to be
the cultural Big Bang in the universe of pleasure. New modes of discipline and governmen-
tality notwithstanding, across centuries and continents Western modernity valorized plea-
sure seeking, legitimated the pursuit of pleasure as a basic right, and multiplied the means
of pleasure. Colonialism combined with the industrial revolution spread, intensified, and
accelerated this (Schivelbusch 1992; Walker 2017; Courtwright 2019). There have been ups
and downs and tensions, but the general trend has been an erosion of norms against pleasure
and an accumulation of norms allowing and even promoting it. This makes for a rough road
for drug controls.
Historian David Courtwright shows that the trade in sugar, alcohol, opiates, tobacco, co-
caine, cannabis, and other intoxicants that has been so central to modern market economies
has a dark side he calls limbic capitalism:

Limbic capitalism refers to a technologically advanced but socially regressive business

system in which global industries, often with the help of complicit governments and
criminal organizations, encourage excessive consumption and addiction. They do so by
targeting the limbic system, the part of the brain responsible for feeling and for quick
reaction, as distinct from dispassionate thinking. … It was a late development in a long
historical process that saw the accelerating spread of novel pleasures and their twinned
companions of vice and addiction. The pleasures, vices, and addictions most conspicu-
ously associated with limbic capitalism were those of intoxication.
(2019:6)

The mass consumption culture that came into full flower after World War II and the ex-
traordinary economic boom it helped spawn were rooted in the notion that human needs
and wants could and should be met through the consumption of commodities – not saving
and scrimping, making things and making do, as most people had to do during the Great
Depression, but indulging the pleasures of consumption (Ewen 1976). The notion that in-
toxicants could somehow be kept separate from all this seems naïve.
In not much more than a single generation, the USA experienced the repeal of alcohol
prohibition, the end of the Depression, victory in World War II, the invention of televi-
sion, the rise of mass marketing, a pharmaceutical revolution which established the idea
that ingesting a pill could change consciousness and alleviate suffering, and the subsequent

28
 Intoxications and their meanings

spread of recreational drug use. The production and consumption of various pleasures be-
came fundamental to postwar America and beyond. Citizens as workers are still encouraged
to keep their noses to the grindstone and marshal self-control as disciplined neoliberal sub-
jects, but the modern economy has come to depend on citizens as consumers loosening the
grip of ­self-control and seeking pleasure (see Bell 1976; Lenson 1995; Reinarman and Levine
1997:334–344; Alexander 2008).
Alexander (2008) argues that capitalist globalization entails accelerating forms of social
and cultural dislocation – from families of origin, from conventional work roles, from com-
munities, traditions, and life-ways that orient us and give us a stable conception of self. Such
anomie or normative disorientation loosens the bonds that anchor the self and thereby makes
obsessive behaviors more likely and more destructive. Ironically, neoliberal societies then
call for individuals to “take responsibility” for their own actions by means of the self-control
that these same societies tend to undermine (Bell 1976). With rising precarity and cascading
diasporas, Alexander shows, the regulation of the self and its desires has grown increasingly
difficult for an increasing proportion of the population. This puts governments in the dif-
ficult position of constantly having to problematize and police one or another intoxicant.
It seems unlikely that the genies of consciousness alteration can be put back in their bot-
tles. Intoxicants of various types have become technologies of the modern self. More people
now see at least periodic intoxication as normative – not that literally everybody is getting
high all the time but rather that the majority of people have enjoyed doing so and expect
to again in the future, as do many people they know (Parker et al. 1998; Eisenbach-Stangel
et al. 2009;Walker 2017).
These people are no counterculture, no deviant demimonde of beatniks, hippies, junkies or
marginalized others. They are ordinary neighbors, workers, and parents – educated, em-
ployed, engaged citizens. They have the demographic bulk and the social capital to resist
stigma. They are the constituency who have voted repeatedly for drug policy reform, i.e., for
new ways of thinking about intoxicants and intoxication.
In his study of the 1960s counterculture, Bennett Berger observed that while they did
not succeed in a revolutionary sense of upending the existing social order, they did have a
significant impact on Western culture. He noticed a shift in sensibility he called ”conscious-
ness of induced consciousness”: “[O]ne of the basic achievements of the [Sixties] ‘generation’
may be a mind-set aware of the induced character of its own dissatisfied consciousness,” which
left them “ready to reject those inductions for more promising ones deliberately chosen”
(1981:197–210, original emphasis). As Berger knew, earlier strands of this awareness ran
along crooked paths from the Renaissance, the Enlightenment, and the scientific revolution.
But I think he was right that in the half-century since The Sixties, consciousness of the
induced character of human consciousness has seeped from the counterculture out into the
broader culture.
More people are now more aware that there are discoverable reasons why we feel as we
do, that it is possible to feel otherwise, that our present consciousness is but one state of con-
sciousness among many. As consciousness-altering technologies, intoxicants have been and
remain an essential element in this shift in sensibility.

Notes
1 The author gratefully acknowledges the helpful comments of Karen Bassi, Troy Duster, Harry
Levine, Sheigla Murphy, Marsha Rosenbaum, Cathy Soussloff, and anonymous peer reviewers.
All remaining flaws are the author’s doing.

29
 Craig Reinarman

2 I am grateful to Prof. Karen Bassi for this point.

3 Lawrence Weschler (2004:18) observed that the striking thing about Vermeer’s paintings is that
they portrayed an intimate, interior peace in the century when the European world outside was
convulsed in religious and nationalist conflict. It is impossible to know the specific consequences
of religious or spiritual intoxication as we imagine we do in the case of a barroom brawl. But peo-
ple walked out of such churches into a world where bloody religious wars were fought for decades
by people certain they had God on their side.
4 There are, of course, strong religious traditions in our own time in which this sort of altered state is
common. Many church services in African-American communities include music, singing, sway-
ing, the call-and-response and passionate preaching that kindle in participants a joyous altered
state (Gates 2021). And millions have felt a transcendent exhilaration hearing the ­speech-sermons
of Martin Luther King, Jr.
5 My example is positive, but Walter Benjamin (1936) among others called attention to the simi-
lar process by which politics was aestheticized in service of nationalistic war in fascist regimes.
Mussolini and Hitler staged mass rallies in majestic settings designed to create awe and instill the
rousing, empowering feeling of being part of something larger than oneself.
6 The reference is to the 1952 documentary film, “Trance and Dance in Bali,” by Margaret Mead
and Gregory Bateson, depicting Balinese achieving ecstatic altered states by means of dance.

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 2
NIC’D UP
A practice theory approach to understanding
vaping nicotine as intoxication

Ruth Lewis, Emily Kaner and Tamar M.J. Antin

Introduction
Concerns about the popularity of vaping nicotine among young people have garnered much
attention in recent years, particularly within the United States where fears about the long-
term health consequences associated with vaping, as well as concerns about vaping as a po-
tential gateway into smoking, are widespread (Al-Hamdani et al. 2019). In an efort to curb
the appeal of vaping among youth, major public health bodies in the United States, including
the Department of Health and Human Services and the Ofce of the Surgeon General, have
emphasized addiction in their framing of youth vaping as a health and social problem, assert-
ing that “America faces an epidemic of youth e-cigarette use, which threatens to engulf a new generation
in nicotine addiction” (Health and Human Services Secretary, 2018) and “Nicotine is a highly
addictive substance, and many of today’s youth who are using e-cigarettes could become tomorrow’s ciga-
rette smokers” (Ofce of the Surgeon General, 2016). These problem-based framings continue
to defne the mainstream US public health eforts, generating extensive media coverage
yet telling us little about how and why young people might be drawn to vaping in the frst
place. Indeed, amidst the cacophony of voices debating appropriate responses to the so-called
“youth vaping epidemic” (Ofce of the Surgeon General, 2019), the voices and perspectives
of young people who vape have been largely overlooked.
Within the rapidly expanding scientifc literature on vaping among youth, a dominant fo-
cus has been describing patterns in vaping behavior – who vapes, how often, how much, and
so on. Driven by disciplinary concern for understanding the distribution and control of dis-
ease, epidemiological studies often seek to identify risk factors and “propensities” for vaping
among youth at an individual level, often with a view to informing eforts to modify behav-
ior. Yet, while the patterning of vaping behavior across a population is important to estab-
lish, these studies reveal little about how vaping is actually integrated within daily lives, nor
how it has been able to quickly become embedded within youth cultures across the globe.
This gap speaks to broader critiques of public health eforts focused on individual-level
behavior change – eforts argued to have delivered only limited public health gains (Blue
et al., 2016; Meier et al., 2018). As articulated by Meier et al. (2018, p. 207), “the large-
scale household or health surveys that so often underpin our epidemiological and evaluation
research rarely contain data on the location, purpose, paraphernalia, sociality, symbolism,

DOI: 10.4324/9780429058141-4 33
 Ruth Lewis et al.

skills and temporalities” of the practices they purportedly describe, thus producing explana-
tory models that are overly individualized, and potentially limited in their scope to provide
the contextual understandings necessary to efect change.
By contrast, other scholars have argued that practice theories ofer an alternative paradigm
with the capacity to transform eforts to improve public health by shifting focus beyond the
individual as the unit of analysis, instead centering the practices themselves (Blue et al., 2016;
Cohn, 2014; Hennell et al., 2020; Keane et al., 2017; Meier et al., 2018). Rather than view
actions such as vaping as single behaviors, practice approaches instead conceptualize these as
routinized or patterned domains of activities that involve the active integration of three key
elements (Shove et al., 2012):

• Materials – which encompass the objects, technologies, resources, and infrastructures

necessary to engage in the practice.
• Competences – which encompass forms of skill, practical know-how, and technique re-
quired to perform the practice.
• Meanings – which include shared understandings of the social signifcance and symbolic
meanings of the practice.

Within this framework, a focus on the life of a social practice, like vaping, elucidates the
elements involved in the practice, how the practice emerges, exists or dissipates, how it “re-
cruits” practitioners, how it is performed and transformed by those who “carry” it, how it
appears to change over time and by context, and how it interacts with other practices (Shove
et al., 2012). A key premise of practice theories is that emergence, persistence, and change
in practices are explained by the connections between elements being made, sustained, or
broken (Shove et al., 2012). To illustrate this, Blue et al. (2016, p. 42) ofer the example of
smoking: engaging in smoking on a regular basis depends on the integration of materials (e.g.
cigarettes, lighters, tobacco crops, transport systems, and retail infrastructures); competences
(e.g. knowing how to light a cigarette and inhale and understanding social conventions
about how to smoke in diferent social situations); and meanings (e.g. understanding smok-
ing as associated with relaxation, sociability, glamour, masculinity, and so on). As with all
practices, smoking is inherently unstable as these elements change over time: new products
come in the market, necessary forms of competence evolve, meanings shift. Furthermore,
social practices do not exist in isolation, but rather interact with other practices, creating
“bundles” of practices which may be characterized as either in harmony or in confict (Blue
et al., 2016, p. 43). From a practice-informed perspective, declines in smoking can in part
be understood as a result of tobacco control measures which have unraveled the bundling of
smoking with practices such as working, eating, and socializing, by placing them in confict
and thus promoting “defection” from smoking (Keane et al., 2017).
Practice theories have recently been utilized productively in analyses of vaping, including
work by Keane et al. (2017) who argue that approaching vaping as a social practice reveals
“some of the less immediately apparent reasons why vaping has been able to establish itself as
part of the pattern of everyday life for many vapers” (p. 466). In their analysis of written ac-
counts from vapers in Australia, Keane et al. (2017) elucidate how vaping is easily integrated
with other routinized practices, such as driving, watching television and smoking, thus
opening up possibilities for nicotine consumption across space (e.g. where one can do it) and
time (e.g. when one can do it). Similarly, drawing on accounts generated with poly-tobacco
users in the USA, McQuoid et al. (2018) attend to the socio-temporal organization of vaping
compared to the use of cigarettes and smokeless tobacco, emphasizing the “spatial fexibility”

34
 Nic’d up

aforded by vaping. While these rich insights into the integration of practice elements help
explain movement between smoking and vaping among some, elements relating to intoxica-
tion have received less focus within practice-informed analyses of vaping to date.
Intoxication is not generally a lens through which nicotine use is viewed, including within
the feld of drug and alcohol research. In a recent chapter, Keane (2020) argues that this may
be due to the dominance of medical models, which present intoxication as a pathological
state defned by impairment, harm, and loss of control. Building on broader conceptualiza-
tions of intoxication which emphasize the use of substances – both legal and illegal – to in
some way alter consciousness (Bancroft, 2009; Hunt & Frank, 2016), Keane presents a com-
pelling case for a more “expanded and de-pathologised framework of intoxication,” which
can attend to “small and brief shifts in mood and perception” (p. 48), and where “altered
states of consciousness are not necessarily disruptive and dramatic” (p. 61), or discernible to
others. From this view, the “mild and transient pleasures” experienced when people ingest
nicotine – be that through smoking, vaping, or otherwise – can be encompassed within these
broader understandings of intoxication.
Inspired by early work of Becker (1953), studies of intoxication have elucidated the social
processes by which users of a substance learn to give meaning to the intoxicating efects
of their substance of choice (Bancroft, 2009). In “In Becoming a Marijuana User,” Becker
emphasized that individuals’ desire to use marijuana is not because of some psychological
predisposition, but rather “is the result of a sequence of social experiences during which the
person acquires a conception of the meaning of the behavior, and perceptions and judge-
ments of objects and situations, all of which make the activity possible and desirable” and
“lead to the use of marijuana for pleasure” (p. 235). Here, Becker highlights how identifying
processes that are essentially made up of elements of a social practice – that is, the materials,
competences, and meanings – leads to an understanding of why marijuana is a desirable
form of intoxication for some. Though vaping has not generally been analyzed from a lens
of intoxication, with some exceptions (e.g. see Keane, 2020), taking such an approach can
highlight how young people who vape learn to desire and experience (or reject and refuse)
the pleasurable efects of vaping nicotine, ascribe meaning to the experience of consuming
nicotine without combusted tobacco, navigate the boundaries of nicotine intoxication, and
derive pleasure from mastering the skills associated with vaping. Research directed toward
elucidating the pleasures of intoxication is generally considered taboo in health-related re-
search (Hunt & Evans, 2008; Hunt et al., 2007; Moore & Valverde, 2000) – it is “the great
unmentionable,” in Moore and Valverde’s terms. Yet, pleasure is arguably a crucially im-
portant part of the process that makes drug use desirable in the frst place (Reith, 2005). As
such, public health eforts that fail to understand how youth learn to desire and negotiate the
intoxicating efects of nicotine and instead fall back on conventional frames of addiction will
ultimately result in poorly designed prevention programs and interventions that are incon-
gruent with the experiences of young people who vape.

A tale of two studies

Below, we present a practice-focused analysis that brings together empirical accounts of va-
ping from two studies conducted in 2016 and 2017 with young people who vaped nicotine.
Both studies were based in urban areas in Northern California – Study 1 involved in-depth
interviews with 49 young people aged 15–25 in the San Francisco Bay Area, and Study 2
involved seven small group discussions with 26 young people aged 18–24 in a mid-sized
city in San Joaquin county. Methodological details of each study are provided more fully

35
 Ruth Lewis et al.

elsewhere (Antin, Hess, et al., 2019; Antin, Hunt, et al., 2019; Lewis, in preparation). Here,
we draw attention to a key feature of the samples of young people we spoke to: across both
studies, participants were predominantly smoking-experienced, with the majority (59 out of 75)
noting that they had smoked cigarettes prior to ever trying vaping (see Table 2.1). We high-
light this shared characteristic of our samples to emphasize that these included very few of
the “never-smoking” youth that have become centered within acrimonious debate about
whether vaping represents a potential gateway to youth smoking (Levy et al., 2019). Rather,
these were mainly current or formerly smoking youth who described being drawn to vaping
as a strategy to help them reduce or stop their cigarette smoking. This common pathway
from smoking to vaping among participants in Study 1 is described more fully elsewhere
(Antin, Hess, et al., 2019). Given the intensifying social gradient in smoking, it is perhaps
unsurprising that many of the youth in our studies were economically disadvantaged.
The landscape of vaping developed rapidly over the course of the 2016–2017 feldwork
period, in terms of both devices available in the market and their regulation. Both studies
were conducted at a time prior to the proliferation on the market of pod-based vaping sys-
tems, such as Juul – the so-called “fourth-generation” of vaping devices. Rather, young peo-
ple in our studies were using second- and third-generation devices, respectively, vape pens
and tank-based systems (sometimes referred to as “mods” due to their amenability to mod-
ifcation). A further shared feature of the context within which these data were generated
was that this was during a period of intensifying nicotine denormalization, including the
introduction of the Tobacco 21 law in June 2016, which increased the minimum age for sale
of both e-cigarettes and cigarettes to 21. Shortly before the studies commenced, billboards
appeared across California picturing a young woman surrounded by vapor from a pen-style
e-cigarette, with the tagline: “It’s the next generation cigarette, for the next generation of addicts.”
This anti-vaping campaign ad – one of a series funded by the Californian Department of Pub-
lic Health in 2015 – refected the evolution of public health messaging within a long-stand-
ing tobacco control program explicitly aiming to reduce the social acceptability of tobacco
and nicotine use. Through focus on the integration between elements – material products,
regulatory environments, forms of knowledge, social meanings, and so on – practice theories
ofer the ability to consider how practices change as these diferent elements evolve and are
reconfgured. Our aim for this chapter has been to work across data from these two studies,
paying particularly close attention to accounts of vaping as an intoxicating practice at a key
point in the history of vaping (i.e. the immediate pre-Juul era).
Informed by an understanding of practices as dependent on the integration of materials,
competences, and meanings (Shove et al., 2012), we used these three elements as a concep-
tual framework against which we mapped our data. We worked in parallel at frst, con-
ducting an independent thematic analysis of each dataset (Bernard & Ryan, 2010), and then
integrated data from the two studies to identify shared practice elements and key diferences.

Table 2.1 Pathways of nicotine product use among participants in

each study

Nicotine pathway Study 1 Study 2 Total

Smoking before vaping 36 23 59

Vaping before smoking 8 0 8
Vaping only (never smoked) 5 3 8
Total 49 26 75

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 Nic’d up

An overview of key practice elements is provided in Table 2.2. Across the two studies, prac-
tice elements evident within young adults’ talk about vaping nicotine were strikingly simi-
lar, indicating shared meanings that transcended the specifc localities in which participants
lived. The rare cases where an element only featured in accounts within one or other study
are indicated in the table.
As Table 2.2 demonstrates, an overarching feature of young people’s talk across studies
was an understanding that the practice of vaping is intimately tied to the practice of smoking
– young people made sense of vaping devices in relation to cigarettes, they talked about the
forms of knowledge and skill required to vape in relation to those required for smoking, and
the meanings attributed to vaping were very often relationally produced through under-
standings of smoking. In the context of this handbook’s focus on intoxication, we turn our
attention now to the practice elements within participants’ narratives which are most salient
to thinking about vaping nicotine as a form of intoxication.

Intoxicating elements of vaping nicotine as practice

Analysis of the practice elements associated with vaping nicotine that emerged from partic-
ipants in our studies highlights the ways in which vaping nicotine is understood by these
young adults as an intoxicating social practice. In particular, we emphasize three themes
cutting across young adults’ accounts of vaping nicotine in both studies: vaping as functional
intoxication; controlling and calibrating intoxication; and forging social connection and
community through intoxication.

It’s not like a real high? Functional intoxication to cope with the everyday
Intoxication – simply conceptualized as the use of substances to change the mind – was a
widespread goal of vaping nicotine across both studies. Indeed, getting a “nicotine fx” and
achieving “a head change” (also sometimes referred to as getting “nic’d up”) was widely con-
structed as the “point” of vaping. Yet, these head changes were not understood as a “high”
in the same way as the efects of other psychoactive substances, such as alcohol, marijuana, or
ecstasy – a distinction expressed explicitly by some, for example:

…it’s not like a real high. But it does give you a little bit of a head rush, and so that was
cool. But it’s not like a drug. It doesn’t feel like a drug when you do it, because it has –
because you still feel sober. You just feel kind of lightheaded and sober (laughs). So it’s
kind of nice. It’s not like psychedelics or anything.
(Interview with 17-year-old woman)

Here, we see a playing out of the complexities of defning what it means to be intoxicated,
and which substances are considered to “count” as “drugs.” Despite describing a stimulant
efect (e.g. a head rush and lightheadedness), this young woman conveys an understanding
that nicotine is not a drug because – in her view – “you still feel sober.” Yet, although not ex-
pected to provide a “high,” vaping nicotine was nevertheless constructed as serving a variety
of mind-altering functions: to calm the mind, relax, take a break, focus, concentrate, let go,
and so on. Collectively, then, vaping nicotine was articulated as a useful practice to transform
the everyday, resonating with Bancroft’s (2009) concept of “functional intoxication,” where
intoxication becomes fundamentally about using substances to “change the self in the world,
to alter, manage and enhance an individual’s efcacy in the social world” (p. 147). Although

37
 Table 2.2 Practice elements identifed within young adults’ accounts of vaping nicotine via second- and third-generation devices (i.e. pre-pod-based systems) in
California in 2016–2017

MATERIALS COMPETENCES MEANINGS

(e.g. objects, resources, and infrastructures) (e.g. practical know-how and skills) (e.g. shared symbolic understandings)

Vaping devices and juices Achieving desired level of intoxication Relief from Everyday Stress
• set-ups (starter kits vs sophisticated) • knowing how to achieve desired efects from • vaping to reduce and manage stress and
• “authentics” vs generics/clones/fakes vaping (e.g. “a head change,” “nicotine f x,” and anxiety
• product range constantly evolving and expanding “nicotine buzz”) • “time out” and momentary escapism from
• personalization/customization • controlling nicotine levels to avoid getting “nic “real life”
• fragility of devices / easily breakable sick” • enduring signifcance of inhalation and
• sharable (mods, juices) • vaping to moderate efects of other substances exhalation (as stress-relieving, pleasurable)
• portable (e.g. marijuana)
Social Connection & Community
• easily concealable
Learning and displaying technical know-how, e.g. • forging new connection with others
• no lighter, trash or ash+
• using, modifying and f xing devices (e.g. • delineating in- and out-groups
• no lasting bad smell
knowing which buttons to press and how to ref ll • heightening sociability
• variable settings enable diferent experiences (e.g.
juice, f x coils) • vape culture as a supportive community
size of clouds)
• about juice (e.g. understanding PG/VG ratios, • sense of localism in vape culture (vs Big
• variable nicotine levels (vs f xed in cigarettes)

38
how to preserve f avor, and maximize clouds) Tobacco as global)
• less satisfying throat hit than cigarettes
• setting and regulating nicotine levels
• juices (“premium” seen as “safer”) Reducing Harm
Ruth Lewis et al.

• performing and mastering “tricks”

• vaping as “healthier” alternative to smoking
Vapor: a material facilitating the performative and • graduating to “higher end” devices
• easier to control than smoking
sociable aspects of vaping (e.g. vape clouds) • identifying “authentic” vs “fake” devices
• “life changing” in stopping/reducing
• recognizing nicotine levels on someone else’s
Cigarettes: a material intimately tied to the initiation smoking
device (e.g. knowing what a “6” feels like)
and practice of vaping via aesthetic and sensory • substitute to smoking vs supplementary
• charging and storing equipment safely*
similarities and diferences to vaping devices, and • reducing smoking harm by vaping as
a necessary comparative object to describe practice Navigating vape shop environments precarious practice that is easily disrupted
elements (materials, competences and meanings) of • as sites to experiment (e.g. with new f avors, (e.g. if device is lost or broken, costs
vaping nicotine levels, and set-ups), get help with f xing increase, and regulations change)
equipment, and build knowledge about vaping
Money
and harm reduction
• Vaping as expensive, especially start-up costs –
• demonstrating legitimate levels of knowledge to
costs sometimes shared with others
be seen as “worthy” of more sophisticated set-ups
• Can earn money for vaping if sponsored*
• involves navigating male-dominated “macho/
bro” culture to get help (women’s accounts)*
• getting “in” with vape shop workers to get discounts
 Electricity: Need to charge devices Engaging with health-related evidence, e.g. “Diferently Stigmatised” to smoking
Time: Required to invest in f xing equipment • recognizing evidence environment on vaping and [McQuoid et al., 2018]
health as contested • situational stigma (i.e. in some contexts, by
Commercial environments
• critiquing anti-vaping discourse (e.g. due to lack some people)
• “brick and mortar” vape shops as local sites that
of long-term evidence on harms of vaping and • acceptability of men vaping as less
facilitate building of social and cultural capital for
glossing over of reduced relative risk to smoking) contested than acceptability of women
vaping
• knowing how to integrate vaping to minimize vaping
• online shops and advertising
risk and promote smoking cessation (or at least
• possibilities of sponsorship* “Spatially Flexible” [McQuoid et al., 2018]
smoking reduction)
• vaping community events (e.g. mixers and • vaping easily bundled with other solitary
• dif usion of tobacco harm reduction practice
conferences) and group-based practices (e.g. walking,
between smoking peers (e.g. encouraging switch
driving, studying, hanging out, and playing
Regulatory environments to vaping, sharing links to online information,
videogames)
• (dis)parity between bans on vaping and smoking loaning equipment to try, and accompanying to
(e.g. university campuses and hospitality venues) vape stores) “Hardcore vapers” vs “just a hobby”
• regulations on advertising vaping products • variable salience of vaping to self-identity,
Demonstrating social responsibility
• state laws (e.g. Tobacco 21 laws) ranging from vaping as a core way to
• by minimizing others exposure to second-hand

39
• state taxation on e-cigarettes vs cigarettes perform identities among “hardcore
smoke (vs smoking)
Nic’d up

vapers,” to an activity articulated as

Digital environments, e.g. social media platforms as a • understanding and adhering to “common sense”
peripheral to self-identity
resource and infrastructure that facilitates: codes of conduct (e.g. not vaping in restaurants
• advertising of products and practice and around children)
• information sharing (e.g. videos of tricks and how • distancing self from “vaping others” who are
to f x device) irresponsible
• mobilization of vaping-related activism (e.g. about • privileging other people’s comfort over vaper’s
upcoming changes in regulation)* desire to vape
Avoiding vaping-related stigma, e.g.
• not posting about vaping on public social media
• not telling certain friends about vaping practice
• not vaping in certain places
• concealing vaping equipment from disapprovers
+
Indicates only discussed within young adults’ accounts within San Francisco Bay Area study.
* Indicates only discussed within young adults’ accounts within San Joaquin County study.
 Ruth Lewis et al.

Bancroft’s analysis focused on pharmaceutical drugs, the notion of functional intoxication

is useful for illustrating the meanings of vaping-as-intoxication among participants in our
studies. In particular, his articulation of “dispassionate drugs” used to “moderate the self into
the rhythms of modern life and to blunt the edge of stresses and strains caused by its con-
ficting demands on the individual” (ibid) resonates strongly with young people’s accounts
of vaping nicotine to cope with the everyday demands of regular life.
Coping with stress was a prominent theme across our studies, with many young people
describing their daily lives as stressful. In both studies, the majority of participants were
growing up in social contexts characterized by multiple community-level stressors, includ-
ing high levels of incarceration, poverty, violence, and substance use. Stresses relating to
pressures within education settings were also commonly expressed by the young people
we spoke to – both within interpersonal interactions (e.g. with other students, or teachers)
and also arising from the intensity of educational cultures focused on attainment. In these
contexts, vaping was commonly articulated as providing momentary relief; for example,
one young man recounted how vaping during break-time enabled him to get through the
school day:

And before like second blah [class period], I’d just chief on [inhale] like someone’s e-cig in
the stall. So I’d (laughs) get out, like wow, I feel really good for this next class. So yeah,
that’s why I used it back then. Because you know, you’re in school for eight hours a day,
and dealing with fuckin’ bullshit. So that would be my instant stress reliever. It would
be like kids, yeah let’s go to the bathroom.
(Interview with 19-year-old man)

Others talked about turning to vaping to cope with more generalized forms of stress, and
often as part of a concerted efort to not smoke, such as this young woman:

…Stress that I feel like I can’t control because it’s dependent upon another person, or an-
other situation that is larger than what I have in my control. […] Because if I can’t con-
trol it, I shouldn’t stress about it. But sometimes, that just makes me really tense. Because
while I know that I can’t control it, I still desire to have answers, or to be able to control
it. And I know that’s one thing that makes me want the enjoyment that comes from
smoking. I know, at least temporarily relieves that feeling, at least that’s what I associate
it with. But since I don’t like, or I really, really try hard not to smoke regular cigarettes,
when I have my e-cigarette around, that’s what I’ll go to over it, if that makes sense.
(Interview with 24-year-old woman)

Smoking cigarettes to cope with stress is a long-documented strategy; for example, Graham
(1993) documented how mothers describe cigarette breaks as both a symbolic and literal
“time out” from the mundane realities of caring for young children, which enabled them to
re-establish their capacity to cope. As seen above, a sense of vaping providing a temporary
“time out” from daily stress was also clearly refected in young people’s accounts. Yet, a
point of contrast between vaping and smoking articulated by young people is the ability to
customize the stress-relieving experience (i.e. via choice of nicotine level in juice), depending
on self-assessed stress levels:

MAN 1: I just think it’s dependent on the day, like what kind of day you’re having. Some-
times when I have more of a stressful day, I need something that’s higher nicotine to

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 Nic’d up

calm me down and relax me. If it’s a regular day I might go for lower ones [i.e. lower
nicotine content juices], so I can inhale more without feeling a nicotine head change. […]
MAN 2: It’s defnitely more customizable too... Which is one of the reasons why I started to,
yeah. I can control how much I inhale, or what I inhale […] how much I want to taste
the juice, or how much I just want to chug a cloud.
(Small group discussion)

While the stress relief of vaping was partially constructed as caused by the amount of nico-
tine consumed, the modality of consumption also mattered to some, with the afordances of
inhaling nicotine without combusted tobacco enabling a diferent sensory experience to that
of smoking. Indeed, the afective experiences of both inhalation and exhalation were con-
structed by some as key to the process of calming the mind, with accounts calling to mind
the notion of “fow,” where attention is paid to being in the moment. Among those who
vaped to reduce or quit smoking, noticing and giving meaning to these contrasting afective
experiences involved balancing the common complaint of vaping’s diminished “throat hit”
and “lung feel” against the pleasures of exhaling a greater quantity of vapor and capitalizing
on its pliability. For example, one young woman identifed the soothing efect derived from
vapor as underpinning her success switching from smoking to vaping for health reasons:

…it also was kind of fun to try and do diferent tricks. Because with a cigarette, you
(laughs) really can’t do that. You get one puf in your mouth, and it’s like you either
swallow it, or just right back out. You can’t really keep that in your mouth. It tastes ter-
rible and it’s also like the amount of smoke that you get is just, is not enough to do any-
thing fun with. But with e-cigarettes, I liked it because with other types of techniques
of quitting, it’s not really as intense. And it also doesn’t really satisfy you in the same way.
But with an e-cigarette, you still kind of feel – for me, the reason that I’ve kept smoking
so long is because I have really bad anxiety and depression. And so, to have that little
thing that you can hold in your mouth and kind of pay attention to with, it’s almost like
a tick kind of. It’s more of the motion itself […].
(Interview with 18-year-old woman)

Controlling and calibrating nicotine intoxication

Concepts of control and calibration consistently arise across cultures as themes within ac-
counts of intoxication (Bancroft, 2009; Fry, 2011; Hunt & Frank, 2016; Measham, 2004;
Measham et al., 2016). Evidence suggests that characterizations of control are contested
among people with experience of both vaping and smoking; some studies have found that
vaping is commonly understood by smokers as a way to control and reduce nicotine con-
sumption (Keane et al., 2017; McQuoid et al., 2018), whereas others document a construc-
tion among some smokers of vaping as less controllable and more addictive than smoking
(Lucherini et al., 2017). Our participants – mostly either current or former smokers –
commonly articulated a sense of greater control over the frequency and extent of nicotine
consumption when they contrasted vaping to smoking:

I have more control of my smoking habits […] Because with vaping, I don’t have like a
pack to myself. If I have a pack, then it’s kind of an infuence. Like oh, I have this much
of a pack. I have to fnish it, right? [...] And with vaping, I feel a little more healthier.
I don’t feel groggy. I don’t smell bad. My tongue or my throat doesn’t taste bad [...]

41
 Ruth Lewis et al.

because … when you smoke a cigarette, sort of like you have to fnish it. Once you light
it up, you have to fnish it and throw it away. With vape, you can just like one or two,
and okay, I’ll put it down.
(Interview with 22-year-old man)

I prefer to smoke a regular cigarette […] I like the taste better. I like the buzz better. I
enjoy it better. But there also becomes a time when all the other things, I guess stress
me out about cigarettes in general. And while I don’t feel like e-cigarettes are healthy, I
do feel that they are marginally less harmful […] like it’s easier to not chain smoke, yeah
[…] I think I always end up smoking more, when I have an actual cigarette. So, having
the e-cigarette and being able to just take like a quick puf.
(Interview with 24-year-old woman)

The temporalities of control over vaping compared to smoking are imbued within these
accounts in more than one sense. First, there is the notion that it is easier to control one’s
nicotine intake in the moment as the compulsion to fnish an entire cigarette is removed. Sec-
ond, as vaping was widely constructed as less harmful to health than smoking, there is a sense
of taking control over one’s health, thus protecting future time. Indeed, some young people
emphatically described experiencing the stress relief of ingesting nicotine without smoking
a cigarette as “life changing” and a “game changer.” For those seeking to either quit or re-
duce their smoking, noticing and giving meaning to the embodied experience of consuming
nicotine without tobacco appear to be an important cognitive step supporting a shift between
these practices. Yet, as illustrated above, this plays out diferently between individuals. While
the young man in the frst extract actively values the absence of certain sensory experiences
from smoking (e.g. feeling groggy, smelling bad, and tasting bad), the young woman in the
second extract indicates that she has to balance the immediacy of pleasure derived from these
sensations (e.g. better taste and better buzz) against her desire to reduce harm to her health.
In addition to controlling the mode and frequency of nicotine consumption, a further
manifestation of control relates to decisions about how intoxicated to get, and attempts to
moderate intake of a substance accordingly. Within our studies, achieving a head change
from vaping nicotine was usually desired, but the threshold between being “nic’d up” and
“nic’d out” was important:

MAN 1: After a good meal you get that nicotine buzz, man. It feels hella [i.e. very] good. It’s
almost as similar as smoking a cigarette, but to me I feel that if you’re rocking 6s [i.e.
using juice with 6mg nicotine content], I feel like it’s more than a pack of cigarettes. The nic-
otine buzz from a 6 compared to a regular cigarette is intensifed by 3. A 6 can get you
like, “Oh I gotta go to sleep. I feel hella heavy in my legs.” A cigarette, I don’t know, it
doesn’t feel as heavy as a 6 to me.
MAN 2: That’s where the term nic’d out comes from. If you’ve vaped so much you’ll get nic’d
out, and it’s kind of just like, “Yo dude I’m nic’d out, take this vape out of my hands.”

(Small group discussion)

Identifying and managing this boundary between being nic’d up and nic’d out is one ex-
ample of integration between material and symbolic elements of vaping as a social prac-
tice. Knowing how to avoid getting nic’d out (also sometimes referred to as “nic sick”) is
an important skill – or competence – that requires knowledge about the efects of diferent

42
 Nic’d up

nicotine levels, asking others about nicotine levels in their juice when sharing devices, and
learning to recognize what diferent levels of nicotine feel like when vaped; as one young
man commented: “with the mod when you take a hit from the vape it, like, hits you, like a ton of
bricks so you, obviously you can’t do 24 milligrams. It’s usually, I run about like six to three milligrams
now” (small group discussion). Among those with prior smoking experience, the need to
develop these new forms of practical know-how, and their articulation as forms of control
relative to smoking is tied up with the material reality of vaping devices which allow users
to regulate the number of pufs, as compared to the constant burn of a cigarette containing
a pre-determined amount of nicotine (although of course, smokers retain a degree of choice
over how many drags they take from a cigarette, and at what point they stub it out).
Finally, in addition to controlling intake of nicotine-via-vape, young people also talked
about using vaping to moderate the intensity of intoxication from other substances, particu-
larly marijuana. Vaping was commonly described as a way to be able to maintain a repetitive
hand-to-mouth action and inhale something, without getting too high from continuous joint
smoking or bong hits. For example, this young woman described how integral vaping is to
moderating her intake of not only marijuana, but also cigarettes:

WOMAN 1: I just really like the feeling (laughs), like, the activity-
WOMAN 2: Like inhaling.
WOMAN 1: -yeah. The ritual of smoking.
WOMAN 2: Yeah.
WOMAN 1: Um, but it’s not like I could just sit and smoke weed (laughs) for like an hour
WOMAN 2: Yeah.
WOMAN 1: The next thing you get, like, kind of high, and then you just vape after…
INTERVIEWER: Oh okay.
WOMAN 1: That’s what I do.
INTERVIEWER: So you can continue doing the action?
WOMAN 1: Mm-hmm (afrmative). Because it’s, like, soothing to me. Which is... I hate that,
because it’s so bad for you. I feel like even though I don’t even like cigarettes anymore, I
feel like nor do I like the taste of it, nor does it really afect me, um, unless, like, it’s, like,
a really strong tobacco or something. I think I’m mostly... I’m not gonna say addicted,
but I do crave mostly, just, like, the action of smoking.
WOMAN 2: Yeah.
WOMAN 1: That’s, like, what I’m more used to, and it just... Even though it’s not- it’s like a
placebo efect. It calms me down.

(Small group discussion)

Here, we see another clear example of youth using vaping as a way to reduce tobacco-
related harm. The desire to experience the pleasures of the hand-to-mouth action of ciga-
rette smoking is balanced against an understanding of its efects (“it’s so bad for you”), with a
choice then made to satisfy this craving via vaping. Interestingly, this young woman locates
the calming efect of vaping not in the nicotine itself, but rather in the ritual.

More than “just” a nicotine fx? Building connection and navigating community
Intoxicants have long been recognized as operating as a “medium of sociability” (Hunt &
Frank, 2016; Partanen, 1991), and our participants’ accounts indicate that vaping nicotine is

43
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no exception. Young people conveyed how vaping opened up possibilities for sociability, by
ofering a tool through which to both strengthen connection with known others and forge
interaction with unknown others, as this young man explained:

If you’re standing outside vaping, I might walk up to you and say “Hi”, and just talk to
you because you’re vaping. You’re a fellow vaper. I don’t really care why you’re vaping,
you know. But in my eyes, you’re vaping so you’re a vaper. That’s all. There’s no cool
card you have to have, or and you don’t have to be using a certain expensive mech mod
or anything, or mod or anything. Just vaping, and not smoking (laughs) […] it’s just
like vaping isn’t as big as smoking. So when you see someone else that’s vaping, you’re
like ‘hey, you vape? I vape’, you know, like ‘hey, we both vape. That’s cool, man’. And
sometimes, like my mod might be diferent than someone else’s, and you just want, out
of curiosity, ‘what do you got in there? You build it yourself? How many wraps you got
in there? What’s your build look like?’ Because people have these builds that are like,
it’s literally art. The way they wrap these things and wrap it around each other […] So
it’s kind of cool, just to see people’s diferent styles. It’s like art or music, and you’re just
like, oh cool. Just appreciative.
(Interview with 24-year-old man)

In this extract, we grasp a sense by which vaping can diminish perceived social distance
between otherwise strangers by instantly delineating an in- and out-group boundary. Due
to the increasingly deviant status of smoking within mainstream Californian culture, seeing
other people who vape may (at least at the time of our feldwork in 2016–2017) signify a
person’s valuing of health; as another young man expressed, switching from smoking to va-
ping is “a sign that you want to look after yourself ” (small group discussion). For the young man
above, partaking in the practice of vaping automatically defnes someone as a “vaper” – an
identity that (in his view) stands separate from, and in positive contrast to, that of a smoker.
On that basis, conversation with a stranger becomes possible; sharing in this practice indi-
cates a sense that they will have things to talk about – as one young woman summarized,
“it’s a conversation starter, like, it’s something that a lot of guys can relate to with each other” (small
group discussion). As in the account above, these interactions are further facilitated by the
customization of vaping devices, which provide a way to express oneself, and demonstrate
appreciation for others. Characterization of vaping as a medium for sociability was echoed by
this dual user of cigarettes and vape devices, who also contrasted vaping with a construction
of smoking as less socially satisfying:

Say if you smoke a cigarette, you can see people just standing there. Pretty much what
they get from smoking cigarettes is the nicotine, which is a biological satisfaction. But
say if you vape, the amount of vapor it produces is also a little fun thing to do. That
you can do a lot of things with that vapor. Say people do tricks […] So that’s one
thing, pretty much just switching the focus from just getting that nicotine satisfaction
to something else that you can actually practice. That you can actually um, show of,
in front of other people. It’s like something that is fun to do. Not just because, oh, you
feel like nervous or something and you just want to smoke a cigarette to relax a little bit.
There’s something more about it than that […] it’s still kind of a new thing. So, when
you have a bunch of people doing it at the same time it’s like uh, a kind of an icebreaker
to start a conversation.
(Small group discussion)

44
 Nic’d up

This account of vaping as going beyond “just” experiencing the intoxicating efects of nico-
tine is underpinned by a feature commonly commented on across both studies: the possibil-
ity of using vapor to do “tricks.” Although disparaged by some who instead emphasized their
use of vaping for smoking cessation, nevertheless, “tricks” appear to be a fundamental aspect
of the sociability of vaping culture for some youth, as also described elsewhere (Cooper et al.,
2016; Hilton et al., 2016; Measham et al., 2016). By capitalizing on the material features of
vape devices (e.g. “softer” vapor and customizable voltage), practitioners are able to develop
and display a repertoire of tricks that can, at least within certain venues and groups, create
points of connection and camaraderie. For example, when asked to elaborate on how vaping
helped to get closer to friends, one young man said:

Oh yeah, like I said, the whole community, just like with the smoke, it’s like when
you smoke a cigarette, there’s not too much. Or in a way, it’s so powerful that you
just want to get it out of your lungs as fast as possible. Like you’ll smoke it and go
(makes sound), and just spit it out. But with a vape, it can be diferent, because you
can turn it down a notch and make it softer, so it’s something you can hold in for a
while, such as even a whole minute. And then, you can control when to spew it out,
and like doing tricks. So that could be cool with your friends, because you could do
a competition in a way. And then you’d get a little competitive with each other […]
like you can make a smoke jellyfsh […] Or even if they get super skilled at it, they
can make a little caterpillar. So that was always fun to have a competition like that.
It’s like another type of partying.
(Interview with 18-year-old man)

An ethos of exchange and reciprocity is recognized as a key element which can socially ease
interactions between individuals within cultures of intoxication (Bancroft, 2009; Douglas
& Isherwood, 1996; Heath, 2000; McQuoid et al., 2018). However, manifestations of these
values vary not only by intoxicant, but also modality. McQuoid et al. (2018) argue that cig-
arettes and related paraphernalia (such as lighters and rolling papers) are “discrete units that
can be more easily ofered and received between strangers or acquaintances” compared to
vape devices. Across our studies, accounts suggested that the acceptability of sharing vape
devices was certainly contested; while some young people described vape pens and mods
being routinely passed around multiple people at social gatherings, others expressed con-
cerns about hygiene, noting that they would not personally use someone else’s device. In
lieu of ubiquitous norms governing sharing of these material artifacts, the sharing of practical
know-how appeared to be the major medium of exchange between people who vape, includ-
ing knowledge about how to use devices, perform tricks, fx and modify equipment, make
homegrown e-juices, and so on. The very need for these exchanges of information was
tied up with the material complexities of vaping technologies. In contrast to combustible
cigarettes, where the innovations perceivable to smokers are few and far between, the rapid
evolution of vape devices and a dizzying array of favored juices enables a seemingly “cease-
less consumption of novelty” (see also Campbell, 1989, cited in Hunt and Frank, 2016). As
argued by Keane et al. (2017, p. 473), vaping thus becomes “a site for the exercise of discern-
ment, in which choosing becomes an expression of individual taste and distinction.” The
ability to exercise choice over juice and device, and to then customize “builds” appears – at
least for some – to be key to “why vaping ‘works’ as a practice” (ibid). Ironically, however,
the complexity of second- and third-generation devices was of-putting for some, presenting
risks for the long-term integration of the practice as a way to stop smoking:

45
 Ruth Lewis et al.

Like vaping at frst, I was just like over it. I was like this is so much work. Like I don’t
know what coils are, or I didn’t even know how to change the coil. And I don’t even
know what it really is still, like I just know it’s something that makes the vape work.
But I was just struggling for a while, to fgure out how to work everything on it. So at
frst, I was like dude, this is so ridiculous! I’m just about to go buy a pack of cigarettes,
because that’s so much easier.
(Interview with 21-year-old woman)

[describing why he initially saw vaping as “a hassle”] Just all the components that go into
actually working it, you know. You have to unscrew the tank and clean it out and shit,
and load more juices in there. It just seemed – I guess it just seemed easier to smoke
cigarettes or something.
(Interview with 21-year-old man)

In the context of this material complexity, resources providing information and support –
both online and in-person – were key, and the characterization of vaping culture as a “sup-
portive community” was common across studies. Central to this were brick-and-mortar
vape shops, which were identifed as important sites for accumulating knowledge about
smoking cessation, trying new set-ups, fnding the right level of nicotine, sampling new fa-
vors, and learning how to fx and modify equipment. While many young people described
supplementing these inputs via information online and on social media (e.g. YouTube, Ins-
tagram, and Snapchat), a striking feature of accounts was the enduring signifcance of face-
to-face interactions within vape shops and lounges among a generation often characterized
as “digital natives.” Indeed, among some young people, there was a sense that they actively
valued opportunities to experience and partake in local communities within an increasingly
globalized world:

This is what makes it [vaping] a community, because we know the people who make
the juices. We know who owns the shops, that’s what brings us closer. We talk to each
other. Whereas cigarettes, I don’t know anyone in Big Tobacco. I don’t know the guy
who makes it. With cigarettes it’s like one common interest – oh, the nicotine buzz.
With vaping you get, “Oh you use that? Yeah I use that too”, or it’s, “Oh you tasted that
juice? Yeah I tasted that too”, and it just keeps on coming. Everyone starts talking about
it. […] Vaping really is just small business owners, it’s not like these big corporations.
(Small group discussion)

Despite the high value placed on vape shops as sources of information and support, some
young women described these venues as “macho” and “male-dominated,” meaning that they
did not always feel equally supported or respected compared to male customers, for instance:

Woman 1: I’ve defnitely only seen guys that work in smoke shops […] They just au-
tomatically assume that they have the upper hand […] like, they would assume that
I don’t know what I’m looking for, like what exactly I want or like what the price
range of it should be, and so because I’m a girl, like they can take advantage of that and
they’re like, “Oh, like, she doesn’t know what she’s doing. We’ll just, like, upcharge
her and she’ll have no clue.” And I’m just like, no, like, that’s actually super expensive
and never mind.
(Small group discussion)

46
 Nic’d up

While this young woman was assertive in taking or leaving the advice she received within vape
stores, others talked about avoiding going into these venues in the frst place, even noting that
they had temporarily reverted to smoking when their vaping device had broken as they were
reluctant to access help in a vape store due to fear of being ridiculed or patronized for not know-
ing how to fx their equipment. Thus, the combination of practice elements here – the fragility
of devices, the requirement to possess and display a degree of knowledge in order to access help,
and the coding of some venues as unwelcoming to women – is suggestive of the precarity of
vaping as harm reduction practice, and opens up the question of what might be done to address
potential gendered inequalities in access to tobacco harm reduction resources.

Concluding comments: the ever-shifing terrain of vaping as

a social practice
Examining vaping nicotine as an intoxicating practice reveals elements that are central for
understanding why young people are attracted to vaping in the frst place and what encour-
ages or discourages them to sustain or change their vaping practices. Unless they attend to
this deeply embedded meaning of vaping nicotine, public health bodies in the United States
arguably have little hope of developing approaches that are responsive to and inclusive of the
experiences of youth and young adults. Participants in our studies drew attention to what is
so often missing in not just the mainstream tobacco literature but also the mainstream litera-
ture in the alcohol and drugs felds – that is, that the “transient euphoria characteristic of the
drug is explicitly constituted as a key element” that sustains the practice of drug use (Keane
2020, p. 58). Accounts in our studies emphasized how the intoxicating efects of nicotine
were distinct from other forms of intoxication and used strategically as a functional (and less
harmful) way to cope with the stresses of everyday life. Moreover, vaping appeared to be ex-
perienced as a capacity-enhancing practice, with participants appearing to derive pleasure from
mastering the skills of vaping and describing appreciation for their greater sense of control
while vaping, in terms of both the ability to control the intoxicating efects of nicotine and a
notion of regaining control over their health. In this sense, vaping nicotine was positioned in
opposition to smoking cigarettes – the latter being a practice that aforded a less customized
experience and was seen as a far greater threat to health. These young adults’ perspectives on
vaping sit in stark contrast to mainstream public health campaigns in the United States that
frame vaping as robbing young people of control over themselves and their behavior. Finally,
participants highlighted how vaping facilitated the cultivation of social connections and en-
hanced sociability. Sociability has long been acknowledged as an important contribution of
intoxicants; Partanen (1991) argued in his studies of alcohol-related intoxication that “drinks
delineate and articulate a world in which the expression of sociability becomes possible” (p.
27), and, it appears, that vaping nicotine aforded similar experiences among the youth to
whom we spoke.
Having explored some key practice elements relating to intoxication within young adults’
accounts of vaping nicotine in California in 2016–2017, we end this chapter with some brief
refections on the contemporary situation as we write in 2020 – less than four years since
these interviews, but a time in which the landscape of vaping and understandings about
nicotine are continuing to rapidly evolve, both in the USA and globally. As the material and
symbolic elements that constitute vaping shift, what might this mean for the persistence of
vaping as an intoxicating practice?
Perhaps most fundamentally, the material context of vaping has changed dramatically in
ways that likely impact the recruitment of new practitioners, and the defection of others.

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At the time we conducted our studies, sustaining a vaping habit using second- and third-
generation devices required a degree of amateur expertise, with relevant knowledge on how
to fll tanks, fx coils, and so on acquired and exchanged through interactions with vaping
friends, in vape stores, and via online resources. While participating in these exchanges
appeared to be part of the appeal for some, for others it was not, meaning that the risk of
returning to smoking was ever-present. This might in part explain the apparent popularity
of the next generation of vaping devices – smaller, pod-based systems with pre-flled car-
tridges, such as Juul – which began to proliferate in the market later in 2017. This fourth
generation of devices ofers an alternative to the complexity, size and fragility of earlier
tank-based systems (“mods”); they require less technical know-how to operate, are easier
to conceal (both because they are smaller, and they produce less vapor); and, anecdotally at
least, appear less susceptible to breaking. At the same time, however, the concentration of
nicotine within salts used in pod systems is higher than the juices used in earlier devices.
Given that our participants emphasized their ability and desire to control the intoxicating
efects of nicotine – getting nic’d up as opposed to nic’d out – this new generation of devices
may present both obstacles and opportunities to the recruitment of new vaping practitioners,
and their ongoing commitment to the practice. On the one hand, the relative ease of use may
convince young people who smoke that there are fewer barriers to becoming a competent
practitioner and by vaping they may be able to more easily exert control over their health
while simultaneously enjoying nicotine’s intoxicating efects. Yet, on the other, these new
devices may reduce opportunities to experience mastery and inhibit desired customization,
potentially reducing (or, at least, changing) the possibilities for identity work that come with
commodity consumption, and the ways in which vaping operates as a medium of sociability.
These changes in the material design of vaping technologies also raise important consid-
erations for thinking about connections between smoking and vaping as practices – in particular,
the tensions created as actors with divergent motives simultaneously work to tighten and
loosen these relationships. Back in 2017, Keane et al. commented on the evolution in the ma-
terial form of e-cigarettes; while the frst-generation “cig-a-likes” were designed to closely
resemble cigarettes (e.g. in size, shape, and glowing tip), the second- and third-generation
devices were larger and less aesthetically similar (p. 466). Since then, the boxy, sleek, pod-
based systems that now dominate the market have moved even further from the aesthetic of
a cigarette, and closer to the design of popular data storage devices and health surveillance
technologies (e.g. USBs and FitBits). From a practice theory perspective, these design in-
novations might be interpreted as eforts by the tobacco and e-cigarette industry to loosen
associations between vaping and smoking – eforts which mainstream authorities in the USA
might be understood as working to counter through public health messaging aiming to
tighten connections between smoking and vaping within the public imagination.
Within this landscape, young people who vape nicotine as a way to reduce or quit smok-
ing appear to be caught in the middle. As noted earlier, the widely expressed view among
our smoking-experienced participants in 2016–2017 was that vaping was signifcantly less
harmful to health than smoking, and reducing harm was central to how vaping was viewed
as a practice (Antin, Hees et al., 2019; Antin, Hunt 2019; Lewis, in preparation). Yet, while
these vaping youth and young adults were clear in diferentiating vaping from smoking, a
growing proportion of US adults perceive e-cigarettes to be as harmful or even more so
than smoking combustible cigarettes (Huang et al., 2019). It is possible that public confusion
about reduced relative harm may be further exacerbated by intensifcation of anti-vaping
sentiment in the USA, which has included prominently reported stories that mislead the
public about the cause of “vaping-related deaths,” and an FDA-funded national campaign

48
 Nic’d up

targeted at youth which used graphic imagery and emotive language to identify nicotine
itself as the “ultimate threat” (Fairchild et al., 2019, p. 1000). If public understandings about
nicotine continue to shift, might this loosen the meaning of vaping as harm reduction among
smoking youth? If so, what might be the unintended consequences for smoking youth? As
nicotine delivery devices will inevitably continue to evolve, greater attention to the ways in
which related practices are experienced as forms intoxication may provide a more nuanced
lens through which to understand how and why young people are drawn to them.

Acknowledgements
This work was supported, in part, by funds from the Tobacco-Related Disease Research
Program (TRDRP), grant number 24RT-0019. The content provided here is solely the
responsibility of the authors and does not necessarily refect the opinions of TRDRP. Dr.
Lewis is supported by the United Kingdom Medical Research Council [grant codes MC_
UU_12017/11 and MC_UU_00022/3] and the Scottish Government Chief Scientist Ofce
[grant code SPHSU11 and SPHSU18]. Finally, sincere appreciation is due to all of the vol-
unteers who participated in both studies; without them, our work would not be possible.

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 3
RECREATIONAL DRUG USE
AS EVERYDAY LIFE
Explorations of young adults’ gendered
motivations for taking drugs in Nigeria

Emeka W. Dumbili, MaryJane Nnajiofor and Emmanuel C. Ezekwe

Introduction
Most research on gender and drugs mainly focuses on Western societies (Carliner et al.,
2017; Ettorre, 2016). Given that gender is a global phenomenon, there is a need to study how
it afects drug use in non-Western contexts, and this is an important reason for the research
discussed in this chapter. Studies of non-Western settings will also provide novel insights
into the diverse ways in which gender shapes drug use attitudes and behaviours. The chapter
aims to explore recreational drug consumption in a Nigerian city, focusing on the factors
that motivate drug use and how social relations of gender are implicated in this. The chapter
is divided into four sections. First, we review studies concerning drug use in Nigeria before
exploring the gendering of drug use. Next, the methodology used in collecting and ana-
lysing data is presented. The subsequent section then presents the results before the chapter
closes with a discussion of the results.

Drug Use in Nigeria

Recreational drug use1 is a growing public health concern in Africa. Studies from Egypt
(Bassiony et al., 2015), Ghana (Appiah et al., 2018), and South Africa (Brook et al., 2006) indi-
cate that amphetamine, cannabis, and non-medical use of tramadol are popular. In Nigeria,
the dominant discourse surrounding recreational drug use has been problem-oriented, and
this is mirrored in the ways the media reported drug use in Northern Nigeria (Bamigbola,
2019; BBC News, 2018). The government also uses a repressive (war on drugs) approach in
regulating intoxicants in Nigeria (Nelson, 2018). Yet, licit and illicit drugs availability and
consumption appear to be growing (Dumbili, 2020; Dumbili et al., 2021).
Although some epidemiological studies have been conducted, especially in the North,
there is a paucity of research on recreational drug use in the country. Additionally, existing
literature fails to show the motives for drug use clearly or how gender impacts substance use.
Research conducted among the adult population in Plateau State, North-central region,
shows that among other drugs, participants took cannabis, opioids, sedatives, and amphet-
amine (Okonoda et al., 2017). In the same region, the misuse of tramadol was reported

DOI: 10.4324/9780429058141-5 51
 Emeka W. Dumbili et al.

among patients attending an addiction clinic (Ibrahim et al., 2017). In Lagos state, Dirisu
et al. (2019) reveal that young people use cannabis for recreational purposes. Further, Dirisu
and colleagues note that the criminalization of cannabis consumption in Nigeria did not
deter the users.
The widely held notion, especially among adults in Nigeria, is that illicit drug use is a
deviant behaviour, and thus, users are stigmatized (Dirisu et al., 2019; Dumbili, 2020). But
despite the social stigma attached to substance use, evidence shows that male and female stu-
dents in Nigerian secondary schools use diverse drugs, including cannabis and cocaine (Obi
et al., 2017; Oye-Adeniran et al., 2014). In a study that examined the frequency of drug use
among 10–19-year old students in Ilorin, North-central Nigeria, Abdulkarim et al. (2005)
found a 40.1% prevalence rate of drug use. In another study of 620 senior secondary school
students in Abakaliki, Anyanwu et al. (2016) reported that among other substances of abuse,
cannabis and cocaine were common. Among university students, Johnson et al. (2017, p. 11)
reported that the use of various psychoactive drugs was widespread. The study revealed that
the most used drugs are codeine, tramadol, and cannabis. The reasons for drug use include
coping with depression or family problems ( Johnson et al., 2017). In another study involving
undergraduates, Adekeye et al. (2017) indicated that codeine, cannabis, tramadol, and Ro-
hypnol were the most used drugs.
In Nigeria, substance use is gendered and male-dominated. In the past, men occupied
leisure sites and drank alcohol (the most common drug) (Heap, 1998) because ‘drinking has
never been part of the acceptable image of Nigerian women’ (Ikuesan, 1994, p. 942). Recent
alcohol research shows that, although women are beginning to drink, men expect them to
drink what they call ‘women’s alcohol’ (e.g., favoured/sweetened beverages) (Dumbili and
Williams, 2020). Relatedly, while men may drink and get intoxicated, women who ever get
inebriated sufer heightened social stigma (Dumbili, 2015; Ikuesan, 1994), and this is related
to the notion of maintaining traditional/respectable femininity (Dumbili, 2015). Although
there is limited evidence on how illicit drug users are perceived in Nigeria, available research
shows that women are stigmatized more than men (Dumbili, 2020). Given that gender often
shapes drug use patterns and practices (Hunt et al., 2016), exploring how it motivates intox-
icants use in Nigeria becomes imperative.

Gendering of Drug Use

The psychological literature suggests a number of motivations (e.g., coping, conformity,
enhancement, and social) for intoxicant use among young people worldwide (Cooper, 1994;
Litt et al., 2019; Thurnell-Read, 2016). Increasingly, scholars are looking towards more nu-
anced, socially, and culturally shaped meanings of drug use. With respect to gender, bour-
geoning literature shows that adherence to traditional masculine and feminine gender roles
and expectations infuence intoxicant use in diferent ways (Carliner et al., 2017; Ettorre,
2016; Hunt et al., 2016).
According to West and Zimmerman (1987), gender is performative and enacted through
specifcally repetitive actions, and its performance is in interaction with real and imagined
‘others’. ‘Doing gender’ requires actions and resources, and one available resource is psycho-
active substances (Darcy, 2020; Measham, 2002). For example, while men perform and (re)
produce traditional masculinity through (il)licit drug use (Darcy, 2020; Carliner et al., 2017),
women are challenging traditional/respectable femininity norms with intoxicants (Ettorre,
2004; Hunt et al., 2002). This is why Measham (2002, p.335) argued, ‘that gender does not
just infuence doing drugs, but drug use itself can be seen as a way of doing gender’.

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 Recreational drug use as everyday life

In most parts of the world, boys and men are more likely to use drugs and to report more
drug-related problems than girls and women, and this is related to adherence to masculine
norms of risk-taking (Hemsing and Greaves, 2020; UNODC, 2017). Darcy (2020), for in-
stance, notes that illicit recreational drug use is one of the ways Irish men ‘do’ masculinity,
to the extent that some engage in drug-taking games. Some men even construct masculin-
ity in drug treatment settings. As Ezzell’s (2012) study of two US drug treatment settings
shows, male residents demonstrated their masculinity through aggression, the subordination
of women and other men, and they also ‘managed’ their emotion to show that they were
in control. Given the high rates of drug use and related problems among men, Wilton et al.
(2014, p.291) suggested the need to show ‘men how to practice an alternative model of
healthy masculinity’. Research has also identifed that the gaps between men and women
who use illicit drugs are beginning to narrow down (Legleye et al., 2014), and this is because
many women are delving into drug subcultures that were hitherto occupied by men (Brady
et al., 2016; Hunt et al., 2002).
In most communities, acceptable or unacceptable leisure behaviour is determined by cul-
tural norms guiding gender roles and expectations (Hunt and Antin, 2019). Given that gen-
der performance is often contextual and fuid, individuals may enact diverse femininities and
masculinities in diferent settings (Sallee and Harris, 2011). This underpins the importance
of studying masculinities and femininities of drug use trajectories geographically (Connell
and Messerschmidt, 2005; Pease and Pringle, 2001). Our study begins to fll the knowledge
gap in gender and drug use in Nigeria.

Methods

Study Site, Participants, and Interviews

This exploratory study was conducted in a metropolitan city located in Anambra State,
South-eastern Nigeria. The city is made up of two Local Government Areas, and its pop-
ulation is estimated at 399,300 (City Population, 2020). The city is located on a major
highway connecting two other cities and thus exposed to abundant and continuous supplies
of psychoactive substances (Dumbili, 2020). Also, one of the neighbouring cities whose res-
idents visit the study site daily for higher education, work, and other businesses is known for
drug use and related violent crimes and armed robbery (Baker, 2002). The study involved
semi-structured interviews with 23 (19 males; 4 females) young adults (aged 23–29) who
were current substance users.,2 Nineteen of the participants were undergraduate students of
a public university, while the rest were university graduates. Only one of the non-students
among the participants had a fulltime job. Our study did not aim at a particular class, es-
pecially because ‘(illicit) recreational drug use is not restricted to particular social classes
and not attributable to marginalization or disadvantage’ (Darcy, 2020. p. 422). Given that
women who take intoxicants sufer a higher social discrimination than men (Dumbili, 2015,
2020), many of them are reluctant to participate in intoxicant-related research (Dumbili,
2015). This was a primary barrier to the recruitment of additional women in this study, and
we acknowledge this as a major limitation, especially because the study focuses on gender.
The sample selection involved a snowball sampling method, and this was aimed at gather-
ing preliminary data on recreational drug use in Nigeria. Qualitative interviews were used
to facilitate the detailed understanding of the interviewees’ beliefs and perspectives on drugs
and how they make meaning (Roulston and Choi, 2018) of their everyday leisure lives us-
ing drugs (Maher and Dertadian, 2018). Ethical approval was granted by Brunel University

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 Emeka W. Dumbili et al.

London Ethics Board (Reference: 16853-MHR), and all the names used in this chapter are
pseudonyms. Recruitment followed word-of-mouth and (convenience) snowball sampling
methods (Noy, 2008), and it started with the researchers visiting drugs hotspots and students’
of-campus leisure sites and asking around the city for interested individuals.
Interviews ranged between 30 and 85 minutes and were performed in the English lan-
guage. We probed the participants to unpack how their drug career started, the type of drugs
they use and the factors that motivate their drug use. At the end of the interview, interview-
ees were asked to put the researchers in contact with other drug users who would be willing
to share their experiences of drug use with them. This proved to be particularly successful
methods of recruitment, especially concerning out-of-school participants. Drawing on so-
cial constructionism (Burr, 2015), and following Becker’s (1953) guidelines, we employed
the language/jargon (drug slangs) of users, especially where and when such was deemed
necessary or appropriate. Some of the popular drug slangs include gutter-water (a mixture of
codeine, cannabis, tramadol, Rohypnol and spirit or juice), Ruchy (Rohypnol), and TM/
Trams (tramadol). This allowed us to capture the nuances of meaning participants attribute
to drugs they use and to put them at ease. Oral consent was obtained and interviews were
recorded with a digital recorder with the permission of the participants.

Table 3.1 Sociodemographic data of the participants

Name Gender Age student/non-student

Adaora Female 27 Non-student

Alex Male 25 Student
Angela Female 24 Student
Charles Male 24 Student
Chibu Male 25 Student
Chiedu Male 25 Student
Chichi Female 25 Student
Chuka Male 26 Student
David Male 24 Student
Ebuka Male 26 Student
Eze Male 24 Student
Harry Male 25 Student
Ike Male 24 Student
Ikenna Male 24 Student
Katie Female 26 Student
Kingsley Male 24 Student
Nonso Male 26 Student
Okey Male 24 Non-student
Paul Male 26 Student
Sam Male 28 Non-student
Uche Male 25 Student
Vincent Male 23 Student
Willy Male 29 Non-student

Source: Fieldwork.

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 Recreational drug use as everyday life

Data Analysis
Following Braun and Clarke’s (2019) suggestions, we conducted a thematic analysis of the
data elicited using a mix of deductive and inductive procedures. The tape-recordings were
transcribed verbatim, anonymized, and then read repeatedly. Having familiarized with, and
immersed in the data, a manual inductive coding was initiated, and codes were developed (e.g.,
sourcing drug and smoking to cope) directly from the data using the participants’ own words,
terms, and phrases (Linneberg and Korsgaard, 2019). This was aimed at increasing transpar-
ency, and analytical rigor (Gioia et al., 2013), mainly because our study drew on theoretical
concepts ab initio. The next stage involved importing the transcripts to NVivo 12 software,
which was used to manage the remainder of the analysis (Jackson and Bazeley, 2019).
After generating the frst round of initial codes (e.g., pleasure and boosting sex), they were
compared with those generated manually (Maher et al., 2018). Following this, the coding of
the remaining transcripts was completed before searching for and identifying themes (Braun
and Clarke, 2019). This was achieved by reading through the codes and collating them
together to develop themes. Subsequently, the themes developed were reviewed through
repeated and thorough reading of the nodes. Through this process, we identifed extracts
that were more suitable to other nodes, and these were moved to the existing nodes, or new
nodes were created for them. Subsequently, the themes (and associated subthemes) were
named (Braun and Clarke, 2019). While the theoretical concepts (e.g., doing gender) facili-
tated in developing and naming of some key themes, some of the subthemes were identifed
inductively.

Findings
The data presented here described the nuanced experiences of young adults who use psycho-
active substances in a Nigerian city to manage and alter their emotions and bodily feeling
and experiences. In this chapter, we present fndings regarding the gendering of drug use and
the motivations behind it. Drug use narratives included personal and/or group experiences,
and young adults highlighted how taking drugs has become a part of their everyday life.

Coping with Diverse Negative Emotions

Some of the reasons for drug use among the majority of men and all the women in this study
were to cope with work and study-related stress that often resulted in insomnia, depression,
anger, and negative emotion. As some of them explained, the use of cannabis to mitigate
stress and sleeplessness was common:

ALEX: The thing is that marijuana actually reduces stress… After doing the day’s job, you
come home and after taking it, you’re relieved. It makes you sleep for a very long time.
CHICHI: I was having issues with insomnia; so it was in my ‘300 Level’ [third year of univer-
sity] that I got to know that [drug can ameliorate sleeplessness] … And then, I noticed
that whenever I just smoke SK [Skunk cannabis], I sleep better. It helps me sleep, and if
I don’t take it, I can’t sleep.

Chichi, a female participant, further sheds light on the discussion she had with four of her
friends who also use drugs like sleeping pills. Although she did not mention the drugs her
friends used to induce sleep, the excerpt below aptly captures their reactions (suggesting a

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sigh of relief ), when they realized that there were other people using cannabis to mitigate
sleeplessness:

CHICHI: …They were like, ‘ah, so it happens to you too?’ One of them was like; if she
doesn’t smoke, she can’t sleep…

These accounts refected the experiences of many participants. Although polydrug use was
a common phenomenon, they used cannabis specifcally to mitigate stress-related sleepless-
ness, and this is in consonance with research elsewhere on cannabis use motives (Boys et al.,
2001; Glodosky and Cuttler, 2020).
The participants also shared some nuanced accounts which cast light on how their drug
career started and how they discovered that drugs could mitigate stress and sleeplessness. For
example, Katie recounted that she was facing some family and fnancial problems, and thus,
could not sleep. In search of solace, she placed a call to a friend, expecting some money but
instead, was introduced to cannabis use as a relief measure:

KATIE: I called her and was like babe, what’s up? I’m having some issues and can’t even sleep.
Can you help me? She was like, come over to my house. I went, hoping that she would
give me [some money]... On getting to her house, she was smoking and was like, babe
just ‘high up’; if you high up, you will get yourself back… She was like, ‘if I start to
tell you my problems, you won’t believe it, but see how fne I’m because I’m high’. …I
just took like two drags, and it really caught me. I slept like a baby in her house without
thinking of anything… I really enjoyed it because it just made me forget my problem.

From this singular experience, her drug career started, and as she explained, she later learned
that smoking cannabis not only induces sleep but can also relieve sorrow. In a related cir-
cumstance, Chichi narrated how she started using Rohypnol to mitigate stress, negative
mood, and frustration:

CHICHI: It was my friend that actually gave it to me. She came to my house. I was just feel-
ing so bad because of serious fnancial issues… So there was a lot of stress on me. She
was like she wants to get my mind of the issues so that I can forget about everything…
So she gave me two of the drugs and I took them, and I just felt so good. I just felt like
dancing; I felt happy… So it helps with my frustration.

One of the dominant features of traditional femininity is expressing emotion (Brady et al.,
2016), and all the women in this study revealed how they seek help during emotional distress.
Another common practice among all the women and some men was the use of drugs
when they were angry and want to induce happy moods. Adaora, a 27-year old female uni-
versity graduate, who often uses cannabis to mitigate anger, stressed that ‘whenever I am
annoyed, I tend to smoke weed’, and similar accounts were shared among other participants.
As some explained, they use large quantities of cannabis in quick succession to achieve faster
relief from anger:

CHARLES: I smoke out of anger… I do it whenever I am pissed of. ‘I’ll smoke till blood
comes out of my eye’. I smoke and get fucking high, and will keep on smoking... I know
I’m too high, but I’ll still be smoking until I no go dey see person again; [until I will not see
humans anymore].

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Aside from taking drugs to cope with anger, sleeplessness, and other stress-related problems,
the interviewees also used intoxicants specifcally to alleviate depression (general feelings of
low mood, negativity, etc.). Indeed, the incidence of depression permeated our data, and the
majority attributed this to the poor state of the Nigerian economy, and lack of social support
from the government. Adaora, who uses cannabis, Crystal-meth (methamphetamine), and co-
deine, explained that drugs keep her ‘company’. She further narrated some pitiable life events
that put much pressure on her and how these happenings induce depression. In her words, so
you got to pot [you have to smoke cannabis] to alleviate such depressive mood:

ADAORA: …Actually, it [cannabis use] is something you do because of depression from many
angles. Everybody is putting pressure on you, and the next thing is drug use. Because
when you take drugs, everything the government or parents said, you have forgotten.

In this cultural setting, displaying emotions (openly) by men is taboo because it contradicts
the dominant discourses of masculinity, and this notion of masculinity is resilient (Uchendu,
2007). For example, young people, who participated in Uchendu’s (2007, p.283) study, noted
that ‘absence of smiles’ and being unemotional are markers of masculinity in Eastern Nige-
ria. All the male interviewees reproduced such traditional masculinity, in the sense that none
ever mentioned telling a friend about his emotional problems (although many of them shared
explicit stories of using drugs for coping reasons). Some of them even disclosed the peculiar-
ity of such behaviours among women, who share their emotional and other problems with
their girl- or boyfriends. As the account below shows, one of them recounted how he uses
cannabis to raise his spirit and alleviate depression:

EBUKA: What I like about weed is that it gives you this kind of motivation. As in, it brings
your spirit up; it raises your spirit. Like if you‘re depressed…, and you take weed, it will
accelerate [alleviate] it.

The fact that some men associate emotional distress with weakness is not particular to our
study because it is part of masculinity norms (Hemsing and Greaves, 2020). But evidence has
shown that men either engage in heavy drinking or use illicit drugs in a bid to ameliorate
emotional vulnerability instead of seeking help from others (Cleary, 2012).
Given these negative emotions, participants used cannabis to evoke pleasure, fun, and
happiness. Interviewees noted that they use diverse strains of cannabis. Among them is
Charles, who had used diferent varieties (Skunk and Arizona, i.e., imported). As his nu-
anced account reveals, each type produces diferent efects and has a specifc perceived func-
tion, but what he called the ‘normal’ (locally produced) weed evokes pleasurable mood and
‘makes you laugh and laugh out your mind’. Other participants corroborated his account:

CHICHI: Actually, marijuana can give pleasure… and a lot of joy and happiness in you be-
cause you feel diferent; you feel free. You’ll feel like a big burden has just been lifted
of your shoulder.
ALEX: It [weed] gives this pleasure that you might not actually explain. You just feel that all
your problems are solved, [and] there is no problem again.
ANGELA: Ok… when I take weed, I feel happy… it gives excitement.

In this study, only Adaora reported solidary cannabis use. Other participants used the drug
among friendship networks. Also, cannabis was used in drug hotspots and other social contexts

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such as students’ parties, and drug users’ homes/rooms. Despite the social use of cannabis, our
analysis shows that when they are angry or depressed, they mostly smoked alone.
Together, these accounts reveal the gendered experiences of young adults with drugs and
how they use intoxicants for recreational and therapeutic purposes. Their views suggest that
anger encouraged the use of large quantities of drugs. As noted earlier, the general perceptions
of drugs and their regulations have been problem-oriented and paternalistic in Nigeria (Nel-
son, 2018). Our data have demonstrated that young adults in contemporary Nigeria are doing
drugs for fun and pleasure, and thus legitimizing recreational intoxicant use (Askew, 2016).

Managing Heartbreaks
Additional accounts that appeared to be gendered show how women used cannabis due to
its perceived efects to soothe emotional distress resulting from heartbreaks. Three of the
participants recounted how they use marijuana to manage broken relationships with their
boyfriends. For example:

CHICHI: At a point, my relationship became abusive; I was no longer [enjoying it]. I didn’t
want to continue, but I couldn’t leave. So the only thing that kept me going was taking
marijuana… That was the only thing that just made me forget the person I was deal-
ing with and be happy within myself… I actually started taking it when I had my frst
breakup with my fancé. So it helped me get my mind of everything…

A common occurrence among these young women was that because of the heartbreak and
relationship trauma and abuse they experienced, the quantities of cannabis they used in-
creased. Adaora narrated that she was already pregnant before her fancé jilted her. There-
fore, she aborted the baby and began to use more quantity of cannabis to ‘manage’ her
sorrow. The following excerpt further explicated how women heightened cannabis use due
to relationship problems:

KATIE: I found out that my boyfriend was sleeping with my friend. So that day, I smoked
and smoked and smoked, so that I can forget everything…

Many young Nigerian women experience increasingly gender-based sexual violence daily,
and most of these incidences are unreported (Dumbili and Williams, 2020; Fawole et al.,
2002). One main reason why most women do not report sexual violence is because of the
culture of silence, but this encourages a rape culture in Nigeria (Dumbili and Williams,
2020). Given that some emotions are experienced more intensely and frequently by women
than men (Barrett et al., 1998), this may be the reason why only women reported using drugs
to heal emotional turmoil caused by the end of romantic relationships or by living with
problematic and harmful relationships.

Enhancing Sexual Performance and Pleasure

Tramadol Elongates Sex

Our analysis reveals some culturally specifc nuances under the enhancement motives. All the
participants knew about using drugs to stimulate sexual urges and enhance performance. Re-
latedly, nearly all of them have used one or more drugs, specifcally for sex-related purposes.

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Although the participants particularly mentioned fve drugs (cannabis, tramadol, codeine,
Crystal-meth, and Rohypnol), our analysis shows that tramadol – an opioid – was the most
used substance for sexual purposes, and the essence was to prolong sex. The awareness that men
mainly use it more than women was widespread even among the female participants:

CHICHI: I have this neighbour; whenever he brings in ‘heavy-duty’ [fat] girls, he tends to
take tramadol… to give him energy so that he will be able to satisfy them… That is just
what tramadol does; it enhances their power… They use it a lot; especially those men
who are weak and cannot just go on for a long time.

Men’s accounts also show that they possessed a high-level knowledge of the fact that sexual
uses of tramadol were widespread among Nigerian youths. Consequently, they discussed that
this practice was not peculiar to the city where the study was conducted:

CHUKA: There was this friend of mine (…) he came back from [name of place] with dozens
of tramadol, and I asked him the benefts he derives from using it. He laughed, and was
like; tramadol helps him whenever he wants to make love with a woman. [He said] that
he is not good in bed, so whenever he takes it, he lasts very long.

From personal experiences, those who use this drug stated that one of the reasons was because
it helps sexually inactive men, by enhancing their energy for better sexual performance:

DAVID: Let me tell you, everybody has diferent reasons why they take tramadol, but in my
case, the reason was that I was sexually inactive. Someone advised me to take it, and I
would perform well. I took it, and it quite helped.

Interestingly, there was a consensus on another perceived function tramadol performed for
men: it elongates the time they last during sex:

DAVID: Instead of you like ‘coming’ [ejaculating] that time [at the natural time/limit], you’ll
usually ‘come’ like… 15 minutes later. Tramadol prolongs it.

Because of the high premium placed on prolonged sexual intercourse, the use of tramadol
to facilitate protracted sexual episodes was normalized among interviewees (i.e., men who
used it to prolong sexual intercourse held masculine view that longer sex is always better). As
they explained, the essence is not to enjoy pleasurable sex per se but to last long. For instance:

CHARLES: Ok, without TM, you’ll enjoy sex more, but with TM, you ‘strafe’ longer. You
won’t get the whole feeling on TM, but when you ‘come’ [ejaculate], the strength is still
there; so you make love longer...

Some of them engaged with metaphors while describing the reasons for using tramadol before
sexual intercourse. First, they stated the need to satisfy their sexual partners, and most impor-
tantly, to ‘defeat women in bed’ because such will boost masculine ego and guarantee loyalty:

CHIBU: They normally take all these drugs to add to their [natural] energy to stay long with a
woman in bed. It is common among youths nowadays, not only students. Men want to feel
that they are ‘strong’ guys. Like, ‘I am a strong guy that defeated this particular girl in bed’.

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 Emeka W. Dumbili et al.

These accounts have shown that men have a good grasp of the two main functions they be-
lieve tramadol performs. The accounts also aligned with a growing popular subcultural prac-
tice in contemporary Nigeria, where young men and women engage in ‘sex competition’.
Media reports show that young people boast of winning sex bouts, to the extent of placing
a bet before such contests start (Okpara, 2018). The accounts also refected some nuances on
how common the use of this tramadol for non-prescription purposes was in this city, and
how the reproduction of dominant masculinity played out.
In contrast to the common positive features men attributed to tramadol, a few also ex-
pressed some reservations. They stressed that, although the use of tramadol to enhance sexual
performance is widespread, users must urge caution. Drawing on their experiences and their
friends, they note that failing to use the required dosage will backfre:

EZE: I took tramadol just to be at my peak, and then, I noticed that when the girl came, I
was just sleeping. She even woke me up and was like ‘let’s start’, and I was like, ‘please,
I want to sleep’.

Interestingly, when they were probed to unpack the ‘required dosage’ to use, they noted that
it is through trial and error, in that what works for Mr ‘A’ may not work for Mr ‘B’. Indeed,
their accounts align with Becker’s (1963) view of learning to perceive and negotiate the ef-
fects of certain drugs.

Enhancing Pleasurable Sex

The participants shared their reason for taking cannabis for sexual purposes. Unlike the rea-
son above for using tramadol, cannabis was used to facilitate sexual fun and pleasure:

CHARLES: When you’re on weed, you enjoy sex. It doesn’t make you last longer, but you’ll
enjoy it more. As I said, it excites you, so you derive joy…

Some men explained that to maximize pleasure, both sexual partners should use cannabis
because ‘if it is just one-sided, it’s normally somehow because the [other] person will not be
able to meet up with your capacity’.
Narrating how cannabis enhances sexual pleasure, a woman noted that men often talk
and behave more romantically when they use cannabis before sex than when they are sober.
As she notes, this enhances foreplay, making sex more fun. She then drew on her experience
with her boyfriend to describe her narratives:

CHICHI: Let me use my boyfriend as an example. Whenever he is not smoking, he seems to

be a bit dull, but when he’s under the infuence, I fnd out that he’s much more sexually
romantic and he does a lot of romantic things than when he is clear-headed.

Charles, who had earlier noted that sex under the infuence of cannabis is enjoyable,
narrated how he smokes with his ex-girlfriend before sex. He added that she enjoyed sex
more when he was highly intoxicated, to the extent that she encouraged him to smoke
more quantity of cannabis before sex. From these accounts, it is clear that pleasure-
seeking is one of the reasons why women encouraged their boyfriends to use drugs
before sex.

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Women’s Power in Negotiating Sex

Another culturally unique aspect of our fndings is that some females introduced their boy-
friends to sexual uses of drugs. Narrating his experience, one man stressed that if one is not
performing to his girlfriend’s expectation, she will ask you: ‘don’t you think that you need
help?’ ‘Why not try what others are doing?’ While the following accounts supported his
view, they further reveal how, according to some of the male interviewees, women use what
can be called subtle coercion to negotiate and achieve drug-enhanced sex:

ALEX: I had a girlfriend that takes weed. She was the frst person that actually got me into
it... I discovered that our [sexual] capacity was not the same. So she told me that she
takes drugs… So that was the frst time I actually had to ‘do it’ with drugs so I could
[perform well and satisfy her]… I now discovered that weed actually improves sexual
performance.

The analysis highlights men’s motivation to use drugs in an attempt to enhance their sex-
ual prowess. One unique reason is that they believe that young women do not like what
they called ‘fve minutes men’. That is, according to some of the men we interviewed, the
demand for prolonged sex beyond the usually perceived limit among young women is very
high. Therefore, to not ‘disappoint’ these women, which, in turn, will cast doubt on men’s
masculinity and virility, they use drugs. Uche recounted a related, but more nuanced expe-
rience below:

UCHE: I met a girl, and she came around, and we spent a few times [having sexual inter-
course]. We were having a discussion, and she was like, how do I feel [with the way
I performed?]… Like how many minutes can I last in bed? I said a maximum of fve
minutes because that is normal. She was like, that is abnormal. I was shocked… She said
that some guys last for one hour… She said that they have this drug that facilitates longer
sex… and maybe, I should try it out. She said that she doesn’t like sleeping with guys
who just do it ordinarily without any form of inducement.

Men stressed that if they are unable to provide prolonged sex to their girlfriend’s satisfaction,
two things will most likely happen. First, as we illustrated above, she would become angry
and leave their house (i.e., leave the relationship). Next, men contended that the man would
become an object of ridicule among her friends because when young women come together,
they discuss such issues. Therefore, to avoid name-calling and shaming, some men strategi-
cally deploy drugs to enhance sexual stamina.

Sexual Arousal
Another dimension of the sexual uses of drugs, which also appeared to be gendered, is that
only the women reported using substances to stimulate sexual urge. Aside from citing the
use of drugs to enhance sexual stamina by prostitutes in this city, all the participants unan-
imously agreed that the main reason women use drugs is to activate sexual feelings and to
improve pleasure:

KATIE: Sometimes, when I am high like that, I will be like guy, I want to ‘fuck’. I just want
to have sex and be okay…

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ANGELA: When you smoke, you will feel like having sex. It will give you a sexual urge.
It will even make you want to have sex with someone you never planned to have sex
with…

An element of their accounts reveals what can be called spontaneity of drug-induced sexual
stimulation. Still, the analysis also shows that most women intentionally use drugs to activate
sexual urges. Chichi narrated that most young women smoke after having their make-up
because ‘smoking helps them feel sexy’. Earlier, she recounted several relationship problems,
which made her boyfriend unattractive to her. As she stated, things usually turned around
when she takes Rohypnol or cannabis:

CHICHI: I noticed that whenever I take the substance or I smoke, I fnd him more attract-
ing… Whenever I smoke, I feel like I want to engage in sexual activity [with him], and
I don’t feel as irritated as I used to be when I’m clear-headed.

These accounts show how women use intoxication to achieve heightened pleasure through
sex. As we also demonstrated above (i.e., under women’s power in negotiating sex), our anal-
ysis has shown that women are active participants in their own experiences, and not always
victims like the much extant literatures suggest (Sandal, 2020).

Smoking Competition among Men

Constructing and Reinforcing Masculinity

Our analysis also shows that masculinized drug use, in the form of a ‘smoking competition’,
where men compete for superior masculinity is becoming a commonplace among subgroup
male drug users in this city. Although we acknowledge the unequal number of male and
female participants in this study, no women reported playing smoking competition. Men’s
performance of traditional masculinity was a signifcant predictor of what we called smoking
games. To exemplify how ‘smoking game’ is played, we will largely draw on Alex’s account.
This is because it is an insightful exemplar of how drug competition starts in masculinized
social contexts:

ALEX: I’ve witnessed a competition where two guys were arguing about who takes more
[cannabis]. One said that he could take 40 sticks of weed, the other guy was like; it’s not
possible for somebody to take 40 sticks… So they placed a bet of 5,000 Naira [$14]…
We were looking at them; so we became the judge. They brought out weed and fred it
up, but the guy did not actually get to 40. I think he was getting to 30 before he could
not actually go again...
INTERVIEWER: So, what is the beneft to whoever wins?
ALEX: It gives this high status among the ‘drug people’… It is either they call you ‘lord’ or
they fnd one name to give you for actually accomplishing that particular task. And you
are actually recognized [respected] in that particular setting…

The dominant masculinity discourse in Nigeria is that men should be risk-takers (Dumbili
and Williams, 2020; Uchendu, 2007). As our data reveal, smoking contexts appear to pro-
vide spaces for men to perform ‘appropriate’ gender because failing to do so suggests weak-
ness. One participant shared a personal experience of how the reproduction of masculinity

62
 Recreational drug use as everyday life

is implicated in drug use. He highlighted that instead of backing out of the competitive
drug-taking, and then mocked by other men, he would keep smoking:

IKENNA: Sometimes you plan to smoke just one rap but because you are with friends and
then, they just keep rolling up weed, especially when they are passing it around [and ev-
eryone is taking their turn]. You will not want to be the frst person to leave. So, you’ll
just collect it and smoke…

Our data highlighted that winning a smoking contest confers superior masculine status to
the winner and also facilitates the extension of his social networks among admirers, and this
is in line with the competitive and hierarchical view of gender, which has been explored in
Western literature (Connell and Messerschmidt, 2005; West and Zimmerman, 1987).

Discussion
The study has highlighted the contemporary drug cultures in Nigeria and the diversity of
reasons for intoxicant use among young adults. To our knowledge, this is the frst study ex-
ploring the gendered motivations for recreational drug use in Nigeria. We found that young
adults take cannabis, tramadol, and Rohypnol to cope with diverse negative emotions, en-
hance sexual performance and pleasure, and construct gender identity.
We found that cannabis was used primarily to soothe anger and activate pleasure and fun,
and this fts neatly with previous research (Eftekhari et al., 2004). Findings also show that
young adults used drugs to alleviate depression, and this corroborates a study conducted in
Northern Nigeria ( Johnson et al., 2017). Interviewees equally used cannabis, particularly to
attenuate stress and induce sleep, and this practice was widely reported. That interviewees
used drugs to alleviate stress and for recreational purposes confrms Osborne and Fogel’s
(2008) research. Of particular note is the way our participants normalized cannabis use. We
found that cannabis, an illicit drug, is becoming legitimized, and as research elsewhere (Kie-
pek and Beagan, 2018) shows, its social accommodation is becoming high in Nigeria. This
fnding raises serious concern about the government’s war on drugs. Given the roles drug use
play in the everyday leisure lives of Nigerian youths, it is obvious that drug use is becoming
normalized despite prohibition (see Dumbili, 2020; Dumbili et al., 2020). Therefore, there is
a need for policymakers to reconsider the extant policies to facilitate harm reduction.
Following Becker (1963), Maher and Dertadian (2018, p.169) note that drug career is an
‘interactive learning process whereby experienced drug users taught novice users how to
interpret the efects and meanings of drugs’. In this study, we found that some interviewees
were taught how to use drugs by their friends. While the females were introduced to canna-
bis and Rohypnol use for coping and pleasure motives, some of their male counterparts were
initiated and/or ‘coerced’ into drugs for sexual purposes and also for competing with other
men. The socio-cultural implication of these fndings is serious because as noted earlier,
drug use is highly gendered in Nigeria (Dumbili, 2015; Dumbili et al., 2021). As the fndings
show that women even used cannabis with their boyfriends to ensure they accepted drugs,
it can be said that, as part of intimate heterosexual negotiations, women are doing gender
with drugs. Therefore, Hunt et al.’s (2002) assertion that women are developing subcultures
within previously male-dominated drug terrain is corroborated.
Further, the fndings revealed how young adult interviewees used drugs for sex enhance-
ment purposes. While women’s sexual enhancement motive for taking drugs was mostly
to activate sexual urges, men’s reasons are complex, although this may be in part due to

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 Emeka W. Dumbili et al.

diferences in sample size. Our fndings showcase men’s predominance in taking tramadol
before sex and how their reasons converge with masculinities. In what appears to be com-
petitions in sexual contexts, men used tramadol-assisted sexual prowess to ‘defeat’ women
and showcase masculinity. Although studies have not been conducted to determine the
motivations for sex competition, it can be inferred that proving masculine sexual prowess
is implicated. As we argue, this is directly related to the fact that men take pride in defeating
their sexual partners. Unfortunately, such contests have not always ended well. For instance,
a male contestant died during sex bouts (Okpara, 2018). Again, media reports show that
three Nigerian students died during drug-facilitated sex, and the police recovered codeine,
tramadol, cannabis and vodka from the sex scene (Awford, 2019). With these in mind, it
can be concluded that what occurs among young people in other states in Nigeria is being
replicated in the context where our study was conducted.
Intoxicant use is socially constructed (Hunt and Antin, 2019). As such, the socio-cultural
expectations regarding masculinity in Nigeria (Uchendu, 2007) appear to encourage men
to use drugs to fulfl such expectations. The implications of this fnding are multifaceted.
First, as the result shows that men used tramadol solely to prolong sexual intercourse, satisfy
their girlfriends, and assert their masculinity, it confrms ‘the traditional male sexual script
in which sexual activity is goal-oriented’ (Wiederman, 2005, p. 498). The result is also in
line with previous research on sexual uses of alcohol in the same context, which revealed
that men drink specifcally to become more aggressive and demonstrate their masculinity to
their girlfriends (Dumbili, 2016).
Another implication is that the performance of masculinity is facilitating the use of pre-
scription drugs non-medically in Nigeria, and this confrms media reports on the rising
rates of drug use in Nigeria (Bamigbola, 2019). Although the use of drugs to enhance elon-
gated sex among men was popular, men’s accounts have shown that women infuenced this
practice by demanding sex that lasts beyond the natural limit. This reveals that some young
women in Nigeria are no longer doing passive femininity. Previous research shows that sex
outside of marriage is taboo, and women are supposed to be sexual gatekeepers in this part of
Nigeria (Izugbara, 2001). Based on the current study, it is clear that drug-facilitated sexual
intercourse among unmarried youths is common, despite that drug use increases the risks of
unprotected sex and sexually transmitted diseases (Bellis et al., 2008).
Our fndings also demonstrated another important aspect of gendering of drug use, in
that only men engaged in cannabis smoking competition, and their reasons supported the
dominant discourses of masculinities. That is, smoking games were played by men, and drug
champions emerged after taking the highest number of cannabis joints/rolls. Again, not
playing this game was associated with weakness, which attracted ridicule. Therefore, men
played smoking games to protect their masculinity. The result is in line with a recent Irish
study (Darcy, 2020). However, it also shows some culturally unique aspects, in that gambling
partly motivated such games, and there were non-smoking umpires.

Conclusions
Our study has provided some novel insights into gender and drug use motives. Nevertheless,
it has some limitations. First, only four females were included due to the sensitive nature
of the research. As noted earlier, women who use intoxicants are stigmatized in Nigeria.
Therefore, women mostly reject invitations to be involved in drug-related research (Dum-
bili, 2015). Again, we collected data from one city and region. Thus, the fndings may not be
representative of other areas of Nigeria. Despite these limitations, the study has cast light on

64
 Recreational drug use as everyday life

some gender-related reasons for young adults’ drug use in Nigeria. While drug use exposes
interviewees to risks, some of them normalized these risks through drug-facilitated pleasure
and fun-seeking. These results have opened the pathways for understanding the underlying
gendered motives for drug use and how substance use motives could heighten drug-related
problems in Nigeria.

Funding
Emeka W. Dumbili is currently receiving funding from Alexander von Humboldt Founda-
tion through Georg Forster Research Fellowship.

Acknowledgements
We wish to thank the participants for their time and for sharing their drug use experiences
with us. We also thank Drs Laura Fenton and Thomas Thurnell-Read for the comments we
received on the chapter drafts.

Notes
1 Recreational drug use in this study is defned as taking drugs like cannabis and the non-medical
use of pharmaceuticals for ‘pleasure’, ‘fun’, and other functional purposes.
2 This was defned as having consumed any psychoactive substance other than alcohol, at least once
in the last 30 days.

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 4
WHEN THE CLOCK TAKES OVER
Hangovers in twentieth-century British and
American fction and poetry

Jonathon Shears

Introduction
Everyone recognises the fgure of the incoherent drunk, propping up the bar, slurring his
words. Similarly, everyone recognises the fgure of the hangover victim; the man or woman,
shaky, headachy, with bloodshot eyes, who would rather pull the duvet back over their head
than face the world, perhaps reaching for the paracetamol, black cofee or something stron-
ger. They are stereotypes. They are images of a loss of control due to alcoholic intoxication,
although the latter has received less attention than the former in the feld of drinking studies.
This may be explained by the fact that hangovers are usually separated from the period of
intoxication proper – the sciences measure them only from the point at which blood-alcohol
level returns to zero – but this chapter will argue that they tell us as much, if not more, than
drunkenness about the ways societies and individuals manage and shape attitudes to alcohol
consumption.
The hangover is often a period to reappraise one’s alcohol intake. As Muraven, Collins
and Neinhaus have argued, ‘the ability to restrain one’s drinking is critical to sticking to
self-imposed drinking limits’ (2002, 113) and the hangover, associated as it is with resolu-
tions to cut down or even pledges to abstain, is heavily implicated in such decision making.
However, the desire to consume more alcohol to overcome the hangover – often referred to
in British and American cultures as taking a ‘hair of the dog that bit you’ (a reference to a
folk cure for rabies) – provides an example of what they call the moment ‘when the impulse
to drink is stronger than the individual’s capacity to override that impulse’ (2002, 113). The
hangover may well lower what Muraven et al. call ‘self-control strength’ (2005, 140) and it
has been argued that such a response to a hangover can be predictive of problem drinking.
Absence of resolve is captured neatly in the American novelist John Cheever’s ironic journal
entry: ‘Awake before dawn, feeling tired and full of resolutions. Do not drink. Do not et
cetera, et cetera’ (1991, 5). The consequent use of remedies to ofset the hangover has been
characterised as the ‘withdrawal-relief ’ recovery method by Sherry Span and Mitchell Ear-
leywine (1999). In contrast, they label the abstention model a ‘traditional-punishment’ re-
sponse, whereby ‘individuals who experience the punishing efects of hangover will reduce
their drinking’ (1999, 121).

DOI: 10.4324/9780429058141-6 69
 Jonathon Shears

It is natural to want to overcome the physical symptoms of a hangover as quickly as pos-

sible, which explains the fascination with remedies, and feeling sick and jittery may make
the average drinker more likely to lay of for a while. Yet, there are other factors in play than
physiological ones in understanding an individual’s reaction, and decisions in response, to
the hangover. It is now well known that the hangover results from the way that the body
metabolises ethanol to create toxins such as acetaldehyde and formaldehyde, that the contrac-
tion of blood vessels causes headaches and that alcohol is a diuretic, explaining dehydration.
Nevertheless, the corrective aspect implied by the ‘traditional-punishment’ tag suggests not
just physical consequences, but also emotional, spiritual and socio-cultural ones, particularly
concerning moral judgement and the conscience. It is worth noting that the social function
of punishment, according to Émile Durkheim, exists to express a society’s moral outrage and
to reemphasise acceptable standards of behaviour and social interaction (1997). Even if the
hungover drinker is not generally openly punished, a negative emotional state is often the
result of ‘internal attributions for negative events’ during the period of intoxication, as Matt
Treeby and Raimondo Bruno put it, where a negative event involves ‘the production of a
transgressive behavior that breaches an internalized moral principle’ (2012, 613), which might
prompt an individual to make amends for fear of social judgement or even exclusion. In other
words, the suferer develops their own punitive mechanisms, or, as Al Young puts it in his
poem ‘Hangover’, frst published in the collection Sea Level (1986–1990), drunkenness, ‘The
preferred pain of the Western World/… might be crime & punishment, both’ (1992, ll.1–2).
It is in this context that the present chapter reconsiders the signifcance of the hangover for
discussions of drinking studies. If it is often anecdotally claimed that the hangover is nature’s
corrective for drinking, I take it that this is because physical symptoms have usually been
given priority ahead of those more complex emotional ones that are equally unsettling to the
drinker’s constitution and show that the hangover is a socio-cultural corrective to drinking
too. I argue that the symptoms of a hangover become meaningful when their intersections
with social values and behavioural norms are identifed and considered. In the process, the
hungover man or woman is rendered less of a stereotype and more of an individuated subject.
The chapter will argue that the period of the hangover is one when an individual’s drinking
is most likely to bring to light the psychosocial consequences of alcohol use. It will focus on
the hangover not just as a time to reappraise alcohol intake but also as a period of recovery
through refection upon and repair of the self, a process which often involves, even as it can-
not be confned wholly to, the recovery methods proposed by Span and Earleywine, just as
it means giving attention to moral status as well as physical restitution.
To do this, the chapter will make British and American hangover literature – fction and
poetry in this case – its central focus. In The Information (1995), Martin Amis suggests that
literature has an afnity with hangovers because, to some extent, every hangover is a ‘who-
dunit’ (2008, 271). That is, every hangover involves a reconstruction of past events. More
importantly, as Jon Elster puts it, imaginative literature is ‘the closest thing to a controlled
experiment involving high-stakes human emotions’ (1999, 108). There is a rich tradition of
hangover description in transatlantic drinking literature of the twentieth century, which
represents the intersections between social judgement and the subject, giving space to con-
sider the messiness of the hangover’s physical and emotional impacts, but also the variation
in response. Analysis of this literature demonstrates that the hangover ofers a unique route
to understand the consciousness and, perhaps, the conscience of the drinker. It also ofers
an opportunity to explore the manner in which ‘cultural beliefs and social practices’, which
Herring et al. (2012, 2) believe control drinking, form and are experienced and interpreted,
accepted or opposed. This kind of social scrutiny and self-appraisal directly concerns alcohol

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use, but it is generally accompanied by larger questions about the status of the self. There is
more than one way to combat a hangover, but each one tells us something about how the
nature of our attitudes to alcoholic intoxication develops.

Te Traditional-Punishment Model: From Myth to History

The clue is in the name to a certain extent. The word ‘hangover’ implies something remain-
ing or left over from an earlier time. The frst recorded use of the word in relation to alcohol
comes in 1904 in a dictionary of American slang terms by the pseudonymous Gideon Wurdz
where it features under the defnition of ‘Brain’, ‘usually occupied by the Intellect Bros., –
Thoughts and Ideas – as an Intelligence Ofce, but sometimes sub-let to Jag, Hang-Over &
Co’ (Oxford English Dictionary). The more general meaning of ‘A thing or person remaining
or left over; a remainder or survival, an after-efect’ (Oxford English Dictionary) is attributed to
the magazine Outing in 1894. Naturally, this does not mean that there were no earlier doc-
umented hangovers but, for reasons that will become clear, in this chapter I am particularly
concerned with the representation of the after-efects of alcohol consumption from when the
term enters common use. Hangovers are also implicated in the word ‘intoxication’, which,
as Michael G. Cooke observes, includes the word ‘toxic’ (1974, 27). In fact, intoxication has
a longer history of meaning poisoning body and mind than the feeling of inebriation and
euphoria, suggesting the hangover’s implication in drunkenness from the outset.
A new word that indicates a connection to old times, hangover therefore signifes the
physiological leftovers of intoxication as it also incorporates an individual’s response to the
events of their immediate and potentially longer past. This is underlined by the very fact
of Span and Earleywine’s identifcation of a ‘traditional’ response. Tradition implicates a
broader relationship with a cultural past than an individual with their prior actions and the
coinage of the term at the opening of the twentieth century seems signifcant in suggesting
a transition to modernity that can’t quite shake of the values of an earlier age.
Those earlier values are Victorian in part. They can be located in the warnings about the
efects of alcohol on health and moral values made by temperance advocates such as Joseph
Priestley, and are prominent in literary contexts, including the hangover of Charles Dick-
ens’s shame-prone David Copperfeld (1849), Anne Brontë’s tale of the dissolute and sadistic
Arthur Huntingdon in The Tenant of Wildfell Hall (1848), and, most spectacularly, in Thomas
Hardy’s The Mayor of Casterbridge (1886), which follows the penitence of Michael Henchard,
the hay-trusser who sells his wife to a sailor during a night of intoxication at a country fair.
However, as I have argued elsewhere (Shears, 2020), this inheritance goes back at least as far
as the period of the emergence of Protestantism in the sixteenth century, when drunken-
ness became particularly associated with transgression and the hangover with sinfulness and
penance. The biblical injunction to consume alcohol in moderation deploys the hangover as
a spiritual deterrent through recognisable physical symptoms. As it is put in Proverbs 23:29:
‘To whom is woe? To whom is sorrow: To whom strife: To whom is mourning?; To whom
wounds without cause? And to whom is the rednesse of the eyes?’ In each case, the answer
is the man with what we now call a hangover. In this context, the appropriate response to
overindulgence is to feel remorse and seek forgiveness, which involves reconnecting with, or
acquiescing to, acceptable standards of behaviour. The sinful drinker is the sort that the Pu-
ritan John Bunyan captures in The Life and Death of Mr. Badman (1680), composed between
the two parts of The Pilgrim’s Progress (1678; 1684), in which Mr Wiseman tells the tale of
Badman’s wickedness, much of which involves drunken carousing that leads him to gam-
ble, consort with prostitutes and abuse his wife. Badman’s domestic negligence is nothing

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compared to the dereliction of his soul and his debauchery is only curbed when he breaks
his leg while reeling home from the alehouse. Attempts at amendment are quickly forgotten:
‘his conscience was choked before his leg was healed’ (1953, 269). Badman is irredeemable
because he disregards the checks and balances of the hangover. They are the same kind of
moral restraints to which Hardy’s Henchard responds with repentance and regret.
It is true that literary hangovers come in diferent forms and guises and we should not
miss the way genre directs us to variety in human experience. In The Information, Amis adds
to the ‘whodunit’ a comic version of ‘epic’, ‘thrillers’ and ‘tragicomedy’ (2008, 271) – taking
each, in turn, examples include P. G. Wodehouse’s Carry on Jeeves (1925), Raymond Chan-
dler’s The Long Goodbye (1953) and Charles Jackson’s The Lost Weekend (1944). Hangovers
also ofer a creative, ecstatic space of personal insight for some poets, including Robert
Burns, Lord Byron and John Berryman, who in Dream Songs (1969) treats the hangover with
an alternating jokey dismissiveness – ‘Man, I been thirsty’ (‘Song 96’, l.6) – and tranquil ac-
quiescence that speaks of regeneration – ‘out for a sit/now in the emptiest freshest park, one
sober fing/before correspondence and breakfast’ (ll.18–20). Nevertheless, the penitential,
traditional hangover looms large over drinking literature of the twentieth century, even
when the main mode is not serious.
The title of Elizabeth Bishop’s hangover poem, ‘The Unbeliever’ (1946), which presents a
poet-speaker who initially seems insulated from reprisals, indicates the strong current of reli-
gious thoughts and associated moral values that moves through drinking literature. Notably, she
begins with an epigraph taken from The Pilgrim’s Progress, itself a reference to drunkenness in the
Book of Proverbs, which is also the frst line of her poem: ‘He sleeps on the top of a mast’ (2014,
l.1). In Bunyan’s narrative, the character of Christian warns the allegorical fgures Simple, Sloth
and Presumption, each fettered by a chain representing their chief sin, that they

are like them that sleep on the top of a Mast for the dead Sea is under you, a Gulf that
hath no bottom: Awake therefore, and come away; be willing also, and I will help you
of with your Irons.
(2003, 39)

Bishop’s drinker is likewise in a position of sinfulness, discovered in bed ‘with his eyes fast
closed’ (l.2), evocative less of sleep than denial, the bedsheets discarded, ‘leaving out in
the air of the night the sleeper’s head’ (l.5), suggesting equally jeopardy and vulnerability
while not ruling out a residual self-awareness. Sleep cocoons the speaker from both physical
sufering and moral responsibility, but, as he dreams over a cryptic seascape, this is labelled
‘introspection’ (l.14). Herein he encounters only the rhyme word ‘refection’ (l.15), a sign
of egotism. In the fnal stanza, the threat of the hangover, which is a punitive hangover,
rehearses the moral lesson: ‘I must not fall./ The spangled sea …/… is hard as diamonds; it
wants to destroy us all’ (ll.24–26). Bishop’s imagery indicates that the hangover is a type of
fall, but it is also a submersion; it is more than suggested that the liquid sea below is an alco-
holic one that might provide respite if taken as ‘the hair of the dog’, but which will reveal
the hard threat behind its sparkle. The conclusion chimes with the lesson of the proverbial
drunkard who, like Mr Badman, ignores the hangover to seek only further intoxication:

And thou shalt bee as one that sleepeth in the middes of the sea, and as he that sleepeth
in the top of the mast. They have stricken me, shalt thou say, but I was not sicke: they
have beaten me, but I knew not, when I awoke: therefore will I seeke it yet still.
(Proverbs, 23: 34–35)

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The word unbeliever suggests less an absence of faith, as in The Pilgrim’s Progress, than an
inability to face up to, and accept, reality and the weaknesses of the self-involved subject.
‘The Unbeliever’ is indebted to a traditional narrative of punishment and remorse
(although its drinker exists in a state of denial), even as it reinscribes it for a new age,
in-keeping with my observation that hangover is a word that signals both new and old con-
texts. Hangovers are always about inheritance in some way – the relation of past to present –
but similarities in form reveal diferences in content, just as hangovers always have generic
and individuated elements. These tensions are noticeable when literature operates close to
religion, myth and allegory, as we fnd in early twentieth-century drinking tales such as
Jack London’s John Barleycorn: Alcoholic Memoirs (1913) where his self-styled ‘alcoholic’ is set
in similar terms to Bishop’s unbeliever, viewing hangovers as a test of character that enable
him to live a life of hard, masculine excess amongst the Oyster Pirates of Oakland, Califor-
nia. Here, alcohol is something to be conquered in the manner of Herman Melville’s Moby
Dick. Similarly, in John Steinbeck’s Tortilla Flat (1935), heavy drinking is associated, in fairly
primitive ways, with the conficting dyad of joyful exuberance and painful remorse. The tale
of Danny and his friends is one of camaraderie and the strains alcohol puts on male bonding.
When Danny’s friends forget to extinguish a candle and burn down his house, they decide
that they must ‘confess … like little children to a father’, and ‘the three penitents’ (1958,
61) are eventually forgiven. Danny’s disinclination to the responsibility of owning property
means losing the house actually comes as a relief to him. Amends are made by Danny’s
forgiveness, which he proves by sharing a bottle of grappa. It is noticeable that the Catholic
background to the novel is emphasised by a greater focus on shame and forgiveness than on
the guilty introspection that we fnd in fction that exhibits a Protestant front.
Nevertheless, the novels are united in the way they demonstrate that as the hangovers of
the central protagonists worsen, they become less able to evade or cheat the repercussions for
drinking. A change descends, which involves the depiction of the self-policing individual in
breach of Treeby and Bruno’s ‘internalized moral principle’. For Steven Earnshaw, London’s
alcoholic is an early example of the ‘existential’ drinker, ‘an ongoing project’, who confronts
‘what it is to exist by making a commitment to drink large amounts of alcohol’ (2018, 1). That
existential aspect becomes more insistent as the action progresses and the alcoholic narrator de-
velops what he calls a ‘Nietzsche sickness’ (London, 2009, 189). This is a terrible depression that
marks his hangovers; it manifests itself in an inability to reconcile his drinking with his earlier
self-image of the adventurous alpha-male as he acquires a professional status and takes on the
personal responsibilities of marriage and fatherhood. The novel plays with the movement from
myth to history, where the causes of negative afect – guilt, shame, embarrassment, humiliation
and self-pity – appear more deeply internalised and harder to fathom.
Precisely the same thing occurs to Steinbeck’s Danny, who undertakes a week-long
bender during which he fees from his responsibilities to roam the woods and the town,
stealing, fghting and seducing married women. As his friends await his return, they con-
template his punishment – ‘If he is not crazy he will be punished’ – a refection on their
own inebriated lifestyle: ‘“Where is our happiness gone?” Pablo mourned. “Somewhere we
have sinned. It is a judgement. We should go to confession”’ (1958, 189). But when Danny
eventually returns, enfeebled by his drinking, ‘he was not conscience stricken, but … [t]he
rough fngers of violent experience had harped upon his soul’ (200). The hangover marks a
shift in the novel’s action, which leads to Danny dying after falling over a clif edge while
drunk, but more noticeably a change of key, as he is frst overwhelmed by an inexpressible
sadness that cannot be articulated, let alone confessed; ‘a heavy black thought’, or his own
Nietzsche sickness.

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In ‘Hangover’, Young ponders, ‘Where does it say you have to poison yourself/to
have what passes for a good time’ (ll.13–14), attributing this to a sort of human tendency
to self-fagellation, ‘the protestant ethic/of Christian churchkey indulgences’ (ll.8–9).
Bishop, London and Steinbeck attempt to capture an abiding quality to the hangover,
crystallised out of a deeply embedded set of Western cultural attitudes to alcohol, which
actually incorporate, rather than oppose, the ‘withdrawal-relief ’ recovery method or
‘the hair of the dog’. The fact that their characters drink in defance of such norms only
emphasises their existence. It is only when London’s alcoholic and Steinbeck’s Danny
stop pushing back that they appear less as operatives in a common narrative and more as
individualised subjects.
Cheever’s evocative allegory of addiction, ‘The Swimmer’ (1964), plays around with
the same kind of cultural archetypes that yield to the complexity of individual experience.
On the morning following a party at the house of his friends, the Westerhazys, Neddy
Merrill decides that instead of walking home with his family, he will attempt to swim back
through the swimming pools that line the back gardens of the well-to-do neighbourhood.
This is presented as a feat of endurance. The swimmer is, like Bunyan’s Christian, on a
journey of self-discovery, each pool representing a fgurative drinking bout. He grandi-
osely labels himself ‘a pilgrim, an explorer, a man with a destiny’ (1964, 63). However, the
idea that his is a quick route home rapidly evaporates, representing the problem drinker’s
delusion and denial as he is demonstrably more akin to the Simples, Sloths and Presump-
tions of Bunyan’s allegory than to Christian, the swim representing his departure from the
straight and narrow path.
Neddy’s eccentric decision is contextualised by the hangover: while each of the party-
goers acknowledges, ‘I drank too much’ (61), Neddy begins the tale in high spirits, sat by
the Westerhazys’ pool, ‘one hand in it, one around a glass of gin’ (61–62), the link between
water and alcohol being frmly established. Cheever emphasises Neddy’s carefree nature: we
are told, ‘he had slid down his banister that morning’ and ‘jogged toward the smell of cofee
in his dining room’ (62). Yet, the ominous green colour of the water, the fact that Neddy is
‘far from young’ and that ‘[h]e had been swimming and now he was breathing deeply, ster-
torously’ (62), foreshadows the struggles that Neddy is to encounter on his epic swim. Each
pool becomes harder to cross, as the summer takes on a strange autumnal and then wintry
quality, and the increased difculty to climb from each pool suggests the worsening of hang-
overs and diminishment of ‘self-control strength’. Neddy’s loss of status is narrated as he is
mocked by passing motorists and shunned by the respectable owners of the pools. Cheever
gradually reveals Neddy’s character through his encounters on the swim, sketching in a story
of social snobbishness, adultery, domestic negligence and betrayal of friends. Doubts creep
into the earlier impervious confdence as Neddy is shocked to learn from a neighbour that he
has in fact sold his house, his children are in trouble and his brother-in-law has been seriously
ill. ‘Was he losing his memory, had his gift for concealing painful facts let him forget’? (72):
Cheever is unambiguous that ‘the hair of the dog’ is the choice of his own ‘unbeliever’, a
respite from punishment that results in its intensifcation.
Cheever connects, rather than diferentiates, the ‘traditional-punishment’ and
‘withdrawal-relief ’ hangover responses. Allegory takes on the tones of tragedy in Neddy’s
moments of self-awareness that confict with his persistent sense of pride in his act of endur-
ance. This is something he cannot relinquish, even as he completes his swim to discover ‘he
was so stupefed with exhaustion that his triumph seemed vague’ (76). Cheever jokes about
memory loss here, but the drunkard’s amnesia is not so much a forgetting of particular events
as a symbol of his evasion of truth and inability to reconnect with the orthodox values of

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middle-class, mid-century America. His increased absentmindedness indicates both a phys-

iological and socio-cultural disconnection:

At what point had this prank, this joke, this piece of horseplay become serious? He could
not go back, he could not even recall with any clearness the green water at the Wester-
hazys’, the sense of inhaling the day’s components, the friendly and relaxed voices saying
that they had drunk too much. In the space of an hour, more or less, he had covered a
distance that made his return impossible.
(69)

Cheever suggests that the metaphoric journey back must mean all the way back to the begin-
ning, an unpicking of the drinker’s life that is all but impossible.
Cheever’s drinker is an alcoholic, and it must be noted that the examples I have cited so
far are of problem drinkers, but they are generally most signifcant in drinking literature for
the ways they concern themselves frst with the ‘lessons’ of the hangover at what I am calling
its mythic, certainly its biblical, level; that is the level that draws heavily on generic dimen-
sions and establishes paradigms and patterns. However, each in its own way departs from
the inherited models to consider the drinker as a self-identifying subject. Hence, Cheever
explores the quandary of Bishop’s unbeliever-as-abnegator in a character who has sufcient
self-awareness to recognise even amongst the apparent self-satisfaction that ‘he had no free-
dom of choice about his means of travel’ (72–73).

Social and Personal Control Mechanisms

The hangover is made painful because it is not only a physical torment but also frequently
a moral and ethical one. The examples of hangover literature that I have discussed indicate
that the approaches outlined by Span and Earleywine are accurate to the extent that they
are starting points to thinking about socio-cultural attitudes to alcohol use, but they are
only that. If Cheever’s Neddy Merrill swims free of context at an allegorical level, the tragic
psychodrama of the story imposes a self-present subject grappling with ‘internal attributions
for negative events’. Ingbar et al. argue that ‘the view that transgressions must be balanced
by pain inficted on the transgressor has remained a major tenet of Western moral thought’
(2013, 14). As far as the hangover is concerned, the infiction of such pain has a cultural –
perhaps we could even go so far as to now say textual – heritage or superstructure, which I
have outlined, that cannot be overlooked. Its subjective expression is, however, determined
by a drinker’s attitude to their specifc environment and the standards to which they are held
or hold themselves. Joachim Gerich argues that this is manifested in deterrents or what he
terms ‘control mechanisms’, akin to Muraven’s ‘self-control strength’, that take the form of
either self-control, ‘embedded in the person’ or, ‘in the social environment’, social control
(Gerich, 2014, 120). The internalisation of the latter, expressed during the hangover, means
that they tend to demonstrate ways in which these categories are interdependent rather than
independent.
Their interdependence is afrmed in Ingbar’s further assertion that belief and invest-
ment in punishment ‘is strong enough that people may sometimes infict pain on themselves
in order to balance their misdeeds’ (2013, 14), developing the notion of personal punitive
mechanisms that I earlier established. As we will now see, it is possible to identify within the
broader Western mythologies of conscience and shame, set out by Ingbar et al., more precise
interpersonal and social control mechanisms at work in reactions to alcohol consumption.

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These involve aspects of identity formation such as class, sexuality and gender – masculinity
and femininity need distinguishing in this regard – and intergenerational conficts, each
generally presenting as a superstructure of values relating to status and social control.
Central to the tradition of gritty, twentieth-century drinking narratives is Patrick Ham-
ilton’s 1941 novel Hangover Square, a story about an underclass of drifters in the late 1930s in
London, including the masochistic George Harvey Bone, whose heavy drinking exacerbates
the peculiar dissociative episodes from which he sufers. If Bone is a masochist, he is perfectly
matched against his love interest, the sadistically inclined Netta Longdon, who manipulates
the male characters who orbit around her in dingy Earl’s Court, driving Bone into spirals of
self-doubt, pessimism and, fnally, murder. Hamilton is an acute observer of the deprivations
deriving from class consciousness, which leads to resentment in Netta and the fascistic fgure
of Peter, but to an overwhelming sense of diminishment in Bone who pathetically jostles for
some kind of standing in the drinking circle.
Circle is the appropriate word. The group’s shared joke is that each morning they collec-
tively take ‘a little stroll round Hangover Square’ (2001, 29) (a pun on Hanover Square), but
it is really the motif of the circle, rather than square, that exemplifes Bone’s predicament, ex-
pressed through his desire, but failure, to rise ‘from this sad circle in hell in which he had been
condemned to wander so long’ (119), as he characterises West London’s drinking culture.
The hangover as Dantesque circle of hell symbolically adjoins Bone to the long-historical,
biblical tradition of the drinker whose self-inficted punishment foreshadows damnation, but
his particular control mechanisms are evocatively captured by the self-involving wheels of
narration that frame his damaged identity in Chapter 5.
At this point in the novel, Bone’s fragile self-esteem has been given a momentary boost by
a chance encounter with an old school friend who represents a theatrical agency for whom
Netta hopes to work. In Bone’s fantasies, Johnnie Littlejohn becomes a route to higher status
and romantic success with Netta, especially during a drunken night in which they plan a trip to
Brighton together. Characteristically, Bone is the low-status drunk, mocked by other members
of the group; treated as an ‘errand boy’, he is ‘[s]nubbed, isolated, yet obedient’ (114) as he pays
for drinks, fetches sandwiches or undertakes other small tasks for Netta, ‘the dumb butt of their
unfriendly wit’ (121). The repeated, small humiliations at the hands of Netta mean that, waking
hungover the following morning, Bone immediately loses faith that she will really accompany
him to Brighton. The hangover is a time for painful reassessment not merely of the night before,
but of Bone’s larger anxieties as he lies ‘grinding out the problems of his life, delving into the
night before to see where he had got to exactly, where he had left of’ (113).
Regret turns into the greater feeling of remorse, driven by Bone’s personal dissatisfaction
that is a product of his awareness of social inadequacy; even as he proclaims the desire to
reconnect with a more wholesome life, and renounce the heavy episodic drinking that sets
him against acceptable social norms, he knows that his devotion to Netta will draw him
back to a subservient position, playing the part of the oft-ridiculed ‘big drinking man’ (113).
Bone’s trap is sprung by his own conscience as he turns over the memories of the occasion
he caught Netta and Peter having sex at a party. Recalling how the scales fell from his eyes,
the next morning his ‘hangover was not as predicted’ (117) as, rather than misery and loss, he
experiences ‘a sense of release from Netta’ (118) through newly acquired feelings of disgust:
‘He was through now’ (116). But that break is not as decisive as it ought to be. Bone’s restored
pride is based on Netta’s corresponding diminishment in his eyes because she is ‘brought
down to the sordid level of Peter’ (118). Ties of status are inescapable. As such, it is a precar-
ious victory that is undermined the moment Netta ofers the olive branch of the Brighton
trip, and she is restored to her previous, untarnished position in Bone’s psychodrama.

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The hangover subsequent to the mortifying discovery of Netta and Peter’s relationship
that destroys Bone’s hopes, which brought with it a ‘funny feeling of calm, of release’ (117),
leads him to resolve to reduce his drinking and smarten up his act, but that decision is iron-
ically framed by the despair of Bone’s current hangover, emphasising the hellish circularity
of his position, where he fnds that it is the hope that kills: ‘He had thought, last night in
drink, that all his troubles were as good as over’ (123). Bone accuses himself of being ‘a fool
and a weakling’ (115), which derives from the fact that he has breached his pledge not to be
deceived again by Netta. More generally, Bone’s hangovers disclose the superstructure of a
class system in which his lowly status generates a sense of inferiority he cannot overcome,
loading onto the derision of Netta reprisals of his own. Recalling the dual physiological and
socio-cultural disconnection that characterises the hangover of Cheever’s Neddy Merrill, it
is noticeable that, while Bone laments his lot, his refections are punctuated by ‘the myste-
rious gurglings in pipes, the running of h. & c. in the bedrooms of his sober, God-fearing
fellow-guests’ (123), symbolising the conventional life and middle-class values from which
he fnds himself estranged through drink. Bone discovers that he is less ‘modern’ than he
would wish as age-old warnings about drunkenness provide a background accompaniment
to the sound of the hotel plumbing.
George Harvey Bone’s hangovers play host to a conficting set of values that can be un-
packed but that he cannot personally resolve. Emotional discomfort or negative afect is a
response to loss of control. Bone wrestles with a hangover of ideas and values as much as
the after-efects of intoxication. In that sense, Bone’s predicament is equally a crisis in mas-
culinity. His old-fashioned ideas of romance are made to appear quaint amidst the ruthless,
uncaring masculinity of the likes of Peter, who is established as the representative of a hard-
faced generation of new men, secretly in thrall to the brutalism of Hitler and Mussolini.
‘Couldn’t he be a man, and pull himself together, and get her?’ (121) Bone asks himself. But
the hangover works in its familiar way, erecting a bridge between past and present, in both
local and general senses, and Bone’s beliefs, which mark him out as the ‘interloper’ in Netta’s
‘alien and scornful mob’ (121), are the leftovers of an earlier, allegedly simpler time, that
prove to be insurmountable.
Bone’s hangovers are anxious afairs, and he presents diferently from other, noteworthy
working-class drinkers of fction such as Alan Sillitoe’s Arthur Seaton (Saturday Night and
Sunday Morning, 1958) or Charles Bukowski’s Henry Chinaski (Post Ofce, 1971 and Facto-
tum, 1975), the angry young men who, as Earnshaw puts it, ‘defne an authentic self in the
process of being repeatedly or continuously drunk’ (2015, 206). For these fgures, hangovers
are part of the collateral damage of heavy drinking that is more distinctively ideological,
undertaken in line with Seaton’s motto, ‘don’t let the bastards grind you down’ (1995, 76),
where pedantic bosses and toadying workmates are to be mocked and resisted. At least that
is until the social reprisals become too much to bear, as in the case of Seaton, who swaps the
hedonism of Saturday nights for the correction of acceptable working-class, married life,
symbolised by Sunday morning. Despite aiming to evade responsibility by being continu-
ously drunk in defance of orthodox values, both Seaton and Chinaski sufer humiliations
that bite the most during hangovers.
Less openly rebellious, prone to bouts of self-fagellation, Hamilton’s Bone shares
more in common with a character at the other end of the social spectrum, the wealthy,
Princeton-educated Amory Blaine of F. Scott Fitzgerald’s This Side of Paradise (1920), who
also learns, in drink, that the hangover means that his sense of masculine autonomy is in-
escapably tied to inherited values. Hangovers are emotionally crushing to those who invest
in the kind of dreams of success that are most vivid at moments of intoxication. Blaine, like

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Bone, has a code of values that, in his own estimation, set him aside from the other under-
graduates, but that, when breached, prompt melodramatic outbursts of self-recrimination.
Fitzgerald styles him as the egotist par excellence – the vanity and pride of youth as yet un-
challenged by the harder realities of life. But Blaine is also a fgure of conscience. In the most
extraordinary and disturbing sequence of the novel, the prideful Blaine loses control of both
body and mind, but more importantly self-image, during a drunken night that concludes in
a hedonistic party at the house of a young woman picked up in a nightclub by Blaine and
the inebriated Fred Sloane. About to neck a glass of brandy, which he knows would commit
him to a drunken night and meaningless sexual encounter with Phoebe, Blaine is stunned to
notice a man in the corner of the room who had been watching him in a café earlier in the
day. In a rush of paranoia, Blaine believes him to be the devil: Fitzgerald’s description of the
man’s ‘virile pallor’ and hands of ‘versatility’ and ‘tenuous strength’ are ofset by an incongru-
ous pair of pointed shoes with ‘the little ends curling up’ (2011, 130). The near-psychedelic
iconography indicates something of a moment of troubled, sexual awakening for the idealist;
the conficting messages about masculinity embodied in the ‘devil’ combine to function like
a warning sign against sinful excess and Blaine charges out of the party.
The following morning’s hangover is a personal crisis for Blaine:

How much or how little Sloane remembered Amory did not care to know; he appar-
ently had none of the nervous tension that was gripping Amory and forcing his mind
back and forth like a shrieking saw.
(133)

Sloane is able to put the event in perspective: ‘What’s the matter with you? Old remorse get-
ting you? You’d be in a fne state if you’d gone through with our little party’ (133). Walking
down Fifth Avenue, Blaine has a sudden, irrational desire to get of the street: ‘it’s flthy,
and if you can’t see it, you’re flthy too’ (133). The flthy New York street is a projection of
Blaine’s self-disgust, just as, it might be argued, the ‘sudden sickness’ (133) he feels is both
physical and metaphysical. Most remarkable is the manner in which Fitzgerald plays fast and
loose with genre as Blaine’s day proceeds frst as psychological realism, then as horror story:
‘He could feel the little hot veins on his forehead standing out, and his terror had hardened
on him like plaster. He felt he was passing up again through the thin crust of horror’ (134).
Travelling back to college, he encounters a ‘painted woman’ on the train who flls him with a
‘fresh burst of sickness’ (134) linked to the night before. The chapter then fips into the mode
of magic realism as Blaine returns to his lodgings, where both he and his fatmate, Tom, see
the ‘devil’ looking in through the window. Like all good horror stories, there is a foreboding
thunderstorm outside. Like all good horror stories, the symbolism is hard to miss: the abject
monster stalking Blaine in his hungover paranoia is himself. The devil outside is really the
threat that lies within; the horror at his propinquity to a world of vulgarity that threatens his
own ideals of romantic love but also a fragile ego that cannot admit to strictly bodily desires.
In his hangover, Blaine must come to terms with the relationship of his own principles
to, and the fact they may diverge from, a larger social context. Like Bone, there is a streak
of conservatism that fghts past his claims to alterity. Where the values at stake are most
personal, the hangover is at its worst. The terms that apply to Blaine are not, however,
the same terms that we fnd in women’s drinking literature of the twentieth century. As
Rolfe, Orford and Dalton note, women’s drinking through much of Western history has
been associated with ‘unfeminine, immoral, unrespectable behaviour’ (2009, 327) and that
women receive more judgements about things like sexual impropriety, sexual availability

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and lack of self-control. This has been attributed to the persistence of the ‘iconic position’
of wife, mother and homemaker as fundamental to ‘family sustainability’ (Staddon, 2013,
5–6), around which accrues a set of moral norms or social control mechanisms against which
women are measured and which form the superstructure of many women’s experience of the
‘traditional-punishment’ hangover response.
In the frst half of the twentieth century, the novel showcases female characters who
negotiate moral judgement in diferent ways, including Ernest Hemingway’s Lady Brett
Ashley in Fiesta: The Sun Also Rises (1926) and Christopher Isherwood’s Sally Bowles of
Goodbye to Berlin (1939). These are stylish, cosmopolitan women or ‘modern girls’ who drink
heavily in public, and make no attempt to conceal their sexual desires. Nevertheless, both
are condemned as much as celebrated, tarnished by their association with traditionally male
habits of excessive alcohol consumption. In Good Morning, Midnight (1939), Jean Rhys pres-
ents the more psychologically vulnerable Sasha Jansen who drinks to cope with the loss of
her child and breakdown of her marriage. Jansen notably develops a habit of compulsive
self-monitoring as she attempts to control, rather than deal with, her emotions through the
use of alcohol and sedatives.
Bishop’s poetry is foundational in establishing the lineaments of women’s drinking expe-
rience in the twentieth century. According to Renée Curry, ‘[t]he intersection that occurs
among alcohol, despair, and liminal space provides a trembling ground to peruse for insight
into the imagination of ’ (1999) the problem drinker. If conspicuous drunkenness tends to es-
tablish ‘stigmatizing subject positions’ (Rolfe, 2009, 329) for women, then Bishop’s drinking
poems show the emotional consequences. Generally, Bishop defects specifc attention from
the female subject by using male speakers, emphasising the inadmissible nature of women’s
drinking. However, her choice of imagery articulates her true attention. In ‘Crusoe in En-
gland’ (1976), for example, her speaker fantasises a new version of Daniel Defoe’s tale of a
castaway. His is not a story of self-reliance, but one of weakness, as the newly discovered vol-
canic island – combinations of images of fre and water often symbolise alcohol in Bishop’s
verse (Millier, 1998, 70) – on which he fnds himself adrift from civilisation sees him en-
isled by self-pity. Independence is ironically afrmed not through the survival mechanisms
undertaken by Defoe’s Crusoe, but by the dreamer’s inventiveness in turning the island’s
natural abundance into alcohol:
There was one kind of berry, a dark red.
I tried it, one by one, and hours apart.
Sub-acid, and not bad, no ill efects;
and so I made home-brew. I’d drink
the awful, fzzy, stinging stuf
that went straight to my head
and play my home-made fute
(I think it had the weirdest scale on earth)
and, dizzy, whoop and dance among the goats.
Home-made, home-made! But aren’t we all?
(2014, ll.76–85)

The efect of intoxication leads to momentary abandon, but the pride in ingenuity is likened
to drunken delusion, undermined as the verse moves away from the speaker’s claim to sufer
‘no ill efects’. There may be no physical indisposition, but there is a moral judgement in the
transferral of ‘home-made’ from the fute to the speaker. Geographically separated from ci-
vilisation, the island remains tied to recognisably inherited attitudes to women’s alcohol use.
As Brett C. Millier argues, in life ‘Bishop never acquired the knack of homemaking – that

79
 Jonathon Shears

is, of fnding a permanent place to call home’ (1998, 56) and alienation from home, literally
and fguratively, is a recurring theme of her verse (1998, 64). ‘Home-made’ becomes an
accusation directed at the female drinker: the values associated with women’s drinking are
fashioned in and refect upon their relationship to domesticity.
‘Crusoe in England’ increasingly turns upon violated images of motherhood as the speak-
er’s dreams of a splendid isolation – sustained by intoxicants – turn sour: ‘But then I’d dream
of things/like slitting a baby’s throat, mistaking it/for a baby goat. I’d have/nightmares of
other islands/stretching away from mine’ (ll.131–133). Alcohol is associated with further
haunting images of mother-child separation:
One day I dyed a baby goat bright red
with my red berries, just to see
something a little diferent.
And then his mother wouldn’t recognize him.
(ll.125–128)

Bishop’s message takes the symbolism of Defoe, but sets the drinker against herself rather
than the hostile environment. In each case, alcohol consumption leads to self-inficted pun-
ishment driven by inherited notions of acceptable femininity.
‘Home-made, home-made! But aren’t we all?’ is the theme that haunts most iconic
women drinkers in fction, including the aforementioned Sally Bowles and Sasha Jensen.
The hangovers of Helen Fielding’s Bridget Jones in Bridget Jones’s Diary (1996) are often
comically messy afairs, most notably in the case of the hangover bufet she consumes, which
consists of Emmenthal cheese slices, a litre of orange juice, a cold jacket potato, two slices
of cheesecake, a Milky Way, a ‘chocolate Viennoise dessert thing’, broccoli and four Frank-
furter sausages, to recover after one night of particularly heavy drinking (2001, 115–116).
Fielding’s point here, as elsewhere, is, however, generally less about Bridget’s physical dis-
comfort than the reasons for her self-destructive drinking and associated behaviour such as
comfort eating of this sort. Hangovers lead Bridget into uncomfortable confrontations with
her own ‘stigmatizing subject position’ and a superstructure of feminine values, despite her
assertions of autonomy as a self-identifying independent woman.
Although her self-assertive friend, Shazzer, proclaims that the pair represent a ‘pioneer’
generation of women ‘daring to refuse to compromise in love and relying on our own eco-
nomic power’ (21), Bridget feels the pressure from her overbearing mother to marry and
have children and so conform to the ‘iconic position’ of motherhood. Alcohol helps Bridget
surmount social embarrassment and silence her inner critic and she resists the prospect of
becoming what she calls a ‘Smug Married’, but her hangovers are full of self-recrimination –
‘Oh why am I so unattractive? Why?’ (16) – based around negative evaluation of body-image
and personality that she attributes to contemporary representation of women in the media:

Wise people will say Daniel should like me just as I am, but I am a child of Cosmopol-
itan culture, have been traumatized by super-models and too many quizzes and know
that neither my personality nor my body is up to it if left to its own devices.
(68)

Bridget’s mother reminds her, ‘[t]here’s nothing worse than a woman drunk, darling’ (34).
In contrast, Shazzer asserts, ‘[e]ven the most outrageous minxes lose their nerve, wrestling
with the frst twinges of existential angst: fears of dying alone … Stereotypical notions of
shelves, spinning wheels and sexual scrapheaps’ (20). The twinges of conscience are felt most

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painfully during Bridget’s hangovers. In that sense, while gender is a primary focus, these
hangovers are also always an intergenerational crisis as Bridget confronts her mother’s values.
Bridget Jones’s nerves are put under most stress during hangovers, but that is a product
of the confict of values under which she labours rather than a physiological response to
drinking – of the clash between old and new that we have repeatedly seen signifed by the
word hangover in this chapter. The diary format is the perfect medium to communicate the
episodic nature of Bridget’s drinking: the abrupt relationship between the highs of intoxi-
cation and the lows of hangovers. Bridget’s success or failure is measured against her level of
self-control around food and alcohol, every entry famously recording the number of calories
and alcoholic units she has consumed each day. Through this method, Fielding strikingly
represents the diurnal presence of self-control mechanisms.
Yet, it is notable that the confessional-style technique, in-keeping with the broader
pattern of the historical development of confessional literature, concerns itself at least as
much with the limits placed upon the drinking subject’s attempt ‘to set out a personal
identity’ (Levin, 1998, 3) as it does with the true ‘traditional-punishment’ model of re-
connection with moral norms. The ‘existential angst’ identifed by Shazzer, recalling the
‘Nietzsche-sickness’ of London’s alcoholic but also the inability to confront and resolve
the problems of the self that we fnd in Bishop’s ‘The Unbeliever’, is frustrating and trou-
bling regardless of regret for specifc drunken events. Unexpectedly, and despite the fact
that her levels of consumption are relatively low in comparison, Bridget Jones directs us
back towards the residual problem with an inexpressible sense of personal dissatisfaction
or failure that we have seen in earlier drinkers of fction and poetry. The issue is captured
by Charles Jackson’s Don Birnam who, in The Lost Weekend, cannot quite fathom why he
drinks or what it is he has done wrong: ‘you lived always in a state of mortal apprehension
of some dreadful deed committed for which, though you were called to account, you
could never bear witness’ (1989, 162).
The Kaf kaesque notion of being unable to wholly ‘bear witness’ to one’s own crimes and
therefore fully recognise and accept the drinker’s traditional narrative of crime and pun-
ishment, and adopt efective control mechanisms in response, emphasises that the hangover
problematises, even as it generates the conditions for, the individual’s confession of their
misdeeds. There is an element of ego in the likes of Cheever’s Merrill and Fitzgerald’s Blaine
that makes the idea that their problems can be explained away on the terms of the hangover’s
traditional emotional superstructure anathema to them. Hence, the reader is often suspended
from making judgements on the hangover victim even as the materials for making such a
judgement appear to lie readily to hand. This is never truer than in the case of my fnal ex-
ample of hangover literature, A. L. Kennedy’s Paradise (2004).
Kennedy recounts the self-destructive drinking behaviour of Hannah Luckraft, a young
woman who aims to defy, through being repeatedly and continuously drunk, the acceptable
standards of femininity represented by her mother. The story begins with a hangover as
Hannah, who sufers from alcohol-induced blackouts, attempts to piece together her sexual
encounter of the previous night with a married man in a London hotel. Her possession of a
credit card belonging to a Hungarian she cannot recall meeting is her only clue as to what
she has done. Over breakfast where she is forced to share a table with a middle-class family,
Hannah is disgusted to recall that the prim, anxious father was her sexual partner and she
rushes back to her room to shower, a process she describes as ‘healing’ (2015, 31). Hannah
cleanses herself of sexual impropriety, not because she feels guilty for this per se, but because
she feels contaminated by the hypocrisy that she identifes with the heart of middle-class
life: marriage.

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The ‘whodunnit’ aspect of a hangover is manifestly only a jumping of point for the
characteristic ‘who am I?’ storyline. The main plot backflls both the events that led to
Hannah’s arrival at the hotel – including her feelings of inferiority and resentment towards
her brother who had sent her to a Canadian sanitorium to dry out – and her general attitude
to life which is defned by heavy drinking, sexual promiscuity and a complete disregard for
alcohol’s impact on her physical and mental health. The tragic element of Hannah’s story is
that ‘the undiluted favour of paradise’ (187) – the perfect state of intoxication is described
in customary religious terms – exists only in her dreams. Her hungover proclamation that
‘[t]here is no current cause for gloom, or maudlin recollections of the family home and how
handy my mother might have been’ (30) appears to be a level of denial much greater than
that expressed by Bridget Jones. Hannah is eventually forced to confront the fact that ‘I
do feel remorse for every sin. Inside, I am mostly built out of remorse’ (217). Like Bishop’s
hungover women, it is the spectre of domesticity that troubles most; Hannah declares ‘with
home in my head I can’t bear to be awake’ (146). This penitent’s rhetoric chimes with the
‘traditional-punishment’ hangover reaction as I have outlined it.
Even so, Hannah does not correct her drinking habits, nor make amends as she repeatedly
promises. Her hungover pledges to reform are rapidly forgotten amidst the blackouts which
become, in a postmodern fashion, a way to avoid bearing witness to the real reasons why she
drinks and so she remains, in the fnal analysis, unfathomable to herself. Something indeci-
pherable it is claimed is left over: an impulse towards self-destruction. As much as Luckraft’s
drunkenness can be read as her defance of conventional values – a subject on which she is
candid almost to the point of shamelessness – her hangovers also pose a postmodern question
about the fragmentation of the self which cannot be successfully examined due to the foggi-
ness of near-continual intoxication. Hence, the hangover is embraced by Hannah as a release
from memory, an uncoupling of the present from the past:

Because once you’ve begun to have blackouts, you’ll never stop and so before and after
don’t exist – you’ve mastered the art of escaping from linear time. The jumps and jolts
take a bit of getting used to – driving is particularly tricky, guessing what gear you’re in,
or if you’re trying to overtake – but this keeps you bright and springy, alert. And there
is nothing unnatural about it, nothing dreadful: some level of blacking out is what lets
people survive.
(18–19)

Counterintuitively, here the hangover signifes forgetting in personal but also cultural terms.
Unable to remember what you have done the night before means not having to account for
one’s ‘dreadful’ deeds. It is a kind of functional amnesia, which Hannah claims disconnects
her not only from the events of the previous night but from the links that bind her to the
conventional narrative of crime and punishment I have charted that frames the hangover in
British and American fction and poetry.
Naturally, as a narrator whose reliability is repeatedly thrown into question by her drink-
ing, Hannah’s survival mechanism is only sustainable insofar as she is able to consume more
alcohol. Her claim to have escaped linear time is also one utterance amongst many others
that suggest the contrary. There always exists the threat that the unaccounted or unaccount-
able elements of the self that allegedly allow the postmodern drinker to cheat time, and
with it social reprisals, may only temporarily be lost. Even so, inhabiting the frst-person
narrative plane of Hannah means that there are no objective criteria from which to judge
and the reader is forced to grant that she is both fully comprehensible subject and insoluble

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riddle. Hannah fnds that the underlying reasons she feels so bad resist fnal articulation,
although if her ‘paradise’ is intoxication without the socio-cultural repercussions of a hang-
over, Kennedy hints that the wish is father of the thought.

Conclusion
In ‘The Drunkard’ (1946), Louis MacNeice describes a drinker’s train journey home af-
ter a heavy night, which becomes a larger story about the repeated ‘spiral back into time
and down towards Hell’ (2007, l.2), where Hell is both the hangover and the absence of
the heavenly feelings of intoxication. In some senses, MacNeice may be more accurate
when he also calls the journey, ‘Purgatory in reverse’ (l.1), which captures the sense of the
drinker not irredeemably damned, but rather awaiting judgement for his drunken actions.
I have presented similar motifs in a variety of hangover literature, partly to emphasise that
the hangover is so much more than just a physical experience at the withdrawal of alcohol
from the body. In this chapter, what we have seen is that the hangover is actually a com-
plex emotional and socio-cultural phenomenon that discloses the values that individuals
attach to and express through their alcohol use. The literature I have analysed shows that
the sense of being judged for one’s drinking habits is frequently felt most strongly during
the period of the hangover. My argument is that the hangover distils many of a culture’s
attitudes to alcohol, particularly judgements that are associated with the way drunkenness
is perceived to threaten moral norms, which are often tied to issues of class and status,
gender and sexuality or the family.
I have confned my attention to examples of British and American hangover litera-
tures in this chapter, but now we have seen that the hangover is not universal but emerges
from within a culture, its potential value in appraising the attitudes to alcohol use in other
alco-literary traditions, such as those in Asian and Nordic societies, should be apparent. Be-
cause what we have seen through the hangover literature I have analysed in this chapter is
that the hangover has a history. That is to say emotional responses are usually attached to our
ideas about ourselves and the way we are judged that belong to both our own time and earlier
eras. Hence, it seems to me that MacNeice is quite right to stress the movement ‘into time’,
in the sense that while intoxication is often seen as a temporary liberation from social and
personal inhibitions, the hangover witnesses their return, made most visible at times when
longstanding values and stories encounter new subject positions.
For MacNeice, the descent into the hangover as depicted in ‘The Drunkard’ means
an ‘absolute moment’ (l.19), or the consequence-free timelessness of drunkenness, is ‘dis-
placed/By moments’ (ll.19–20), which is another way of describing the social control
mechanisms that police alcohol use, whereby values otherwise located in the environ-
ment are transformed into personal codes of value. At this point in the train journey
of ‘The Drunkard’, ‘the clock takes over – time to descend/Where Time will brief us,
briefed himself to oppress/The man …/whose tongue feels around and around but can-
not taste/That hour-gone sacrament of drunkenness’ (ll.20–24). Here, coming down
from the high of intoxication involves a process very similar to what I earlier described as
a movement from myth to history. My focus in this chapter has been on that equivalent
movement, which demonstrates that the hangover is, as the word indicates, a time in
which alcohol use, along with many other personal issues, is framed by the way in which
the present encounters the recent and remote past. Hangover literature reminds us of
the personal and larger cultural reasons that explain why we so often feel bad when the
aftermath of intoxication kicks in and the clock takes over.

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References
Primary Texts
Amis, Martin (2008). The Information. [1995] New York: Vintage.
Bishop, Elizabeth (2014). Poems: The Centenary Edition. New York: Vintage.
Bunyan, John (1953). Grace Abounding & The Life and Death of Mr. Badman. [1680] London: J. M. Dent
& Sons Ltd.
Bunyan, John (2003). The Pilgrim’s Progress, ed. W. R. Owens. [1678] Oxford: World’s Classics.
Cheever, John (1964). The Brigadier and the Golf Widow. New Work, Evanston and London: Harper &
Row.
Cheever, John (1991). The Journals of John Cheever. New York: Vintage.
Fielding, Helen (2001). Bridget Jones’s Diary. [1996] London: Picador.
Fitzgerald, F. Scott (2011). This Side of Paradise. [1920] Ware: Wordsworth.
Hamilton, Patrick (2001). Hangover Square. [1941] London: Penguin.
Jackson, Charles (1989). The Lost Weekend. [1944] London: Penguin.
Kennedy, A. L. (2015). Paradise. [2004] London: Vintage.
London, Jack (2009). John Barleycorn: Alcoholic Memoirs, ed. John Sutherland. [1941] Oxford: World’s
Classics.
MacNeice, Louis (2007). Collected Poems, ed. Peter McDonald. London: Faber & Faber.
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Steinbeck, John (1958). Tortilla Flat. [1935] Harmondsworth: Penguin.
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Curry, Renée (1999). ‘A Thirst for Reverie: Alcohol, Despair, and Dream Space in Elizabeth Bishop’s
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Earnshaw, Steven (2018). The Existential Drinker. Manchester: Manchester University Press.
Elster, Jon (1999). Alchemies of the Mind: Rationality and the Emotions. Cambridge: Cambridge University
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Gerich, Joachim (2014). ‘The Inhibiting Function of Self-Control and Social Control on Alcohol
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Herring, Jonathan, Ciaran Regan, Darin Weinberg and Phil Withington (eds) (2012). Intoxication and
Society: Problematic Pleasures of Drugs and Alcohol. London: Palgrave Macmillan.
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Connection between Guilt and Self-Punishment’. Emotion. 13.1: 14–18.
Levin, Susan M. (1998). The Romantic Art of Confession: De Quincey, Musset, Sand, Lamb, Hogg, Frémy,
Soulié, Janin. Columbia: Camden House.
Millier, Brett C. (1998). ‘The Prodigal: Elizabeth Bishop and Alcohol’. Contemporary Literature. 39.1:
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Muraven, Mark, R., Lorraine Collins, Saul Shifman and Jean A. Paty (2005). ‘Daily Fluctuations in
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Span, Sherry A. and Mitchell Earleywine (1999). ‘Familial Risk for Alcoholism and Hangover Symp-
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 PART II

Social life of intoxicants

 5
INTOXICATING CONSUMPTION
Capitalism and the commodifcation of pleasure
Gerda Reith

Introduction
Intoxication has long been regarded as problematic for the order of societies. This is espe-
cially so when it is associated with particular social groups of ‘outsiders’ such as ethnic mi-
norities, women and the poor. Historically, the consumption of psychoactive or intoxicating
substances has been subject to moral panics and attempts at governance (exemplifed in the
example of the twentieth century’s ‘War on Drugs’), and can be seen as an attempt to impose
the values of sobriety and productivity on unruly populations of consumers.
Deliberate intoxication stands as a counter to the hegemony of sobriety. It also chal-
lenges ideals of rational, autonomous subjectivity. As Stuart Walton (2003) has noted in Out
of It, intoxicated subjects are also unproductive subjects, whose capacity to work, plan or
even consume in a rational manner is compromised. Intoxication undermines liberal and
neoliberal ideals of productivity, inviting instead unruly pleasure, excess and idleness. The
contemporary vernacular of intoxication – ‘wasted’, ‘annihilated’, ‘obliterated’, ‘smashed’ –
refects the insult to the values of reason and purposive action, and the overwhelming of the
‘civilized’ body by irrational disorder.
However, psychoactive substances can also be a source of pleasure. Their consumption
has long been an important form of individual self-expression as well as an integral feature
of social, collective life. Jacques Derrida (1981) noted that the concept of the pharmakon was
founded on a contradiction: being both a remedy and a poison; a source of pleasure as well as
pain. This is a dualism that continues to inform responses to intoxicating substances today.
In his general critique of classical political economy, George Bataille argued that intoxi-
cation through intense forms of consumption was a means of transcending what he described
as the ‘bourgeois’ values of restrained expenditure and reason, writing of: ‘these moments of
intoxication, when we defy everything…those moments when consumption accelerates…’
(1991, 20). Here, intoxicating consumption is framed as a hedonistic escape from ‘straight’
society, and a deliberate rejection of the values of sober, autonomous subjectivity.
Its value as a form of self-expression has also run as a countercurrent throughout history,
especially in bohemian and literary circles. In the nineteenth century, for example, Wil-
liam James described the power of drugs to stimulate those capacities ‘usually crushed… by
the cold facts and dry criticisms of the sober hour. Sobriety diminishes, discriminates, says

DOI: 10.4324/9780429058141-8 89
 Gerda Reith

no. Drunkenness expands, unites and says yes’ ( James 1902 [2012], 387). These contrasting
framings of intoxication and intoxicants as poison vs cure, and as pleasure vs pain also pos-
sess a social gradient. While the consumption of psychoactive commodities, or ‘drug foods’
(Mintz 1985) such as spirit alcohols, tobacco, sugar, tea and cofee by elite social groups was
regarded as a mark of status during the colonial era, popular consumption of the same sub-
stances by the wider population was frequently subject to critical opprobrium and censure.
At a time when the consumption of opiates was being gradually condemned and prohibited
among the urban poor, in elite circles of Victorian society, it was simultaneously regarded
as an outlet for the artistic temperament, and expressed in literary oferings such as Samuel
Coleridge’s Kublai Khan, and Thomas deQuincey’s Confessions of an English Opium Eater
(Berridge and Edwards 1987).
Today, the Romantic association of drugs with self-actualisation continues to be, for
many, one of the most meaningful aspects of drug use. Here, it stands in opposition to the
demands of rational subjectivity which, as Walton (2003) has pointed out, is above all a sober
subjectivity. For many, ‘the zone’ of drug consumption is an area which ofers escape from
the routines of everyday life in ‘straight’ society. It can be a space of creativity and authentic-
ity where people feel free to explore aspects of themselves and bond with others in ways that
are unconstrained by the rules of everyday life. Indeed, Walton argues, intoxication makes us
question the very values of sobriety and rationality, and is the one area, he says, that ‘allows
us radically to question the point of moderation as a desirable goal in itself ’ (2003, 205).
This ongoing contradiction – between pleasure and control; intoxication and sobriety – is
a theme that has run throughout history, linking various intoxicants in cycles of acceptance
and prohibition that ebb and fow according to a range of social, economic and geo-political
forces. Understanding these patterns has been the subject of a larger project described in
the book Addictive Consumption: Capitalism, Modernity and Excess (Reith 2018). However, the
focus in this chapter is on a more particular, but related, aspect. It is concerned with a recent
trend that involves the commodifcation of intoxicants, as well as the expansion of the very
concept of intoxication itself. This takes us beyond traditionally recognisable intoxicants
such as drugs, alcohol and tobacco, to a wider range of substances and experiences, from
processed foods loaded with fat, sugar and salt, to activities like gambling and gaming, the
impacts of which are described as intensely pleasurable, exhilarating or addictive.
Here, the argument is that our current landscape of intoxicating consumption has been
shaped by the wider political-economic climate of neoliberalism and the structural drivers
of intensifed consumption within it. These have produced an expansion of both the spaces
and opportunities to consume intoxicating commodities as well as an expansion of the com-
mercial possibilities of intoxication itself.

Commodifcation
From around the 1980s, many governments in the Global North adopted political and fscal
policies of neoliberalism. These involved scaling back state involvement in public life, reduc-
ing the regulation of commercial activity and encouraging privatisation and competition in
‘free’ markets. The result was that powerful corporations took advantage of loosely regulated
markets and invested in technology, communications and marketing in an efort to give
them an edge in such a competitive economic climate.
This economic system has driven the global expansion of mass consumer and leisure mar-
kets. Within them, the trend is towards increasingly intensifed forms of consumption (Reith
2018) as well as what has been described as ‘the experience economy’ (Pine and Gilmore 1999):

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dematerialised forms of consumption that provide experiential, rather than simply material, re-
wards. In this commercial landscape, the quest for excitement, thrills, pleasure and immediate
gratifcation is valorised as legitimate forms of self-realisation. Such a dynamic has long been a
driver of the growth of capitalism and has been described by Colin Campbell as a ‘Romantic
ethic’. In The Romantic Ethic and the Spirit of Modern Consumerism (1987), Campbell outlined
how the manipulation of commodities could be seen as a creative practice with a crucial role
in the realisation of selfhood. This perspective on consumption is particularly relevant in terms
of the historical shift to neoliberalism in which sovereign individuals are tasked with using
consumption to create what Giddens (1991) describes as ‘a narrative of the self ’. However, the
dynamic described by Campbell is a distinctive one, and is one in which consumer capitalism
does not actually aim to satisfy. Rather, its goal is to maintain a continual state of longing that
is projected onto an ever-changing stream of new commodities and experiences. He described
the most distinctive feature of modern consumption as an unlimited hunger for an apparently
endless list of desires, writing that: ‘the modern consumer is characterised by an insatiability
which arises out of a basic inexhaustibility of wants themselves, which forever arise, phoenix
like, from the ashes of their predecessors’ (1987, 37).
In a highly competitive marketplace, producers measure success by the ability to monetise
this dynamic: in other words, to commodify the cycle of longing, excitement and pleasure.
This is the backdrop against which corporate entities such as, for example, Nestle, Apple,
Diagao and SkyBet utilise all the commercial tools at their disposal, from consumer research
and personalised forms of marketing to new technologies and Big Data, in order to design
increasingly intensive commodities. Producers compete for profts by designing the most
exhilarating experiences, the most irresistible foods, the most alluring products. As the title
of the recent book, Hooked: How to Build Habit-Forming Products (Eyal 2014), suggests, such a
quest is now framed as a legitimate business aim. Nir Eyal uses his book as a manual for the
creation of ‘hooks’: manufactured experiences that result in ‘peak experiences’ that demand
repetition – and so increased consumption. Ultimately, the author writes, the drive to in-
tensify consumer experience means ‘we are faced with a future where everything becomes
potentially more habit forming’ (Eyal 2014, 18). This process has created a landscape of ‘hy-
per consumption’: of fast foods and mobile gambling; of instant highs and extended ‘happy
hours’, where immediate gratifcation is only a mouse-click away.
The efect of these political-economic and commercial processes can be illustrated by
looking more closely at three diferent forms of intoxicating consumption: drugs, food and
gambling. These are the subject of the remainder of this chapter.

Drugs: intoxicating consumption

The psychoactive substances generally described in penal-medical terms as ‘drugs’ are per-
haps the paradigmatic instance of intoxicants. Although long regarded as problematic, they
are also pleasurable, as well as highly proftable, commodities. This contradiction was not
lost on William Burroughs, who wrote:

‘Junk is the ideal product. The ultimate merchandise. No sales talk necessary. The client
will crawl through a sewer and beg to buy’.
(William Burroughs 1953, vii)

As Burroughs’ quote suggests, drugs can be regarded as exemplary products of consumer

capitalism. They can provide intense pleasure and exhilaration as well as ofering release

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from stress and escape from boredom. Their efects are transient; their pleasures feeing and
sometimes habit forming. All require repeat purchase, as Burroughs was aware. The latter
point means that their lucrative potential is particularly salient in a system of consumer
capitalism. It is a feature that Robin Room highlighted in his description of alcohol as ‘a
quintessential habit-forming commodity [which] along with other psychoactive substances,
is [ ] ideal for building and sustaining markets’ (2015, 141).
It is undoubtedly the case that a range of such commodities, from sugar, tobacco and
cafeinated drinks, to a whole variety of pharmaceutical products, are central to the profts
of multinational corporations like Big Pharma and Big Sugar, Big Alcohol and Big Tobacco.
All of them are descended from the ‘drug foods’ of the colonial era which, as a number of
writers have pointed out, were integral to the creation of the international system of trade
that imperial power rested on (Courtwright 2001; Bancroft 2009). Carl Trocki made clear
the signifcance of psychoactive commerce for the development of capitalism, writing that
‘the entire rise of the West from 1500–1900 depended on a series of drug trades’ (1999, xii).
From roughly the 1990s, a range of commercial, political-economic and ideological fea-
tures associated with neoliberalism converged to produce an expansion of the spaces and
opportunities to consume psychoactive substances in what can be described as ‘intoxicating
environments’ (Reith 2018). During this period, a range of ‘soft’ drugs were joined by new
types, such as ‘legal highs’, ‘smart drugs’ and designer drugs, and these merged with the
consumption of licit substances such as alcohol and tobacco. This psychoactive cornucopia
increasingly came to feature in the leisure patterns of young people, and was described as a
shift towards ‘normalisation’ whereby the recreational consumption of drugs moved from
the margins to the centre of youth culture (Parker et al. 1998).
In Britain in particular, the liberalising agenda of the New Labour government in the late
1990s and early 2000s relaxed licencing and regulatory requirements around alcohol, creating a
situation in which alcohol became cheaper, stronger and more readily available than ever before.
The alcohol industry capitalised on their new freedoms, developing new types of products, as
well as benefting from increased numbers of licenced premises from which to sell them. As well
as dominating the night time economy, the industry also expanded into digital space by mar-
keting products on social networks such as Facebook and Twitter, so generating the creation of
what Grifths and Casswell have described as ‘intoxigenic digital spaces’ (2010). Unsurprisingly,
the result of all this commercial activity was the encouragement of what Measham and Brain
(2005) call ‘determined drunkenness’: quite simply, the act of drinking to get drunk.
During the same period, the trajectory of cannabis moved away from long-standing as-
sociations with deviance and groups of ‘outsiders’ and towards the commercial mainstream.
The legal cannabis is predicted to be worth $91.5 billion by 2028 (Bloomberg 2021). The
industry is organised along conventional business lines, with regulations around product
quality and packaging, and the development of luxury products and specialist stores. This
commodifcation has been fuelled by a range of factors, including regulatory realignment
as well as the shifting status of the groups who consume it. As Joseph Gusfeld pointed out
in 1963, defnitions of acceptable or unacceptable behaviour are partly formed by the power
and status of those social groups doing the defning. This kind of ‘status politics’ has been
at work in the case of cannabis. Away from the dropouts and hippies of the counterculture,
many advocates for the drug are now drawn from the ‘respectable’ middle class: medical
professionals, academics and law enforcement agencies. Alongside this association with more
powerful mainstream groups is the linking of cannabis with medicinal benefts. Its role in
alleviating pain and sickness rather than simply generating pleasure conferred legitimacy by
redefning intoxication and paving the way for commodifcation.

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This process can also work in the opposite direction, when psychoactive commodities
intended solely to alleviate sufering, such as medical forms of opiates, tranquilisers and
barbiturates, are repurposed for pleasure and bought and sold in the black market (Inciardi
and Cicero 2009). Although this kind of cross boundary slippage is not new, the advent of
technologies such as the internet, websites like the Silk Road and the manufacture of new
kinds of ‘legal highs’ have made it much more streamlined and have fuelled the expansion of
the trade in intoxicating commerce in cyberspace (Power 2013).
Status politics also infuenced the normalisation of the drug Ecstasy (MDMA). Consumption
by middle-class young people helped undermine long-standing associations of ‘drugs’ as a ge-
neric class of intoxicants with urban deprivation and social dislocation, and paved the way for the
growth of commercial subcultures based on music and fashion. Ecstasy tablets themselves came
to symbolise the commodifcation of intoxication, with pills stamped with the brand logos of
corporate capitalism, such as the distinctive emblems of McDonalds, Nike and Versace.
With the imagery of drugs like Ecstasy adopted by the mainstream, with cannabis in-
creasingly reconfgured as respectable, with ‘legal highs’ available online and with the in-
creasing variety and availability of strong, cheap alcohol, the boundaries between legal and
illegal; between drug and commodity and between forbidden and licit pleasures become
increasingly blurred. In a situation in which, as Parker et al. put it, ‘illegal drugs have become
products which are grown, manufactured, packaged and marketed through an enterprise
culture whereby the legitimate and illicit markets have merged’ (Parker et al. 1998, 25),
intoxicants have become commodifed as the ultimate consumer experience.

Te expanding landscape of intoxication

The broad category of ‘drugs’ can be seen as the paradigmatic example of intoxicating con-
sumption. But recently an increasingly wide range of substances and experiences have come
to be described in similar terms. From fast foods to the kinds of human-machine interactions
with technology involved in internet and smartphone use, and activities like gambling and
gaming, the concept of intoxication (along with its close semantic ally, addiction) has ex-
panded. This expansion has been driven by a number of factors within neoliberalism more
generally. In particular, by corporate eforts to commodify, and so proft from, an expanded
understanding of intoxication, as well as new ways of thinking about the concept of intoxi-
cation itself that were produced by neuroscientifc forms of knowledge.
Towards the end of the twentieth century, neuroscience came to attain scientifc and
cultural hegemony in understandings of intoxication, initially with respect to narcotic
drugs, but later gradually expanding to encompass a wide range of commodities and ex-
periences. This perspective was spearheaded by the infuential U.S.-based National In-
stitute on Drug Abuse (NIDA), and, from the outset, was tied up with understandings of
addiction. Powerful brain scanning and imaging technologies were utilised to look into
the ‘black box’ of the human brain to see what happened when individuals were exposed
to stimulating, pleasurable experiences: initially, those derived from the consumption
of substances like heroin and cocaine. From this vantage point, scientists produced new
understandings of subjective states, based on what was described as a ‘common path-
way’ in the brain’s pleasure centre that was ‘lit up’ by powerful pleasurable stimulation.
Ultimately, this mechanism was regarded as responsible for the generation of intoxi-
cating – and also addictive – states. So, from the outset, understandings of intoxication
were entwined with ideas about addiction – a state to be controlled and medicated, or
otherwise removed from orderly society.

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The application of these forms of knowledge was not limited to the efects of illegal drugs
for long. As the insights from neuroscience were drawn on to explain a wide range of human
behaviours, so its potential for probing the material ‘source’ of intoxication in consumers
came to be of immense interest for the corporate realm. So, at the very point at which the
mass leisure, entertainment and fast food industries were growing, these forms of scientifc
understanding were also expanding to a wide range of commercial applications in an efort
to better understand – and so monetise – consumer desire. Fortuitously, in the lab at least, it
appeared that the ‘common pathways model’ did not distinguish between the kinds of sub-
stances or activities that could generate pleasure. Not only heroin, but also Coca Cola, fast
food, shopping and gambling could all ‘light up’ the zone. Such understandings opened the
way for the commercial application of scientifc forms of knowledge, and was mobilised by
Big Business, particularly in felds such as neuromarketing, in eforts to understand, and so
proft from, the pleasure centres of their customers.
Alongside a range of other commercial strategies, these insights have been utilised,
particularly by the food and gambling industries as part of their aim to manufacture more
intensive, more alluring, more habit-forming products. These are the subject of the next
section.

‘Big Food’: craving and ‘the bliss point’

The global food industry – ‘Big Food’ – has mined neuroscientifc knowledge to commodify
the intoxicating potential of their products. In the pursuit of their over-arching goal, neatly
summed up by Marion Nestle (2002), as persuading people to ‘eat more’, they have adopted
a number of strategies. These include tactics such as supersizing, discounting and product
placement, as well as lobbying, sponsorship and heavy investment in marketing and public
relations. All of this is made possible, of course, within a political-economic climate in
which the state has relaxed regulatory restrictions of the industry, while encouraging com-
mercial competition and supporting key sectors (such as the sugar industry) with protection-
ist economic policies. As a result, the convenience and fast food industry has generated an
environment in which cheap, energy-dense foods are available in greater varieties, in more
places and larger quantities than ever before.
But one of the industry’s most notable tactics, from the point of view of a study of in-
toxication, has been its scientifc engineering of foods in the quest for the key properties of
taste, known in industry circles as ‘the bliss point’. This is the point at which combinations of
sugar, fat and salt, along with optimal consistency, are synthesised to create ultra-processed
foods. The bliss point has been described as ‘the defning facet of consumer craving’ (Moss
2014, 30). The elusive qualities of this ultimate ‘hook’ are the key drivers of industry at-
tempts to generate intense sensations of pleasure (that, naturally, require repeating) in new,
ever more appealing food products. It is a quest which has led a number of the largest compa-
nies to invest heavily in brain imaging technologies and research in attempts to examine how
customers react to foods. In such experiments, fMRI scanners reveal that the sight, taste and
smell of foods high in fat, sugar and salt – described as ‘hyper palatable’ – ‘lights up’ the same
regions of the brain as those of conventional narcotics, travelling along the same neurological
pathways to reach the brain’s pleasure zone, where they generate intense feelings of euphoria.
Once there, the chemistry of these processed foods continues to act like a drug, generating
feedback loops of reward and withdrawal (Fraser et al. 2014, 204); pleasure and pain, which
require repeated consumption to satiate. As the popular brand, Lays, once boasted in promo-
tions for its potato chips, ‘Betcha can’t just eat one!’.

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The result of all this commercial activity has been a proliferation of cheap, processed,
energy-dense foods. Their distribution has a social and geographical gradient, with both
food outlets and marketing concentrated amongst low-income and ethnic minority groups.
As with the conditions for the spread of ‘intoxicating environments’, such a system also
contributes to an expansion of whole environments that have been characterised as ‘obe-
sogenic’ (Swinburn et al. 1999). The health consequences have a similarly social gradient,
with low-income population groups sufering disproportionally from a range of conditions
related to obesity.
Products that are packed with sugar, fat, cafeine and salt, and scientifcally engineered
to deliver maximum pleasure make them akin to mildly psychoactive substances. Tellingly,
the derogatory shorthand ‘junk’ that is often used to describe them is also slang for heroin,
an association that draws attention to their psychoactive and experiential aspects. And, like
drugs, these foods provide an experience that is typical of consumer culture itself: pleasurable
and yet transient; consumed quickly and so requiring constant repetition. In this, today’s
‘junk foods’ have some similarities with their historical predecessors: the psychoactive com-
modities or ‘drug foods’ of the colonial era.

‘Big Gambling’: into ‘the zone’

The gambling industry – or what Markham and Young (2015) call the ‘state-industrial
complex of “Big Gambling”’ – shares similar features with Big Food, both in its commodi-
fcation of experience and in its commercial strategies. Gambling companies have benefted
from the neoliberal trend towards greater deregulation of markets, often as a result of po-
litical lobbying and sponsorship which has provided them with unparalleled opportunities
for expansion. They also beneft from globalised fnancial systems, communications and IT
platforms and from sophisticated forms of technology, all of which have allowed them to
produce faster and more intensive products. The Big Data harvested from these technolog-
ical systems is used to generate aggressive and often targeted marketing of their products in
ways that normalise and promote them further (Reith 2014). The expansion of the products
and images of commercial gambling throughout the spaces of everyday life has generated
what I have elsewhere described as ‘aleatory environments’ – from the Latin word alea to
gamble – where devices like smartphones and widespread internet access make games avail-
able at the click of a button.
The gambling industry exemplifes the promotion of experiences based on risk taking and
thrills rather than tangible commodities, making it a prime example of both the experience
economy (Pine and Gilmore 1999) and a quintessential type of dematerialised consumption
(Reith 2014). It has harnessed technological and fnancial systems to generate games that are
increasingly fast and repetitive, and that circulate money, often dematerialised as credit and
other cashless technologies, in cycles of loss.
These trends are particularly encapsulated by electronic gaming machines (EGMs), as
well as by the recent ascendance of digital and mobile forms of gambling. The anthropologist
Natasha Dow Schüll (2012) has documented the tactics used by industry to create machines
that are manufactured for the extraction of proft, or what she describes as ‘addiction by
design’. In this respect, Big Gambling, like Big Food, mobilises marketing, design and tech-
nology in an efort to intensify consumption and produce particular subjective states. For
example, every aspect of casino architecture, ergonomics and ambience is crafted to keep
people gambling for as long as possible in order to maximise what is known in industry cir-
cles as ‘time on device’. Low ceilings and an absence of clocks along with optimal levels of

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sound, lighting, colour, temperature and even odour are calibrated to generate an ambient
climate that encourages individuals to lose track of time and money. Products, in terms of
both games themselves, as well as the devices they are played on, from electronic machines
to smartphones and consoles are carefully designed to produce an optimal experience. The
trend is for games that are more immersive, with sophisticated graphics, customised interac-
tion, feedback loops and cashless technologies that produce a seamless experience. As well as
making fnancial loss invisible, these kinds of features accelerate play and generate hypnotic
states in which, for players, the outside world ceases to exist (Schüll 2012, 64).
These strategies work to produce distinctive subjective states that have been described by
players and researchers alike as the experience of ‘the zone’ (Reith 1999, Livingstone 2005,
Schüll 2012): an afective, trance-like condition in which gamblers’ surroundings, the passage
of time, the value of money and even their sense of self are dissolved by the immersion in in-
tensive play. Like the kind of peak experience described by Csikszentmihályi (1990) as ‘fow’,
gamblers in the zone are fully focused on the here and now, in hypnotic rhythms of play.
As is the case in other industries, neuroscientifc knowledge has been invoked to explain,
and also accelerate, the impact of these commercial features on customers’ brains. The ap-
plication of fMRI technologies has again been used to suggest that gambling activates the
reward system in much the same way that a drug does, with brains ‘lighting up’ in fMRI
scanners when exposed to images – usually via a video screen – of gambling wins (Potenza
et al. 2003). Biological markers and cognitive defcits have also been proposed as explana-
tions for the highs, euphoria and cravings induced by gambling (van Holst et al. 2010).
Across a wide range of commercial activity, particularly the three areas of drugs, food and
gambling discussed here, the result of these political-economic and scientifc processes has
been both an intensifcation and an expansion of consumption. Psychoactive commodities,
cheap, energy-dense foods and commercial gambling are increasingly available and pervasive
throughout everyday life, in environments that can be described, respectively, as, intoxicat-
ing, obesogenic and aleatory.
These processes also produce particular forms of subjectivity. So, for example, the engineer-
ing of foods to encourage people to ‘eat more’ generates the experience of the ‘bliss point’, while
the design of gambling machines to encourage players to extend ‘time on device’ creates ‘the
zone’. In this, we can see the convergence between commercial understandings of the ‘bottom
line’ and medicalised understandings of intoxication and addiction. The ‘bliss point’ has its
counterpart in ‘the zone’: the neurological basis of pleasure, as well as the location of proft. What
makes fast food taste so good is similar to what makes machine gambling so appealing, and both
underscore the ability of intoxicating consumption to undermine self-control and sobriety.

Governance
This system of modern consumerism rests on a contradiction. The same political-economic
drivers that commodify and encourage intoxicating consumption also produce another de-
mand: namely, for individuals to exercise restraint. This means that, even as they are per-
suaded to engage in the intoxicating pleasures of the market, consumers are exhorted to
control their desires and maintain a sober responsibility for their own well-being.
This tension is the latest manifestation of a long-running dualism in Western societies
that has been described by writers from Aristotle and J.S. Mill to Freud and Max Weber. In
various ways, they talk in terms about the taming of the unruly appetites of the body by the
civilising efects of society. More recently, Daniel Bell (1976) described what he termed ‘the
cultural contradictions of capitalism’ as the requirement to balance a production-centred

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ethic based on self-discipline and control with a consumerist one based on instant gratifca-
tion and pleasure. All of these accounts, in one way or another, have been concerned with
the wider theme of control and its necessity for the orderly functioning of society.
Today, this enduring requirement for control is deployed largely through neoliberal ideals
of responsibility and is set against the supposed excesses of intoxicating consumption. The
ideology of responsibility is a cornerstone of neoliberal systems of governance. It rests on the
key normative values of autonomy and rationality and is an aspect of what Foucault (1991)
described as ‘governmentality’. This is a key feature of power in neoliberal societies. As the
state has reduced its presence in the regulation of public life, individuals are increasingly
tasked with governing their conduct through various forms of self-control. In this way, the
state is able to govern ‘at a distance’, often without exerting direct disciplinary power, but
rather through shaping the subjectivities and behaviour of individuals who then act as will-
ing participants in their own control.
These kinds of governance are an aspect of what Pat O’Malley (1996) describes as a
‘new prudentialism’ in which the ongoing management of consumption becomes a primary
means of self-realisation, health and well-being. In it, the seductions of the market are to be
countered by self-governing individuals, who manage desire and restrain excess in cultur-
ally appropriate ways. Here, responsible consumption becomes evidence of the ‘right’ way
to live; the ‘right’ way to be. As a corollary of this individualising and normative project,
the individual is also regarded as the site of blame when things go wrong. So, problems
of uncontrolled consumption – intoxication and addiction, overeating and obesity, binge
drinking and gambling – tend to be framed as failures of individual behaviour, rather than
as side-efects of the system of consumer capitalism itself.
These tensions run through the three examples discussed in this chapter, where exhor-
tations to ‘drink responsibly’ are matched with reminders to ‘gamble responsibly’ and ‘eat
healthily’. Even consumption of the most archetypal type of intoxicant – drugs – is permit-
ted, albeit within the shibboleths of ‘controlled’, ‘informed’ or ‘responsible’ behaviour, and
guided by the principles informed choice and harm reduction.
In the case of the latter, governance is based less around disciplinary forms of control and
binary distinctions between legal/illegal, and more around ideals of controlled/uncontrolled
consumption that is enforced and monitored by individuals themselves. Ultimately, it works
to produce what Angus Bancroft (2009) has described as a ‘carefully managed hedonism’ as a
counterpoint to the expansion of psychoactive consumer culture. Researchers of illicit drug
consumption have described this in various ways, with Johanna Jarvinnen (2012) writing of
drug users as ‘rational risk managers’ and Fiona Measham (2004) describing a loss of control
that is at the same time ‘controlled’. Pat O’Malley’s statement on the issue, which once would
have read as an oxymoron, now sums up the contradictory nature of consumption under
conditions of neoliberalism. As he puts it, ‘as rational, calculating risk-takers, [consumers]
enter the sphere of “responsible drug use”’ (1999, 205).
Similar trends are in play around alcohol. At the same time that the alcohol industry
promotes cheaper and stronger drinks, it warns its customers to ‘drink responsibly’: a tag
line that accompanies every advertisement and cut-price promotion. The economic and po-
litical processes that saw the expansion of a culture of heavy drinking in British culture also
produced a contradictory trend in which ‘excessive’ drinking came to be defned as a coun-
terpoint to neoliberal ideals of responsible consumption. The social gradient of criticisms of
intoxication was apparent here in the framing of the ‘binge drinker’. This fgure, which was
heavily classed and gendered, was a focus for widespread disapproval over the ostentatious
drinking of mainly white working-class women, whose public displays of intoxication were

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framed as a fouting of ideals of ‘feminine’ behaviour and a signifer of more general irre-
sponsibility and promiscuity (Skeggs 1997, 967).
Meanwhile, the corollary of a global food system that promotes fat- and sugar-laden
foods that are scientifcally designed to induce craving is what has been described as an
‘epidemic of obesity’. Such a state is framed as one that threatens both individual health and
national efciency (Schrecker and Bambra 2015) resulting in a climate in which tensions
around food are consistently articulated in concerns about self-control and productivity.
Here, the key message of the system of Big Food – ‘eat more!’ – is countered by the equally
strident demands of healthy – and therefore responsible – eating: ‘eat less!’ It is accompanied
by exhortations to eat healthily, to exercise willpower, to control appetite and to engage in
ongoing care of the self. And so, monitoring diet, counting calories and rejecting ‘junk’ are
counterposed to a commercial landscape of supersized soda and Big Macs.
It is in this context that writers such as Susan Bordo (1993) have described how the con-
sumption of food is invested with wider metaphorical meanings, with ideas about obesity rep-
resenting more general cultural fears about loss of control, unmanaged desire and unproductive
bodies. On the one hand, the ft and – crucially – productive bodies that are assumed to result
from healthy eating are framed as visible signs of willpower, and so markers of responsible citi-
zenship. On the other, overweight bodies are taken as evidence of a failure to tame appetite and
so a burden on healthcare and society more generally. In such a framing, we can see the ‘de-
structive’ nature of consumption counterposed to the rational and orderly values of production
in a manner that recalls long-standing historical dualisms. The tension between self-control
and abandon are made visible on the human body in very literal ways where the overweight
frame is a physical representation of consumption that is out of control (Reith 2018).
Gamblers are faced with similar normative demands to act ‘responsibly’. As the gambling
industry produces ever more intensive games intended to produce maximum ‘time on de-
vice’, and promotes and makes them widely available throughout aleatory environments,
gamblers are exhorted to resist. Their task is to inform themselves about risk, manage their
money responsibly, control their impulses to avoid slipping into ‘the zone’ and – as if it were
that simple – ‘when the fun stops, stop’ as the U.K.’s industry-body’s Senet Group strap-line
tells them. In recent years, gambling corporations have embraced this ‘responsibility agenda’
and have made much of their commitment to a range of measures, all of which are based on
warning individual players about the potential risks of gambling and ofering them similarly
individualised solutions should they develop problems. These measures generally amount
to supporting awareness raising campaigns and ofering voluntary limit-setting schemes,
of questionable efcacy, that put the onus of for example, setting limits on expenditure and
banning themselves from venues, on to gamblers themselves.

End points
The celebratory, but also destructive, aspects of a range of intoxicating commodities repre-
sent the dualism of the pharmakon. Various substances have long embodied this contradiction
but today, their place in a system of consumer capitalism brings about new dimensions. The
commercial potential of a range of substances, activities and experiences has been embraced
by companies who, operating in relatively unrestricted and highly competitive markets, have
endeavoured to produce the most pleasurable and habit-forming products and services. In
short, they have commodifed intoxication.
In so doing, they have encouraged the production of what Scott Vrecko has elsewhere de-
scribed as a ‘landscape of temptation and excess’ (2010, 559). At the same time however, action

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within this system is subject to contradictory pressures. The same political-economic system that
produces temptation and excess also demands that individual consumers resist it. It is in this sense
that Guthman and Du Pois’s claim about the conficting aspects of the modern food system has
wider resonance. Just as, as they put it, neoliberalism ‘encourages (over) eating at the same time
that neoliberal notions of discipline vilify it’ (2006: 437), so the neoliberal system encourages the
consumption of intoxicating commodities and experiences at the same time that neoliberal no-
tions of responsibility demand self-control and sobriety. Ironically, at the very point that the state
rolls back its regulation of markets and consumerism proliferates on a global scale, responsibility
for its control has become overwhelmingly an individualised concern.
And, because all of this is a normative venture, those who fail to control their behaviour
are presented as fawed consumers, an unproductive minority who are lacking self-control
or personal responsibility, and are, therefore, also blameworthy. In diferent ways, and at
diferent times, those who have succumbed to the pleasures of intoxicating consumption
have been regarded as outsiders, as deviants, and been subject to critical discourses based on
normative-medical concerns about health and productivity.
The individualising focus of ideas about responsible, controlled, sober and productive con-
sumption ultimately acts as a discursive sleight of hand. The emphasis on the shortcomings of
individual consumers, rather than the wider political, commercial and regulatory environment,
shifts the focus of the problems of intoxicating consumption away from those who enable and
produce it and towards those who consume it in a way that supports the corporate status quo.
All of this is part of a long-running concern in Western thought about the need to subjugate the
unruly pleasures of the body to the civilising force of society. Today, the enduring historical ten-
sion between control and restraint is realised in the pairing of intoxication with responsibility:
the latest in a long line of the many contradictions of capitalism.

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 6
PRODUCING PLANNED
HEDONISM AMONG
OPIATE USERS IN AN
ONLINE DRUG MARKET
Angus Bancrof

Introduction: markets embed a specifc formation of illicit drug culture

The purpose of this chapter is to outline how a specifc type of online drug-focused mar-
ketplace produces drug dealer and user subjectivities. Typically, illicit drug distribution can
be characterised as taking place between three diferent distribution modes. In one corner,
there is social supply with principles of mutuality, reciprocity and a fat network distribut-
ing arrangement (Coomber and Turnbull, 2007). In another, there is distribution through
market exchange which prioritises the cash nexus, proft/value incentives and relationships
mediated by consumption (Felstead, 2018). Finally, there is a third mode, that of ideologi-
cally driven, altruistic supply that emphasises the drug and its use in a political, ideological
or spiritual relationship (Tupper, 2008). That broad brush typology is then complicated by
many nuances and subtleties in practice (Hammersvik et al., 2012). The distribution modes
may involve varying degrees of exploitation and obligation, they may promote practices of
care or generate harm and they may expand drug distribution or keep it within a tightly
bound social and cultural context (Belackova and Vaccaro, 2013; Coomber and Moyle,
2014). Diferent distribution modes and self-representations may occupy the same technical
infrastructure and market space (Bakken, 2020; Demant et al., 2018).
The generalisation of market exchange as a mode for illicit distribution and organisation
has had wide-ranging efects on how drug users obtain and consume drugs. As has happened
more broadly in capitalist societies, we have seen an expansion in the conscious use of market
forms for identity formation, self-creation and expression (Dijck et al., 2018). Market prin-
ciples validate certain qualities in products, sellers and users: professionalism, the capacity
to make objective judgements, to act as self-directed, accountable agents, and they invite
drug users to express themselves as instrumental, refexively hedonistic consumers (Turner,
2018). Like markets, which they increasingly are integrated with and identifed with, dig-
ital technologies are both disruptive and confrmatory. They transform opportunities for
illicit drug exchange, the formation of cultural collectives of drug users and the capacity for
self-creation. They also confrm and reproduce some existing hierarchies, especially those
between self-identifed recreational and dependent users. They create new spaces for trade
and discussion, defne new attributes and foreground the experimental and the competitive
(Martin et al., 2019). That has implications for how we understand drug use normalisation as

DOI: 10.4324/9780429058141-9 101

 Angus Bancrof

happening through markets. The drug distribution mode afects the parameters of normal-
isation. Social supply contributes to normalising particular use patterns and destigmatising
their use (Coomber et al., 2015). Self-organising digital markets can broaden that to pro-
mote and embed norms of destigmatisation and harm reduction. However, foregrounding
a market-focused engagement with drug distribution can produce unwanted efects for use
communities. The process may concentrate market power, promote bulk purchase over re-
tail, create supply chain risks and ultimately increase dealer power. It can and does alter the
nature of the products being sold, altering characteristics such as potency.
Cryptomarkets are one such example of market innovation forming the focus of this chap-
ter. They are hidden, anonymous marketplaces which mostly deal in illicit drugs along with
some other illicit goods and services. They are hosted on the Tor (‘The Onion Router’) dark-
net. Tor is developed and operated by a network supported by The Tor Project foundation.
It emphasises benefts of privacy and security. The system uses encryption and signal routing
to hide participants’ digital identities. The markets are hosted by administrators who connect
their servers to the Tor system. This is called ‘onion hosting’. Along with the use of a dis-
tributed cryptocurrency, typically bitcoin, cryptomarkets allow transactions to take place in
relative anonymity. Drugs are bought and sold, and then delivered to the buyer using couriers,
the postal system or dead drops. Mostly, they handle the ‘last mile’ of the drug trafcking
system. Their social profle varies. Many sellers, buyers and market hosters are based in more
afuent countries, and within that they represent a more connected and afuent fraction of
users (Dittus et al., 2017). However this mode of distribution is widely used in Russia along
with the Telegram encrypted messaging app (Davitadze et al., 2020). Users are a specifc de-
mographic – not necessarily more afuent but digitally skilled and adept at operating with this
kind of market. Cryptomarkets function as a drug distribution ecosystem and forum for drug
users and sellers to meet virtually and examine the drugs being sold, the reliability of sellers and
the desirability of particular drug efects. They also provide sites of contestation of the illegality
and stigmatising of illicit drugs (Barratt et al., 2016; Hübschle, 2017).
I am focusing on market modes of distribution and the efect they have as it provides an
opportunity to examine how the process of drug distribution shape intoxication subjectivi-
ties and the drug as a specifc type of object with tangible characteristics. Market-based drug
distribution embeds some basic principles about drugs as objects: that they are commodi-
ties, they are interchangeable, that they are consistent in form and predictable in quality.
It also frames drug users as specifc types of subjects: they are consumers, they are focused
on product qualities such as purity and they expect and reward customer service by deal-
ers. It emphasises competition between drug dealers and between consumers. Just to pause
here: not every market really does that in practice, and as we will see, apparently open and
consumer-led markets can in fact concentrate power among a small number of providers
who can set the terms of trade. In this way, the illicit drug markets function much like cap-
italism everywhere. An apparently open, free and voluntary relationship really depends on
the consumer adapting themselves to the terms of trade ofered. It narrows the drug users’
self-perception to that of a drug consumer focused on calculated, planned hedonism, meaning
an expectation of pleasure along with a risk-refexive subjectivity (Bilgrei, 2019). That is a
powerful ideological efect of a market society and culture. The focus of this chapter will be
a specifc element of that, how drug buyers in cryptomarkets construct, assess and reward
potency as a tangible quality of the drugs they are buying and using.
In capitalist societies markets are often presented as naturally occurring creations, places
where people with something to sell and others with a need to fulfl meet in mutual ex-
change. This is a powerful view in understanding some qualities of illicit markets, and

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 Producing planned hedonism

moving away from pathologising the actions of drug dealers and users within them. Markets
are places of competitive exchange and they come into being to address problems of stability,
predictability and reliable valuation (Beckert and Wehinger, 2012). Markets are also inven-
tions, social constructs which institutionalise, design in and reward specifc ways of being.
Players in illegal markets face various problems. They have to succeed in making their activi-
ties work together despite relations being disparate, remote, and feetingly interacting. There
is a problem of ordering interaction in ways that will lead to the expected outcome. Market
actors want to exchange but they want to do it at a price that suits them. That can be tricky
to agree; hence, formal pricing mechanisms are handy. Every participant is risking some-
thing, and this is more the case in illicit markets. Therefore, participants use heuristics to
reduce that risk – platform loyalty, brand loyalty, vendor loyalty and markers of quality and
reliability which of course may not be that reliable. Markets can only solve these problems
if they are culturally, socially and institutionally supported (Beckert, 2009). Drug markets
are institutionalised whether in the street (Coomber and Maher, 2006), social media (Moyle
et al., 2019) or the darknet (Aldridge and Décary-Hétu, 2016).
Digital illicit markets and cryptocurrencies promise greater transparency, democracy
and accountability but this is not necessarily borne out in reality (Bratspies, 2018; van
der Gouwe et al., 2017). To the extent to which these qualities do come about, they are
due to the eforts of participants and sometimes involve circumventing or resisting the
centralising, proft-driven logic of the markets themselves. I argue that the cryptomarkets
discipline users towards a specifc set of stances and towards the drugs they purchase: that
the drugs they buy are ‘good’ drugs – both in the sense of legitimated and also being of
the most suitable quality and efect, and that drugs are or should be informationalised and
commodifed as consumer products. Users adopt a tendency to reify, quantify and engage
in cost beneft analysis and rational use discourse about their drug consumption. They
show willingness to accept harm as a necessary and sometimes welcome risk as long as it
allows for users’ agency. There are some partial exceptions to the focus on drugs as prod-
ucts, particularly in the feld of psychedelic use where user communities often resist com-
modifcation. Those precepts foreground a market efect in our analysis in that the supply
chain matters in shaping what is being bought and consumed, and how it is consumed. The
buying and distribution infrastructure places users squarely in the hyper-modern category
of risk-refexive, hedonistic consumers.

Research
The chapter draws on research from a drug cryptomarket. Discussion forum data were col-
lected from a leading cryptomarket, Agora, from 2014 to 2015. Agora was dominant in the
cryptomarket ecosystem before voluntary closing after succumbing to technical and organ-
isational problems. Launched in 2013, it survived the coordinated takedown of cryptomar-
kets in Operation Onymous in 2014 and thrived afterwards (Décary-Hétu and Giommoni,
2017). For this paper 3,500 posts were coded from the whole dataset to understand the
relationship between market use and the self-orientations of opiate/opioid users. The focus
of my analysis of Agora was on opiate users’ threads, as after reviewing the dataset potency
was a theme to the fore in opiate buyers’ and sellers’ discussions. It was critical to their un-
derstanding of the cryptomarket as a useful mode of drug distribution. Discussions of psy-
chedelic and other drug use were included for comparison. The threads discussed a variety
of drugs as users consumed many diferent drugs alongside opiates. Their drug repertoires
included Xanax, benzodiazepines, cocaine and amphetamines.

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 Angus Bancrof

Making the drug

Intoxicants are valuable commodities (Reuter and Greenfeld, 2001), risky objects generative of
human subjectivity (Fraser and Valentine, 2008; Vitellone, 2004), totemic and productive cul-
tural entities (Fitzgerald, 2015), efective technologies of governance (Seddon, 2009) and facil-
itators of social life which articulate and afrm social order (Fraser and Moore, 2011). Drugs as
objects carry all of these elements which shape their efects in the world. They go into defning
whether a drug is a good or bad object and in what terms. I examine potency as a biochemical
matrix composed of diferent elements – predictability, purity, consistency, lasting efect and
pharmacokinetics. The relationship between the substance and the body is critical: the phar-
maceutical lasts in the body, metabolises and leaves traces and memories (Dennis, 2016). This
efect is a material and social product, a human and non-human assemblage (Dennis, 2019).
Power is composed of chemical potency and potency is a political quality. The two compose the
intoxication consumption regime, the ontological politics of the drug (Fraser, 2020).
There is a recurring pharmaceutical myth that diferences in drug efect are largely pro-
duced by diferences in chemical purity and stability. To move away from that, the triptych
of drug, set and setting was identifed by Zinberg (1986). Outcomes are a result of the
interaction between these three points, the chemical substance, the user’s psychology and
expectations and the consumption environment. Going slightly further, drugs themselves
become diferent substances in diferent consumption regimes. Medical diamorphine and
street heroin are qualitatively and quantitatively diferent, in composition, consumption and
efect (Strang and King, 1997). This has a real world efect in the attributes applied to the
drug and in decisions about regulation that directly afect the market (Moeller et al., 2021).
Cryptomarkets are notable in shaping potency because the markets are designed to expose
drug purity as a factor in the purchasing decisions made by buyers. Both buyers and sellers
value the market’s ability to help informationalise the product and introduce explicit dis-
cussions of purity. The link between drug content and potency is one that can be examined
critically. Many assumptions are made about what purity means for the user and these are
picked apart in the cryptomarket user forums. Users were concerned to demonstrate that the
drugs they used were ‘good’ drugs. In the case of psychedelic users, this meant that drugs
were efective in the world. They wanted the psychedelics they shared to transmit spiritual
psychedelic culture, to heal and to disrupt harmful ways of thought and life. Opiate users
wanted the drugs they consumed to be efective on themselves, to be potent.
The starting point for discussions of potency was the pharmaceutical quality of the drug,
which became known in several ways: as an embodied experience, through a visual and
chemical assay of the drug, and through user reports of it. The qualities of the drug were
viewed in terms of the way it ftted best with the context and purpose of use. Users advised
caution and told others to approach stronger drugs with a degree of care. Less experienced
users were thought to be more at risk and with more potent drugs it was harder to establish
an efective dose-response relationship. There is a danger of the drug becoming unwanted,
a bad drug that induces overdose or other unwanted efects. For opiate users, potency was a
tricky feature, both desired and dangerous, as greater purity typically meant more adverse,
unwanted efects. Warnings from the drug vendor could be a badge of quality and risk, as in
this quote from a heroin buyer:

When [vendor] mentions that this is of comparable strength to Diamorphine, I undoubtedly agree.
Those without a tolerance must take extreme caution with this product, the infrequent user will most
probably get a very strong efect at 5mg, with a full blown nod at 10 mg.

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 Producing planned hedonism

Users and vendors posited statements about the likely purity of each batch expressed as a
percentage. However, they were also aware that purity is a slippery and subjective construct
and the percentage ‘purity’ given was used as a rule of thumb or guide to the drug’s relative
efectiveness. Users expressed potency in terms of strength and the challenges the drug pre-
sented when being used, stronger batches being ‘hard to come to grips with’ and ‘not to be
trifed with’. Side efects were accepted by some heroin users as indicators of good potency.
Users personifed the drug as an animal, strong but dangerous as with this heroin user:

I got [vendor’s] stuf back when he was still sending out ‘good’ quality, but I still rank him at the
bottom. It seemed potent, but I’m pretty sure that it seemed so potent because it was cut with some
antihistamine or other sedative. Didn’t really make me itchy or nauseous, which good dope [heroin]
always does.

An unexpectedly strong efect like the heroin ‘nod’ could be reassuring to users. Users of
this thread are often self-defned as addicted. The nod told them that they were still able to
feel pleasure, to experience risk and that their drug use was not wholly defned by addiction.
The unexpected pleasure that came with using a particularly efective batch was reassuring
to those that experienced it. It signifed that they still retained the ability to shape their drug
use and experience a range of efects from it. In contrast, users of ecstasy/MDMA in the
same market tended not to see those drugs in this way. Side efects were largely characterised
as ‘dirty’, wholly unwanted contaminants. In contrast, evidence of contamination of her-
oin was literally rejected, such as residue in the spoon after cooking heroin. In contrast to
unpleasant side efects which could be taken to be dirty or as desirable and indicating high
potency, residues were always dirty, always unwanted. They signalled unused contaminants
that had been introduced into the drug. In terms of potency, the remnants from cooking
were a fnal clue before consumption as to the true nature of the drug being consumed. The
residue may act as a cue and primer for consumption. A complete burn of the drug indicates
purity and so prepares the user for a more exciting ride.
As Mary Douglas theorised, dirt is a matter out of place – an environmental but also
primarily a moral and social contaminant (Douglas, 2013). The drugs’ pharmaceutical po-
tency mediated its moral purity. The relationship between heroin users and side efects was
a complex one. Where ecstasy users sought a clear dividing line between desired efects and
‘dirty’ side efects, for heroin users dangerous side efects were too closely bound up with
desired efects to be separable.

Commodifying the drug and introducing supply chain efects

Moving on from the drug as a good or bad object, this section is about the terms in which
the drug is defned as desirable/undesirable as a market commodity. Drug users’ subjective
reports often are able to distinguish whether the drug is desirable, for example, distinguish-
ing MDMA from undesired analogues by noting particular adverse efects or the lack of
efect in tablets sold as ecstasy (Brunt et al., 2012). Online markets and discussion forums
promote information sharing and a consumerist rationale around which users shape a drug
user identity (Bilgrei, 2019).
Vendors’ reputation depended on a consistent, potent product, delivered as expected. Sta-
bility was expected between testing and consumption, and the vendor’s capacity to provide a
consistent stream of the product. Assay data was a useful go-to for buyers. Vendors and users
would post drug test results on the forum. Independent harm reduction services would also

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do the same. Users also assessed the methodological qualities of the testing methods being
used. They discussed sampling problems and the construct validity of test results. The use
of drug testing was incorporated into the narrative of the good vendor who supplied a pre-
dictable, potent product. The use of tests was not wholly reliably as an independent measure.
Agora combined many of these information sources into an understanding of the drug
as a commodity. Some qualities that matter here are consistency between diferent batches
of the same product, consistency within the same batch, and whether it is in a form that can
easily be separated into smaller doses. Commodifcation promotes an understanding of the
drug as an instrumental object. From the vendor’s point of view, the ability to price diferent
batches according to their characteristics and for that to mean something to drug users is key
to their business. Selling heroin in grades according to diferent potencies allows them to sell
batches of diferent purity and present this as a business choice rather than a necessity caused
by variation in the supply chain.
A critical efect of commodifcation was the way in which changes in potency and the
drugs being sold were driven by supply chain needs rather than necessarily consumer de-
mand. Discussions of changing drug potency often make an assumption of a consistent po-
tency-risk curve (ElSohly et al., 2016). The higher the dose, the higher the risk from each
intoxication event. However, there is at most a weak long-term correlation (Desmond et al.,
1978; Risser et al., 2007; Schifano and Corkery, 2008). Localised market fuctuations create
short-term risks depending on the quality of shared intelligence about purity and dose (Mars
et al., 2018a). Confounding factors such as disruption to local markets and injecting sites are
more signifcant in terms of negative outcomes (Maher and Dixon, 1999).
Therefore, the vendor may not know what they are selling. Even if the vendor has a good
sense of the purity of the drug – which is not a given (Coomber, 1997) – any individual
package made for retail sale will vary from the total purity of the dealer’s supply. The user
will also introduce another degree of variation when choosing an amount from that package
to use. The potent quality of fentanyl introduces challenges when it comes to dose titration
(Lamy et al., 2020; Lokala et al., 2019). One of the challenges of fentanyl is framed as the
drug being so potent that it is very easy to get the mix wrong. That may be a product of how
it is sold. When cut to supplement heroin, it becomes difcult to manage the dose properly.
Small variations in a sample will mean signifcant diferences in the efect, and it is unlikely
for a street sample to have the drug spread evenly throughout.
These challenges are not insurmountable – many users manage well and are able to ti-
trate their dose with confdence. However, it places more demands on the dealer and user in
order to achieve the expected and desired dose (Broadhurst et al., 2020). Potency mattered
for heroin users in particular who elaborated on a strong link between potency and pleasure.
Potency meant a combination of material qualities, including purity, lack of unnecessary
adulteration and the right mix of constituents. A critical distinction was drawn between
unwanted ‘cutting’ where the dealer padded out the drug for their own proft and necessary
mixing where the dealer added to the drug either during or after production to produce par-
ticular intoxicant qualities. This required an understanding of pharmacokinetics and phar-
macological efects. For example, one heroin type could be preferred because it produced
a longer lasting high, or another because it staved of cravings for a longer period of time.

Users as hyper-modern and risk-refexive consumers

Consumption begins with contemplating the drug’s qualities, creating or selecting the time
and place of consumption (Duf, 2014). Rationality is an orientation to a specifc kind of

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cultural valuation that is produced by technical mechanisms and shared culture (Childs et al.,
2020). The cryptomarkets are geared towards a rational actor subjectivity and cue up and
reward this kind of behaviour and presentation by their users. Elements of this subjectivity
were value as defned by potency; quality as refected in price; a focus on pharmaceutical
makeup and potency; and embodying drug use practice as planned hedonism. Users show a
tendency to reify, quantify and engage in cost beneft analysis and rational use theory. They
resist some of the implications about what being an opiate user means. Self-identifed addicts
in the Agora forums employed an addiction repertoire, using diferent types of drugs in dif-
ferent ways depending on the context.
This is not straightforward as users had varying degrees of control over their consumption
context. Some had to hide their use from family members while still consuming or main-
taining a working life. Stigma and structural harm became manifest as part of that. Use of a
potent drug could be a way of afrming agency in the users’ self-perception, as one heroin
user argued:

Opiates are fairly easy to control as long as you keep a strict schedule (no longer then 3 days in a
row/no using during a workweek). I have been doing heroin for about 2 months now almost every
weekend and I actually decreased my initial dose…. Still gives you a pretty nice rush and a good
baseline euphoria while maintaining enough wits/awareness to watch tv, play video games or what
have you.

The combination of maintaining daily life along with regular heroin consumption do-
mesticated potency in their view. Markets may reward participants who are better placed
to present themselves as instrumentally motivated rational actors mediated by a process
of social embedding (Moeller, 2018). Heroin became an everyday drug rather than a
problem drug. Users recognised that market information would only tell them so much
and that at some point they would have to use experiential methods to assess the likely
interaction with the drug such as using low solution testers and observing others (Mars
et al., 2018b).

Te market infrastructure refects and reproduces that subjectivity

Key decisions taken in designing and maintaining the buying and distribution infrastructure
are designed with this subjectivity in mind through a combination of the technical afor-
dances and features of the marketplace, with the organisation and market power of both the
cryptomarket administration and the vendor, and the Tor infrastructure (Collier, 2020). The
listing system, the discussion forums, the reputation scoring system, the dispute resolution
system, messaging, platform encryption and favoured cryptocurrency services are all part of
this. Platforms present themselves as technically efective, socially neutral systems. However,
they are designed to promote kinds of engagement and behaviour which are benefcial to the
platform owners. For example, Finalise Early (FE) was a practice where interests diverged
between vendors and buyers (Moeller et al., 2017). The practice of FE means that payment
is released immediately. FE is largely in the interest of the seller. Initially, discounts were
provided for using FE; over time, some vendors simply required it as a part of doing business.
FE is a technical afordance of the platform. The platform concept draws on critical digital
studies of integrated digital economies (Pasquale, 2017). Platforms envelop users in a system
which binds them economically, culturally and personally. They promote particular kinds
of performance and action such as that of being a rational participant (Childs et al., 2020).

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 Angus Bancrof

As platforms, cryptomarkets value the vendors’ ability to provide a range of product. Variety
was valued as much as purity. Some users especially appreciated vendors who acted as a one
stop shop for substances ranging from opium to fentanyl and counterfeit Xanax.
Platform users had to develop both their technical and cultural competence in dealing with
the cryptomarket as a platform which has technical afordances and economic dynamics that
they could fnd difcult. The cryptomarkets tend to centralise and reward bigger players –
both buyers and sellers. While often beginning as fairly open retail ventures, they morph
into systems that reward the more professional and well-resourced players through econo-
mies of scale and the ability of larger vendors to arrange sweetheart deals with the market
administrators. These larger and more successful players can set the terms of involvement of
others, for example, by only selling to better established customers. New users expressed this
in terms of having to adopt the right online persona that would adapt to the norms of the
platforms. In several discussions, the drug buyers expected themselves to be evaluated as a
good or bad customer depending on their engagement with the vendor.
The community shared principles of adaptability to the norms of the platform. Users were
encouraged to leave reviews of the drugs they bought. Most vendors had very high scores,
typically at least 4.5 out of 5. This led to some suspicion that the system was easily gamed by
the vendor or corrupted by the administrator. While that was likely to happen, in part the
review system was normalised and supported by the community of buyers in order to make
it more efective. Users admonished disgruntled customers to express their sentiments to
the vendor directly or in the discussion forum rather than dropping a negative review score.
A result of the platform’s qualities was account ‘stickiness’. Vendors and buyers were re-
luctant to create new accounts despite the potential security advantage. Having to start a new
account ‘clean’ without their established reputation and without the existing relationships
with market administrators and key customers would be far too disruptive. The platform
design imposes security costs on its users. This helps keep them in the walled garden.

Discussion and conclusion

Illicit markets shape subjectivities and drugs as commodities. Planned hedonism pulls opi-
ate users who engage through the cryptomarket into that orientation. Cryptomarkets are
a social-technical matrix that users must become savvy in when they use them. It involves
a combination of cultural knowledge, technical and material qualities, and personal and
organisational capacities. There is an overlayered network of infrastructures which are in-
volved, from the market’s technical and administrative infrastructures to at-home drug test-
ing methods. The drug as a usable substance is shaped in the relationship between dealer,
user, market and consumption context. Potency is a quality users and dealers bring into
being (Moeller, 2018). Potency was a quality often referred to by users but was not a uni-
versal quality. The talk around opiates in the market was a struggle between the specifcity
of the particular batch that was being sold and consumed and the immutable characteristics
of the drug. Producing a predictable efect involved assembling several supports – material,
environmental, psychological, cultural and experiential.
Potency was desired, dangerous and elusive in the eyes of users. It was a quality they felt
was acted upon them and was acted on by them. Potency was examined as a community
construct that involved concepts of pharmaceutical purity, best ft to purpose and the user’s
set. Theorising the pharmaceutical qualities in these terms allowed me to account for its ma-
terial stabilities and instabilities across diferent domains. The various opiates being discussed
possessed relevant material qualities which were enacted in their presentation, purchase and

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 Producing planned hedonism

consumption. As a political economy, it applies to other systems such as the commodifca-

tion of alcohol and performance-enhancing drugs where risks and pleasures are similarly
produced, distributed and enacted in consumption.
Cryptomarkets advertise their capacity for introducing predictability. As the experi-
ences of users showed, however, markets could be vehicles for introducing risk and limiting
knowledge. Users learnt and taught each other how their own experiences and judgements
were ultimately the only ones that could be relied on. They are systems which embed the
political economy of the digital drug market, its focus on competition, consumer identity
and principles of agorism. Agorism is the principle that societies should organise around
voluntary anarchic exchange. The ideological emphasis on agorism in the markets tended to
obfuscate some of the political economy aspects such as supply chain efects and the domi-
nance of better established players (Lokala et al., 2019).
Problems arose when the supply chain was seen to introduce invasive substances (Mars
et al., 2019) of which fentanyl was one. Discussion around substances like that would draw
on a range of data from users’ trip reports to public health warnings in order to resolve the
substance as unwanted or as one that, while risky, could be absorbed into the user’s drug
repertoire (Bilgrei, 2016). The drug was then defned as dirty or clean depending on its ac-
ceptance within the community (Douglas, 2013). Adulterants were treated in a similar way.
Some could be desired as changing the form and experience of the high, others as unwanted
or dangerous.
The markets presented themselves as ofering tools to make the drug buying and con-
sumption process transparent. User ratings and tests were intended to support a rational
approach to drug consumption. The ability of users to manage their use efectively was both
supported and limited by this. The relative transparency about the products’ pharmaceutical
qualities exposed the limits of users’ and vendors’ abilities to manage and limit pharma-
ceutical risks. Adulteration could be introduced further up the supply chain so it became
impossible to avoid consuming unwanted adulterants. Although the markets were designed
to get around supply chain risks, they often highlighted and reproduced them. These factors
illustrated how markets can increase transparency and obfuscate power relationships at the
same time. The markets were relatively open and supportive of users, so this was in many
ways a positive harm reduction environment. Users placed a lot of store by their ability to
engage in efective harm reduction practice. Alongside that it was apparent what risks could
not be mitigated. Users would use the information provided to seek out some risks, associ-
ating higher potency, higher risk heroin with a better experience. Though that might sound
negative, it was a useful counterpoint in that it shows users’ desire to enact their agency and
not reduce their experience to a balance of risk and beneft.

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 7
CRAFT DRINKS,
CONNOISSEURSHIP AND
INTOXICATION
Tomas Turnell-Read

Introduction
The emergence of ‘craft’ drinks over recent decades has been a prominent trend in the drink-
ing cultures of many countries. Most visibly, craft breweries play a small but growing role in
the global beer industry (Danson et al., 2015), and are perceived as being at the forefront of
a number of consumer trends. Craft beer has spread widely, and academic research has anal-
ysed developments in diverse contexts, including Sweden (Sjölander-Lindqvist, Skoglund &
Laven, 2020), Greece (Melewar & Skinner, 2018), Ireland (Drakopoulou et al., 2018), Mex-
ico (Gómez-Corona et al., 2017), Italy (Fastigi & Cavanaugh, 2017), Canada (Eberts, 2014),
New Zealand/Aotearoa (Kuehn & Parker, 2021), Australia (Holden, 2011; Argent, 2018),
the UK (Thurnell-Read, 2014; Wallace, 2019) and, most noticeably, the USA (Reid, Mc-
Laughlin & Moore, 2014, Chapman, Lellock & Lippard, 2017). However, with only a few
exceptions (Thurnell-Read, 2017a; Land, Sutherland and Taylor, 2018), the fact that craft
beer involves the production of an intoxicant, and its consumption explicitly gives rise to
situations in which alcohol is imbibed and intoxication occurs, remains unexamined in this
body of literature. As a corrective to this, the chapter observes the way in which the rise of
a craft drinks culture based around ideas of taste and connoisseurship shapes understandings
of intoxication. It examines changing discourses and practices that frame the consumption of
intoxicants, as well as shifts in the ways in which those intoxicants are perceived and experi-
enced. Thus, it has been shown that craft beer and, for that matter, artisan gin, ‘natural’ wine
and craft cider (Smith Maguire, 2018a; Abbotts, 2019; Thurnell-Read, 2019a), are widely
seen in a positive light and rarely, if ever, as intoxicants leading to drunkenness and disorder.
A culture of connoisseurship involving a commitment to developing knowledge and pref-
erences within a particular category of drinks has a seemingly long history in regard to wine
(Inglis, 2015; Smith Maguire, 2018a, 2018b) and whisky (Spracklen, 2013), but is a relatively
new phenomenon in relation to beer (Thurnell-Read, 2018). It is only recently, with the
emergence of craft beer, that beer drinkers of such products may be seen as more ‘sophisti-
cated’ and as having more ‘prestige’ than those who drink mass-produced mainstream beer
brands (Reid, McLaughlin & Moore, 2014). This shift away from mainstream, or ‘macro’,
lager produced on an industrial scale and marketed globally under widely recognised
names such as Budweiser and Carlsberg has important implications for how intoxication and

DOI: 10.4324/9780429058141-10 113

 Tomas Turnell-Read

intoxicants are understood. Rather than being seen as ‘problem’ drinking, framed by notions
of excess and transgression, the drinking of so-called connoisseurs tends to invoke images
of discernment, taste and studied cultural appreciation. Signifcantly, beer consumption is
increasingly seen as an activity through which beer consumers can perform their cultural
capital by consuming particular beers in a culturally approved manner which is used to
leverage status and respect from other consumers (Thurnell-Read, 2018). Further, there
has been an increasing diversity of spaces in which this cultural capital can be performed,
including specialist craft beer bars, at real ale festivals and on web-based applications such as
Untapped. Whether or not intoxication is desired or achieved, the image of the connoisseur
as a bon vivant who mobilises their cultural capital and good taste in the appreciation of fne
wines, rare single malt whiskies and inventive artisan beers goes some considerable way to
justify and legitimate what may often be substantial levels of alcohol consumption.
A striking feature of the growing corpus of academic literature on craft drinks has been
the absence of discussion of drunkenness and intoxication. The real and perceived negative
outcomes of intoxication – antisocial behaviour, public disorder and violence, sickness and
personal injury – have been vigorously contested in policy, media and academic debates
(Hadfeld, Lister and Traynor, 2009; Plant and Plant, 2009); yet, they tend not to be readily
associated with craft drinks consumption even when such does involve considerable intake, in
terms of both volume and frequency. Indeed, a common refrain associated with craft drinks
is that it involves a ‘better’ type of drinking where the emphasis on enjoyment of favour
and an appreciation of the drink itself and the context of its production, in terms of locality,
ingredients and process (Thurnell-Read, 2019a), supplants the emphasis on intoxication,
or ‘determined drunkenness’, characteristic of the ‘new cultures of intoxication’ that have
dominated public debates in recent decades (Measham and Brain, 2005). Rather, nested into
the origin stories of the craft beer movement is the idea that real ale and craft beer consumer
cultures are not overtly concerned with intoxication. Indeed, Charles Papazian, the founder
of the American Homebrewers Association who is considered to be one of the most infu-
ential fgures in the growth of craft beer in the USA, is famed for observing that drinkers
of craft beer ‘got happy, not stupid’ (Elzinga, Tremblay & Tremblay, 2015). The implication
of this, which will be explored in greater detail in the course of this chapter, is that craft
beer drinkers are not disposed to many of the problems associated with intoxication and are,
instead, benefciaries of a cultural discourse of moderation.
That so much recent research has explored an emergent social phenomenon which in-
volves the production and consumption of alcoholic products without ever mentioning in-
toxication, drunkenness or, indeed, addiction is telling. This chapter goes some way in
addressing this but also explains why craft drinks consumers appear to be able to successfully
distance themselves and their beer consumption being associated with the more widespread
negative implications of intoxication and alcohol harms. This chapter explores the ways in
which the production and consumption of a specifc intoxicant, alcohol, are framed by a
discourse and practice of ‘craft’ that foregrounds notions of quality, taste and connoisseurship
that result in intoxication being downplayed or legitimated. The following section outlines
the emergence of craft drinks in recent decades and examines how the craft beer ‘subculture’,
which values quality, innovation and authenticity, has produced novel spaces and practice in
and through which alcohol is being consumed. Then, more specifcally, the next section will
examine the ways in which the rise of craft drinks has been associated with an elevation of
cultural prestige associated with such drinks and increasing social status for those who con-
sume them. Importantly, here, the sociology of culture and consumption has lent a concep-
tual framework with which to understand how the specifc act of purchasing and drinking

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 Craft drinks, connoisseurship and intoxication

alcohol is part of wider social processes that refect stratifcation of society in terms of social
class and status. Finally, in addressing intoxication specifcally, the fnal substantive section
of the chapter will set out the central theme already alluded to in this introduction that the
culture of connoisseurship that has emerged around craft drinks is invoked to legitimate and
justify intoxication in a way that is not seen in relation to most other alcoholic drinks specif-
ically and intoxicants in general.

Te Craf Drinks ‘Revolution’

The emergence of craft beer, and craft drinks more generally, has been described as a ‘rev-
olution’ involving radical upheavals in business practices and signifcant changes in con-
sumer tastes (O’Brien, 2011). This movement is now widely understood to have emerged
in response to a protracted period of market rationalisation that saw the beer industry in
many Western countries monopolised by a small group of large corporations specialising in
increasingly centralised production and distribution of standardised products. The growth
of a craft beer industry has therefore been explained as, at least in part, stemming from ‘the
desire of people to break away from the smothering homogeneity of popular, national cul-
ture, and re-establish connections with local communities, settings, and economies’ (Schnell
and Reece, 2003: 46). In a heroic response to this encroachment by big business, the now
often told story goes, a small cohort of pioneers resisted this ‘McDonaldisation of beer’
(Thurnell-Read, 2020) by establishing small but ambitious and fercely independent brew-
eries producing beers that valued quality and tradition over profts. In the UK, this develop-
ment was closely associated with the Campaign for Real Ale (CAMRA), a consumer group
founded in 1971 with the specifc remit of campaigning to promote and protect ‘cask condi-
tioned’ beer, while in the USA, developments were led by key organisations and events such
as the American Homebrewers Association and its fagship Great American Beer Festival
(O’Brien, 2011; Acitelli & Magee, 2017).
These decades of market disruption and change have resulted in a number of outcomes.
Most notably, there are a vastly increased number of breweries operating in many countries,
with the meteoric rise of craft beer in the USA providing the most obvious and well-studied
example (see Tremblay & Tremblay, 2005). The Brewers Association, which defnes craft
breweries as having an annual production of fewer than six million barrels of beer and having
less than 25% of ownership or control in the hands of non-craft beverage industry compa-
nies, counted 7,450 craft breweries in the USA in 2018 with California (841), Colorado (396)
and Washington (394) hosting the most craft breweries by state. Meanwhile in the UK, the
number of breweries passed 2,000 in 2017 and has only recently experienced some slowing
in what have been many years of continuous expansion (Featherstone, 2017). A large part of
this growth is therefore accounted for in the vast array of independent quality-led breweries
opening over recent decades (SIBA, 2019), as well as new sites of production and consump-
tion such as brewpubs which have fourished in the UK and the USA in particular since the
1990s (Elzinga, Tremblay & Tremblay, 2015). Further still, as craft beer tends to distinguish
itself by its diversity in terms of styles, favours and strengths available (Reid, McLaughlin &
Moore, 2014), there is now a range and variety of beers widely available that perhaps a pre-
vious generation of beer drinkers could barely dream of. Beyond the beer itself, one of the
most striking trends is the proliferation of information and the means by which knowledge
about drinks is communicated. Thus, there is now an increased abundance of beer guides,
tasting notes, tutored tastings, ‘Meet the Brewer’ and ‘Tap Takeover’ events, brewery tours,
while an increasingly diverse range of online platforms and fora all provide dynamic cultural

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spaces for communicating new tastes and practices. As will be examined below, consuming
craft beer has become an ‘intellectualised’ activity with drinkers honing their knowledge
about beer styles and breweries and demonstrating their cultural capital in being able to per-
form the selection, consumption and evaluation of diferent beers from a vast and changing
range of options in a culturally approved manner (Thurnell-Read, 2018).
Beyond these changes to the beer itself, real ale and craft beer breweries, retailers and
consumers can be attributed with numerous innovations in methods of sale and forms of
consumption. Craft beer has given rise to new sites of consumption such as beer festivals
(Thurnell-Read, 2017b), micropubs (Hubbard, 2019; Robinson & Spracklen, 2019), ale or
brewery trails (Fletchall, 2016; Thurnell-Read et al., 2021), brewpubs and brewery taps
(Wallace, 2019) and specialist retailers or ‘bottle shops’. In many such venues, beers are
served in smaller glasses to allow patrons to sample a wider range of beers. In addition to
being new places in which alcohol is purchased or consumed, all these spaces carry with
them innovations or, at least, palpable changes in the associated ethos or drinking culture
that goes with the consumption of craft beer. Thus, as Schnell and Reese (2003: 46) observe,
‘many brewpubs have also catered to our craving for uniqueness by providing one-of-a-kind
social settings, commonly decorated with local historical photos, maps, and other artefacts
of a place’s personality’. Hubbard (2019), for example, identifes the emerging micropub
movement in the UK as aiming to ofer a sociable space in which enthusiastic landlords
communicate their passion for real ale and a small but dedicated clientele of regular custom-
ers prioritise a ‘friendly atmosphere and a place for convivial chat’ accompanying a slow and
appreciative drinking which is in contrast to the scale and pace found in main stream com-
mercial drinking venues. While intoxication does invariably occur in these drinking spaces,
a discourse of moderation is widely invoked as justifying alcohol consumption as being so-
ciable and focused on the enjoyment of the act of drinking itself rather than the outcome of
drinking in terms of drunkenness and inebriation. While it is possible that the lower alcohol
content of many beers ensures a favourable impression in comparisons to ‘stronger’ drinks
such as wines, spirits and cocktails, the ongoing trend for high strength craft beers suggests
that there is a wider cultural association linking beer with sociability, conviviality and mod-
eration which the craft beer scene readily benefts from.
A further key trend is that the real ale and craft beer movements have invested heavily in
what Flack (1997) frst identifed as the connection between beer and an increasingly prom-
inent trend for ‘neolocalism’. To be able to draw a distinctive contrast with the placelessness
of generic national and global brands ‘craft breweries often attempt to ingrain themselves
into their local community and represent the history and landscapes of the area through the
label design, logo design, and beer names’ (Murray & Kline, 2015: 1204). Thus, beers which
are ‘carefully named to refect a sense of place’ evoke connections with, and sense of pride in,
specifc localities (Melewar & Skinner, 2018: 6), while microbreweries work to build ‘strong
connection’ to local economies and communities, thereby providing ‘a means to identify
and promote distinctive qualities of place’ (Paulsen and Tuller, 2017: 105). In so doing,
we might deduce, craft beer engenders a goodwill from consumers and, potentially, policy
makers, that is far wider and more positive than many scale producers of alcoholic beverages.
Craft breweries develop and deploy narratives which lay claim to an ‘authenticity’ which
roots the beer, the brewery and the brewers themselves in the cultural and economic lives
of local communities (Koontz & Chapman, 2019). Further, in the context of this chapter, it
is also pertinent to speculate that because craft breweries go to such great lengths to project
an image built on ‘place and locality, cooperation and commitment’ (Sjölander-Lindqvist,
Skoglund and Laven, 2020: 10), the association of the alcoholic product with the state of

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intoxication is not as straightforward or automatic. Consumers can drink as an expression

of pride and community rather than what might, in other settings, be seen more simply as
drinking to achieve intoxication.
The implication of these changes, which shall be explored more in the sections below, is
that the kinds of drinking that take place in these new types of venues is attentive to a wider
range of motivations and values than simply sustained drinking for the purpose of achieving
drunkenness. Rather, beer festivals, brewpubs and speciality craft beer bars invoke a range of
values relating to locality, community and commitment, meaning that craft beer benefts from
‘a cadre of passionate and well-informed consumers who communicate and network through
brewpubs, tap houses and participation in beer clubs and festivals’ (Drakopoulou et al., 2018:
641). Further still, craft drinks makers and consumers invest in ideas of ‘authenticity’ which are
communicated via packaging, branding and the narratives told and heard by both producers
and consumers (Thurnell-Read, 2019a). The discourse of ‘craft’ therefore goes a long way
to create an aura of respectability around alcohol consumption. Indeed, craft breweries have
regularly been described in positive terms as ‘contributors to rural development’ (Murray &
Kline, 2015: 1201). Further still, drinking beer at craft breweries, which commonly draw on
place-specifc imagery and pursue functional collaborations with other local businesses and
community organisations to display their embeddedness in locality (Argent, 2018), involves
‘a very efective form of place-making’ which tends to generate benefcial goodwill for brew-
eries which are seen as hubs or focal points of their community (Fletchall, 2016: 540). As the
following sections will examine, these discourses that foreground localism, taste and studied
appreciation – rather than intoxication, drunkenness and social disorder – are central to images
of respectability and social status embedded in craft drinks consumption.

Raising the Glass: Craf Drinks, Taste and Status

The brief summary ofered by the preceding section raises several themes which help to il-
lustrate the trend towards cultural legitimacy and status of craft beer. First, by foregrounding
choice, knowledge and an emphasis on appreciation of favour over the intoxicating efects
of the beverage, craft drinks and those who consume them are distanced from mainstream
products and brands that are produced and consumed en masse and associated with drinking
for the primary or sole purpose of achieving intoxication. Second, in having given rise to nu-
merous innovations in the mode and style of production, sale and consumption, craft drinks
are often seen as progressive and inventive. Positive values associated with independence,
community and locality may work to legitimate drinking craft drinks as an activity under-
taken by trend setters and passionate consumers. Third, the craft drinks sector can be char-
acterised by a great deal of symbolic labour carried out both by producers and by committed
consumers to frame craft beer products as being ‘authentic’. This abundance of communica-
tion about the taste and value of craft products helps inform consumers but also ensures the
ongoing positive framing of products. Fourth, and related to these second and third points,
the production of craft beer is seen to contribute to local economies and foster positive social
interactions emphasising a community of likeminded consumers in close contact and collab-
oration with producers who value principles such as sustainability and innovation as well as
proft. Taken together, these and other characteristics of the craft beer sector and consumer
culture go some way to giving this particular intoxicant a greater cultural legitimacy than
other forms, such as the consumption of mass-produced beers or branded spirits with the sole
intention of getting drunk. Further, it establishes social class as an infuential constituent in
craft drinks consumption and whether or not it is viewed positively in wider society.

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The connections between alcoholic drinks and social class can be complex and varied.
Being a drinker of wine, beer, spirits or, for that matter, a consummate ‘omnivore’ of difer-
ent drinks for diferent occasions ( Järvinen, Ellergaard & Larsen, 2014) is signifcant because
alcoholic drinks are consumed in social contexts and cultural values are attached to particu-
lar drinks styles and brands, the places they are bought and the people who buy and consume
them. The role played by social class and social status is more overt with some forms of alco-
hol, and in some contexts, than with others. Thus, as Mary Douglas (1987: 9) observes, ‘con-
noisseurship in the matter of wines is in itself a feld for competition’ where connoisseurship
‘has its own power for social domination’ marking those who do not possess the ‘correct’
taste and knowledge as being in an inferior position to those who do. The romance of wine
and wine-making inspires ‘wine tourists’ motivated by the desire for learning about wine
and the regions in which it is produced (Hall et al., 2004), while newly rich consumers may
purchase and consume vintage wines in a conspicuous manner to impress others (Overton
and Murray, 2013). We must be aware, then, that certain drinks can carry and bestow status.
The processes by which some alcoholic drinks have gained favourable status make for
interesting reading. Champagne, for instance, has benefted greatly from a lengthy history
of myth making that has imbued this particular variety of one intoxicant as symbolic of
glamour, celebration and national identity (Guy, 2007; Rokka, 2017). More recently, the
process has been observed in relation to a number of other alcoholic drinks categories. For
example, as Delmestri and Greenwood (2016) explain, in Italy grappa has since the 1970s
gone through a period of ‘status recategorization’ whereby it went from a low-status product
to a desired and desirable commodity emblematic of Italian culture, taste and style. Mean-
while, the emerging terminology of artisanal and ‘ultra-premium’ spirits has provided telling
examples of the linking of social class, taste and alcohol market segmentation activities. Both
tequila in North America (Gaytán, 2017) and gin in the UK (Thurnell-Read, 2019b) have
been subject to signifcant changes in how they are produced, marketed, sold and consumed
as a product with far higher status than previously thought possible. We can even see this
trend in intoxicants more widely, with Roseberry (1996) accounting for the rise of ‘yuppie
cofee’ in the USA where eforts are made by a range of actors within the cofee trade to ele-
vate the status of cofee following its dispersal as a mass-produced and consumed commodity.
Such developments can also be observed in the beer sector which has undergone a steady
process of ‘intellectualisation’ over recent decades (Thurnell-Read, 2018). While producers
and suppliers work to increase understanding amongst consumers by communicating in-
creasingly more complex designations, styles and terminology, consumers, in turn, respond
with a willingness to pay a higher price for beer but also their own greater commitment to
increasing their knowledge by learning new modes of beer appreciation. This trend is also
supported by various institutions and organisations. In the UK, the most notable example of
this is the CAMRA. Founded in 1971 to protect and promote traditional cask conditioned
beer, the organisation has a long history of campaigning which, in various ways, promotes
beer as a culturally and economically valuable commodity rather than merely a means to
intoxication. Thus, over fve decades, CAMRA and its members have sought to cham-
pion traditional cask conditioned beer through activities, including publishing the Good Beer
Guide and an annual Great British Beer Festival. Other organisations, although less widely
recognised, have also played an infuential role in either maintaining or increasing the status
and value of beer. For example, The Beer Academy has, since 2003, run training courses such
as its one-day course ‘How to Judge Beer’ and accredited ‘Beer Sommeliers’ to enhance the
knowledge and appreciation of beer within the industry. These and other developments have
helped a new language and aesthetic of beer appreciation become established meaning that

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certain beers are now accepted as high status commodities which consumers are required
to learn about in order to fully appreciate in a mode which was perhaps previously reserved
exclusively for wine.
As an outcome of many of these processes identifed above, beer is now seen as a com-
modity that consumers can invest time and efort in getting to know. Using the terminol-
ogy of French Sociologist Pierre Bourdieu, whose work on consumption, distinction and
cultural value has become infuential in recent years (Bourdieu, 1984), what we see is the
establishment of a ‘distance from necessity’. This is where the drink is consumed because of
higher level motivations such as taste and appreciation of style, with these replacing hitherto
low status more basic motivations, principally the desire to quench thirst or achieve intoxica-
tion (Bourdieu & Nice, 1980). Rather than a subsistence product, beer has become a cultural
feld into which people can become absorbed and, for those who choose to, the possibilities
to commit to long-term pursuit of knowledge about beer and varied experiences of con-
suming the ‘right’ beers in the ‘right’ places as a form of ‘serious leisure’ (Thurnell-Read,
2016). Being familiar with a range of breweries, being able to identify varied beer styles
and, importantly, being able to communicate and perform conspicuous personal preferences
means some consumers are now engaged in an ongoing and complex performance of taste in
selecting, consuming and evaluating craft beer which, to do well, often requires tutoring or
learning (Thurnell-Read, 2018).
In many ways, these developments can be celebrated as the results of years of dedicated
labours by passionate brewers who commit to ongoing improvements of the quality of their
products (Fastigi & Cavanaugh, 2017). However, while the increasing glamorisation of the
craft beer industry means that many craft brewers beneft from increased cultural cache that
align craft brewing with creative industries, working conditions for many remain precarious
(Miller, 2019; Wallace, 2019). Numerous studies have now raised concerns about persistent
inequalities in the sector by outlining how both the production and consumption of craft
beer tend to be dominated by white, middle-class men (Reid, McLaughlin & Moore, 2014;
Darwin, 2018; Kuehn & Parker, 2021; Land, Sutherland and Taylor, 2018; Wallace, 2019).
Indeed, once a particular cultural terrain becomes valued and valorised, it may also become
defended by ‘gatekeeping’ activities which mean that new entrants face increasing barriers
and resistance. The cultural politics of craft beer is, therefore, increasingly fraught with di-
visions and inequalities in relation to social class, gender and ethnicity.

Drink Less, Drink Better?: Connoisseurship and the Legitimation of

Intoxication
Because craft intoxicants hold higher cultural status than their mass-produced equivalents,
the consumer can derive social status from being seen to consume such beverages and having
that consumption and their associated position as a ‘knowledgeable’ and ‘tasteful’ consumer
acknowledged by others. Much of this emphasises a sense of middle-class respectability and
refnement, where a studied appreciation of style, taste and favour over consumption orien-
tated towards inebriation and drunkenness, and means discourses of craft and connoisseur-
ship often obscure or neutralise the physical, psychological and social harms associated with
intoxication. Such concerns, which see public debates lament the errant ‘binge drinking’ of
the working class while readily overlooking the often equally prolifc alcohol consumption
of the middle and upper classes, have dominated wider debates about alcohol and its place in
many societies (Plant & Plant, 2009). Yet, here we see that the way in which craft beers are
selected, consumed, evaluated and discussed by self-confessed ‘beer geeks’ raises pertinent

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questions to how intoxication is understood when it is, at least ostensibly, no longer the sole
or even primary motivation for the consumption of intoxicants. Connoisseurs of real ale are
associated with a slow, steady and studied pace of drinking unlikely to result in extremes
of drunkenness and disorder (Hubbard, 2019) and in framing their own drinking practices
draw on what ‘discourses of moderation’ to justify their alcohol intake as safe, sociable and
respectable (Thurnell-Read, 2017). An emphasis on control appears to be central to this.
Thus, Wallace (2019: 957–958) notes that in his research a South London brewer positioned
craft beer as ofering meaningful connections between customers and producers in a manner
cast in contrast to hedonistic drinking, while another explained his customers approach to
alcohol to be one of ‘three pints of something not too strong and then home’ drawing on an
image of a bourgeois suburban drinking based on moderation and self-control.
As Smith Maguire (2018b) and Thurnell-Read (2018) illustrate in relation to wine and
beer, respectively, high status consumption draws on a demarcation of qualities to establish
that some drinks carry far greater cultural validity than others and require of the consumer
an educated and intellectual disposition. Koch and Sauerbronn’s (2019) study of the mean-
ings and values of craft beer consumers in Brazil is illustrative here, as they show that craft
beer consumption is informed by a ‘drink less, drink better’ ethos focused on taste and
appreciation and an associated rejection of the perceived excesses of mass-produced beer
consumed on mass. They suggest that:

…members of the craft beer subculture of consumption do not want to be seen as

drunks, troublemakers, or anything negative. They enjoy beer and try to understand it
more deeply, not as merchandise, but as a combination of special ingredients made by
praised brewers.
(Koch & Sauerbronn, 2019: 9)

This ‘drink less, drink better’ ethos, which favours quality over quantity (Arthur, 2018)
involving drinking which is ‘sociable’ rather than disorderly, is a framing identifed across
a number of recent studies as well as in wider public discourses about craft drinks and
intoxication.
In the UK, where many CAMRA members spend considerable amounts of time and
money pursuing their interest in beer by learning about new breweries (Thurnell-Read,
2016, 2018), the bourgeois language of connoisseurship and taste (Bourdieu, 1984) is fre-
quently used to distinguish the respectable ale drinker from other drinkers. In contrast to
stereotypical representations of hardcore drinking in the media and in youth culture (Lyons,
Dalton & Hoy, 2006), craft discourse is therefore normative in that it can position the know-
ing and tasteful consumer of craft beer or artisanal gin as legitimate while marginalising
‘other’ consumers and ‘other’ intoxicants as illegitimate and harmful. These ‘others’ are often
either explicitly or implicitly labelled as belonging to a working-class habitus. Robinson
and Spracklen (2019), in their study of real ale micropubs in the Yorkshire town of Skipton,
note the widespread use of a ready contrast between real ale drinkers and lager drinkers1
where the latter are ‘louts’ and ‘idiots’ who drink to get drunk in contrast to the former
who appreciate good beer and the convivial atmosphere of a well-run drinking venue. Sim-
ilarly, Spracklen (2013) analyses the discourses that inform the drinking of Scottish whisky
enthusiasts to demonstrate that, while alcohol may be consumed in large quantities, the
social codes and rituals of the community ensure that misbehaviour and extreme intoxica-
tion are rarely encountered or tolerated; yet, the norms of the particular habitus ensure that
such drinking rarely leads to misbehaviour. Under this emphasis on drinking for a range of

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intrinsic and extrinsic rewards, two drinkers consuming similar amounts of alcohol could
be discursively rendered either ‘sensible’ or ‘risky’ drinkers by virtue of their alcohol being
consumed in the sociable context of the local community pub or the high-volume vertical
drinking of commercial drinking venues, respectively.
Rather than a singular focus on drinking for intoxication (Measham & Brain, 2005), real
ale and craft beer drinking spaces have tended to develop associated events and activities
such as music (Robinson and Spracklen, 2019), food, traditional games and charity events
(Thurnell-Read, 2017b), meaning that the symbolism and discourses which surround craft
beer production and consumption beneft from linkages to wider cultural activities. Thus,
for many breweries and in many beer consumption settings, an aesthetic prevails which
foreground local or national culture and readily draws on either symbolic themes of tradi-
tion, heritage and nostalgia or of contemporary urban cool and sophistication. Drinkers of
real ale and craft beer can be said, in Bourdieusian terms, to be performing their cultural
taste and distinction by distancing themselves from more unruly, and therefore lower-class,
drinkers (Spracklen, Laurencic & Kenyon, 2013; Thurnell-Read, 2017a). Hence, associating
beer more closely with food, music and other cultural felds – for example, as happened
when CAMRA began hosting a stall at the BBC Good Food Show from 2005 onwards –
has served to improve the image of real ale, in particular, and craft beer more recently by
making the consumption of the actual alcoholic drink part of a wider grouping of pleasurable
activities and leisure pursuits. Indeed, many craft beer breweries have been keen to position
their products as part of new urban and suburban lifestyles based around fashions and cultural
tastes (Zukin, 2008; Ocejo, 2014, 2017).
There are, however, a number of contradictions in this logic. Darwin (2018), for instance,
notes that the prevailing and highly gendered ethos of craft beer consumers in the USA is to
see strong beers, in terms of both alcohol content and bitterness due to higher hop favours,
as being more legitimate and more masculine. Likewise, Chapman et al. (2018: 310) identify
‘beer’s continued dissociation from femininity’ as infuencing the shape and development of
craft beer communities where a supposedly manly drinking style prevails over others. Strong
beer is consumed, at least in part, to signal a perpetuation of earlier images of manly drinkers
‘holding’ their drink as a way of displaying their masculinity (Peralta, 2007). Similarly, while
contemporary craft beer sectors are notable for their striking diversity of beer styles, favour
profles and strengths (Reid, McLaughlin & Moore, 2014), an ‘ethos of continual experi-
mental’ (Drakopoulou et al., 2018) and a ‘spirit of diversity, variety and novelty’ (Danson
et al., 2015) could all be seen as encouraging regular excessive consumption of alcohol, albeit
cloaked in a justifcatory rationale of wanting to ‘keep up’ with the latest brewery open-
ings and beer style innovations. As such, a committed craft beer connoisseur could drink
several new beers every day for many years and still not exhaust the supply of new beers to
try. Likewise, a tightly knit community of real ale enthusiasts and craft beer ‘geeks’ means
that there is rarely a shortage of opportunities to consume alcohol nor of sociable occasions,
such as beer festivals and beer launch events, on which to do so. Therefore, the ‘beer geek’
descriptor, often knowingly or ironically invoked, potentially masks unhealthy levels of al-
cohol consumption whereby the desire to remain conversant with the latest developments in
a rapidly changing craft beer subculture that values innovation and novelty could plausibly
give rise to pressures to stay up-to-date with new brewery openings and beer launches that
result in the volume and frequency of alcohol consumption being sustained or increased by
such ‘committed’ craft beer afcionados. While, as noted at the outset, this issue has barely
been considered in academic writing relating to the emergence of craft drinks sector, some
actors in the industry itself have attempted to instigate a conversation about these issues.

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For example, the acclaimed British beer writer Pete Brown (2018) has written about excess,
alcohol and mental health issues in the craft beer sector, indicating that a wider discussion is
needed about the physical and mental health of those working in, or in other ways active in,
the craft beer community.

Conclusion Toughts and Future Developments

A central concern of the chapter is the thinking through the ways in which the aesthetics,
symbolism and narratives that pervade the emergent craft drinks sector function to provide
a discursive and actual distance from intoxication. For craft beer drinkers, an ethos that ‘the
taste, quality and beer selection trumps all’ (Fletchall, 2016: 554) provides a handy contrast to
long-established images of alcohol consumed solely for the pursuit of intoxication. Thus, while
craft beer has benefted from various forms of positive public relations, it has largely avoided
any sustained criticism from public health and public order perspectives. As the chapter has
shown, the assumed craft beer drinkers are middle-class, educated, probably male and likely
white, and appear to be given the beneft of the doubt in terms of whether their alcohol con-
sumption, couched as it is in a discourse of connoisseurship, leads to any negative outcomes in
terms of personal physical and mental or wider social harms. It is possible to widen this conclu-
sion by drawing some speculative connections between the rise of craft drinks and two further
areas of concern where current rapid social, cultural and economic changes raise interesting
tensions between intoxicants, intoxication and wider social contexts and cultural discourses by
which they are consumed: frst, the increasingly common legalisation of cannabis and, second,
the recent growth in demand for low and no alcohol drinks.
In its legalisation in many US states and, recently, in Canada, there has been a seismic up-
heaval in the discourses, meanings and practice around the sale, purchase and consumption
of cannabis (Barcott, 2015). This has rapidly led to a rush to establish brands which associate
the formerly prohibited intoxicant with a range of positive associations such as pleasure, lux-
ury and, in a development echoing the evolution of craft beer outlined above, taste (Shapiro,
2018). While academic study of the social and cultural conventions and meanings of the
newly legalised cannabis industry remains nascent, there are perhaps some early indications
that similar trends to those identifed above are and will continue to take place as cannabis
consumption rapidly normalises and diferentiates. Discourses of connoisseurship and pro-
cesses of intellectualisation are evidently already at work in this feld. With its emphasis on
authenticity, innovation and variety that appeal to an increasingly intellectualised consumer
base, craft beer ofers a range of readymade examples of market strategy which many can-
nabis producers and retailers may draw on as they rush to either corner a growing market or
gain a foothold in an already congested sector. As these trends develop, and more countries
follow suit in legalising cannabis for recreational use, the emergence of cannabis connois-
seurs, and an array of products, services and spaces catering to their needs, will be a notable
avenue of academic research over the coming years.
A further trend with some notable connections to the case of craft drinks outlined in
this chapter is the recent rise of low and no-alcohol beers (Smale, 2019). The Society of
Independent Brewers reported seeing a strong increase attributed to increasingly ‘health
conscious’ consumers and to a generational shift away from tolerating drunkenness in public
and on social media (SIBA, 2019). Recent developments have seen an increasing number
of low and no-alcohol beers produced by established craft breweries or specifcally low and
no-alcohol beer enterprises partnering with established craft breweries in ‘collaboration’
brews (Gilbert, 2019). Although a very recent trend, many craft brewers now see brewing

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a non-alcoholic but still good tasting and stylistically ‘interesting’ beer as a challenge to
demonstrate their skill. Likewise, certain groups of consumers seem to be exhibiting levels
of commitment, passion and taste akin to the wider craft beer geek subculture but in rela-
tion to beers with 0.5% alcohol or less. Social media appears to be playing a key role here
with both corporate actors and consumers using platforms such as Twitter and, in particular,
Instagram to communicate about new products. The potential, indeed probable, situation
where ­non-alcoholic versions of beer, cider, wine and spirits become widespread and cultur-
ally valued brings with it the possibility of consumers of craft drinks choosing to have the
taste but without the intoxication.
Taken together, this chapter and these final speculations about future directions illustrate
the importance of considering the fluctuations in cultural value and social status attached
to different intoxicants. As beer has gone from being solely a widely consumed yet always
relatively low-status product to a more diversified field inclusive of a subculture of craft
‘connoisseurs’, the discourses and practices that link it to intoxication have also undergone
remarkable change. Only in recent decades has it become socially acceptable to spend sig-
nificant amounts of time, effort and money in honing one’s capacity to judge and appreciate
beer. The research drawn on here, although notable for an ongoing absence of discussion of
the intoxicating effects of craft drinks consumption, serves to foreground the importance
of cultural contexts in which intoxicants are consumed, meaning that new narratives and
discourses are propagated which are able to cast one form of intoxicant consumption as su-
perior to others and, in so doing, working to justify the consumption of certain intoxicants
by certain people as acceptable and, even, as desirable.

Note
1 The term Real Ale used in the UK and beyond to describe a beer brewed from traditional ingre-
dients and matured by secondary fermentation in the container from which it is dispensed, and
served without the use of extraneous carbon dioxide. The term lager originally describes German
beers that were conditioned through extended storage at cool temperatures before service. In
modern usage, the term lager is used more widely and is often associated with the most common
and widely commercial beer brands which tend to be characterised as light, clear and having a
lower flavour profile compared to traditional beer styles.

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 8
ECSTASY
A synthetic history of MDMA
Peder Clark

Introduction
In 1990, posters which delivered a stark warning about drugs started appearing across En-
gland. A black and white photo depicted a ghostly pale young man, attended by health
professionals and laid prostrate on a hospital bed, while white text on a red background
cautioned potential users that ‘sometimes the after efects never wear of’ (Figure 8.1).1 While
its message and appearance were very much of a piece with the ‘scaremongering approach’
(Wibberly and Whitelaw, 1990) employed by mid-1980s campaigns on heroin and crack
cocaine, the intoxicant that the government-backed anti-drugs campaign was primarily
concerned with was relatively new: 3,4-Methylene-dioxy-meth-amphetamine, MDMA, or
more commonly, ‘ecstasy’.
First patented by Merck in the early twentieth century, and reinvented by the Californian
chemist Alexander Shulgin (amongst others) in the 1960s and 1970s, MDMA had, from the
summer of 1988 onwards, become inextricably linked with the nascent ‘rave’ scene in the
UK. As author Sarah Champion has suggested, ‘Chicago’s house music and the drug ecstasy
became a double-act like fsh and chips’ (Champion, 1997: xiii). The psychoactive properties
of the substance, which include reports of euphoria, mild hallucinogenic efects and in-
creased energy, were seemingly a perfect foil for the new house and techno music sweeping
through British nightlife. Capitalising on this preference for North American dance music,
a travelling New York DJ, Leonardo Didesiderio aka Lenny Dee, was struck by the lurid
imagery of the billboard campaign:

I was in a very strange place, experiencing ecstasy for the frst time … This poster and
billboard was all over the United Kingdom. Needless to say, I thought it was fuckin’
great, as I was totally into X [ecstasy].
(Major Problems, nd)

Didesiderio was in fact so taken by the poster that he decided to appropriate it wholesale
for the label art of his next 12-inch under the moniker Major Problems. With track ti-
tles such as ‘Flashback’ and ‘Overdose (The Final Trip)’, the record gleefully parodied the

DOI: 10.4324/9780429058141-11 127

 Peder Clark

Figure 8.1 Central Ofce of Information ‘Drugs: sometimes the after efects never wear of’, 1990.
Source: Licenced under Crown copyright, image courtesy of US National Library of Medicine http://resource.
nlm.nih.gov/101449661

shroud-waving tendencies of the government-sponsored The Efects Can Last Forever cam-
paign in pursuit of hedonistic abandon.
The poster then, and its transatlantic response, are illustrative of the tension at the heart
of many ‘cultures of intoxication’ (Withington, 2014) in the modern era; the possible cost to
one’s health balanced with the escape from the mundane. At one extremity, the puritanical
tendencies of the medical establishment, warning ecstasy users that they were engaging in a
‘dance of death’ (Henry, 1992); at the other, the user whose lifetime consumption reportedly
exceeded 40,000 pills (Kouimtsidis et al., 2006). These poles, illustrated in broader culture
on the one hand by widely recirculated tabloid headlines in the Sun newspaper, and on the
other by the nostalgic, celebratory flm of Fiorucci Made Me Hardcore by Turner Prize winner
Mark Leckey and Jeremy Deller’s more recent Everybody In the Place, have been understood
using Stanley Cohen’s pliable phrase ‘moral panic’ (Clark, 2019; Speed, 2019).2 Originally
applied to the ‘mods and rockers’ subcultures of 1960s Britain, Cohen’s sociological classic
explained how something new and fashionable from youth culture can be deemed dangerous
and a threat to wider society, a ‘folk devil’ that attracts widespread criticism and censor-
ship from ‘respectable’ society (Cohen, 1972). Cohen’s typology has ofered a convenient
analytical framework to explain frst ecstasy and raves’ appeal to youth culture, and second
its condemnation by the establishment and older generations (Redhead, 1993; Thornton,
1995: 119–120). This criticism was in part predicated on colourful accounts of the handful
of deaths attributed to the novel psychoactive substance, and the uncertainty around ecsta-
sy’s short- and long-term efects. But it was also ecstasy’s associated cultural trappings – the
repetitive, insistent music, the baggy clothes distinct from the buttoned-up power-dressing
of the 1980s, and the huge raves deemed a threat to public order – that made it disruptive to
the prevailing culture. The fipside of this ‘moral panic’ is the transgression and deviancy of
the ‘folk devil’ in the frst place, whose insurgent allure helps to explain rave’s continuing
attraction as a topic for contemporary art practice, amongst other audiences.
This chapter suggests that historians and other critical drugs researchers might look be-
yond these binaries of harm and hedonism to develop more nuanced perspectives on ecstasy.

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Ecstasy has too easily been characterised as a good-time party drug with a dark side, con-
nected in contemporary parlance with EDM (Electronic Dance Music) mega-raves and the
sometimes lethal consequences of over-consumption. In doing so, this chapter also provides
an intervention on academic discourses that have echoed the rhetoric of house music (such
as lyrics that reference ‘the House Nation’ or ‘Peace Love Unity and Respect’) and popu-
lar histories – such as Simon Reynolds’ Energy Flash or Matthew Collin’s Altered State – in
highlighting ecstasy’s universalising afect, and that of club drugs more generally (Reynolds,
1998; Collin, 1997).3 For example, in their article in the Past & Present special issue on ‘cul-
tures of intoxication’, Karen Joe-Laidler and colleagues compare the experiences of users of
MDMA and ketamine in disparate global cities in the early 2000s. They argue that

the pleasure derived from intoxication involves not only a physiological reaction but
also an opportunity to transcend normal everyday routines. In this process of stepping
outside of oneself, one may develop a spiritual awareness—a heightened sense of self,
of others, and of oneness with the collective … [this] spirituality lies at the core of the
experiences of young people in both San Francisco and Hong Kong.
( Joe-Laidler et al., 2014: 66)

Joe-Laidler et al. therefore make the case for a sort of chemically assisted ‘glocalisation’, in
which cultural specifcities are acknowledged but ultimately downplayed in order to high-
light their interviewees’ transcendent and semi-mystical experiences of MDMA. Clearly,
these processes were to a certain extent evident in the early years of rave, with American DJ
Lenny Dee’s delighted reaction to British anti-drug billboards. Furthermore, such conten-
tions are supported by ecstasy’s contemporary position as an intoxicant of global popularity,
a quotidian adjunct to young people’s nightlife. But while the collective joy apparently pro-
vided by ecstasy should be taken seriously – and Joe-Laider and colleagues rightly assert that
‘this pleasure imperative has received relatively little attention from academics’ ( Joe-Laidler
et al., 2014: 62) – I want to instead follow musician, artist and queer theorist Terre Thae-
mlitz’s lead, and in her words ‘keep sight of the things that we are trying to escape from’
(Thaemlitz, 2008).4 As Thaemlitz argues in his consideration of New York Deep House and
drag ball culture in the early 1990s:

The House Nation likes to pretend clubs are an oasis from sufering, but sufering is in
here with us … House is not universal. House is hyper-specifc.
(Thaemlitz, 2008)

Although Thaemlitz’s personal position could probably be crudely characterised as anti-

drugs, her approach is instructive (Saulwick, 2015). Ecstasy emerged into widespread popu-
larity from very specifc subcultures, and in highlighting the supposed universalising afect
of ecstasy, there is a danger in neglecting the principles that have more readily been applied
to other psychoactive substances. In common with other intoxicants, ecstasy can mean very
diferent things in diferent temporal and spatial settings, and in diferent cultural contexts.
As Thaemlitz suggests, ‘[h]ouse isn’t so much a sound as a situation’ (Thaemlitz, 2008),
and similar principles should apply to our consideration of house music’s most commonly
accompanying intoxicant. In short, this chapter argues that ecstasy, like other psychedelic
substances, needs to be considered in terms of ‘set and setting’ (Zinberg, 1984).
Ecstasy has meant diferent things to diferent people at diferent points in diferent lo-
cations. This chapter moves beyond existing work which focuses either on the moral panics

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periodically associated with ecstasy or on the apparently universalising afect that its con-
sumers report. This brief, synthetic and inevitably partial history of the drug and its con-
sumption, following its frst synthesis in Germany to its widespread use in Britain, will
illustrate this argument.

‘Adam’: ecstasy before the rave, 1912–1985

MDMA was frst synthesised in the laboratories of Merck, the Darmstadt, Germany-based
pharmaceutical corporation in 1912, not as an appetite suppressant as some accounts
suggest, but as a haemostatic agent (i.e. to aid blood-clotting and prevent bleeding).
Initially referred to as ‘Methylsafrylamin’, it was patented that same year, but only men-
tioned occasionally in internal company documents up until the 1950s (Freudenmann
et al., 2006). Despite these inauspicious beginnings, the patent also contained a clue to
one of its further usages, with an allusion to its potential use ‘as an intermediate in the
production of therapeutic compounds’ (Pentney, 2001: 214). The chemically similar and
historically linked substance MDA (3,4 methylenedioxyamphetamine) had been used by
the US military as a potential ‘truth serum’ in the 1950s, as well as for selected medical
indications by pharmaceutical companies, including as a cough remedy and appetite
suppressant (Pentney, 2001: 214). Its hallucinogenic properties had been noted, and it
started to fnd its way into recreational uses, ‘quickly develop[ing] a reputation for pro-
ducing a sensual, easily manageable euphoria, thus its nick-name “The Love Drug”’
(Naranjo, 1983; Passie and Benzenhöfer, 2016: 68).
MDMA was synthesised around the same time – the Californian chemist Alexander
Shulgin claimed to do so in the mid-1960s – and some histories suggest that it was considered
less toxic than MDA (Pentney, 2001: 214; Benzenhöfer and Passie, 2010: 1357). Although
Shulgin was unlikely to be the frst to do so, he is widely accepted as being responsible for
its introduction into clinical usage, via his friendship with psychologist and psychotherapist
Leo Zef. Zef had been tipped of about MDMA by a chemist friend, and almost imme-
diately became an enthusiastic proponent, postponing his retirement to proselytise about a
substance that he viewed as potentially transformative for many of his patients. Zef was also
insistent that those dispensing MDMA should also have personal experience, to ensure that
they ‘know the efects of any such drugs in themselves, before giving them to anyone else’
(Stolarof, 2004: 18). MDMA was used in ‘hundreds of [psychotherapeutic] sessions’ by Zef
and other associates, but it was also beginning to be recognised for its potential as an intoxi-
cant (Pentney, 2001: 214–215; Richert, 2019: 142–146). Indeed, Shulgin himself would refer
to MDMA as his ‘low-calorie martini’, an understated description which belied the baccha-
nalian reputation it would later attain (Shulgin and Shulgin, 1991: 73).5
The emergence of MDMA from an object of laboratory experimentation and biomedi-
cal enquiry can therefore be traced to the mid-1970s, with unconfrmed reports of its frst
usage as an intoxicant in the late 1960s (Siegel, 1986). Street drug samples were seized by
the Drug Enforcement Administration (DEA) in various locations across the US, but most
particularly in the mid-West, between 1970 and 1974 (Passie and Benzenhöfer, 2016: 71). By
the mid-1980s, the DEA estimated that MDMA was available in 21 states across the US and
Canada. This availability was concentrated on the east and west coasts – New York, Cali-
fornia, Florida – with one signifcant exception: the southern state of Texas (Siegel, 1986:
349). According to some accounts of ecstasy lore, it was the nightspots of Dallas that would
be the making of ecstasy’s reputation as a drug perfect for dancing in nightclubs – but also its
unmaking as a still legal high in the US.

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But before attending to this legend, it is important to stop and note the shape-shifting that
MDMA had already taken in its early years. Far from being the party drug of contemporary
lore, MDMA held at this stage a much more sedate and cerebral reputation. Praised by psy-
chotherapists for its ability to evoke ‘honesty’ and lucidity from its patient-users, it was also,
perhaps inevitably, being sampled by curious psychonauts who had previously experimented
extensively with mescaline and lysergic acid diethylamide (LSD) (Richert, 2019: 144). For
example, Timothy Leary frst tried MDMA in 1978, and became an enthusiastic, if initially
private, advocate (Leary, 1985). Indeed, in Storming Heaven, Jay Stevens’ classic history of
LSD, MDMA was discussed, alongside other ‘new psychedelics’ such as 2-CB, as a more
sophisticated successor to acid. Stevens related an afternoon spent with ‘an octogenarian
former professor’ who insisted that ‘Adam’ (a common name for MDMA at this point) was
a ‘very intriguing drug … extremely useful’ (Stevens, 1987: 287). Upon sampling the drug
himself, Stevens stated that ecstasy

didn’t create insights so much as remove barriers and eliminate the native fear of appear-
ing emotionally clumsy and foolish. You were high, but you weren’t high. There was
none of LSD’s powerful rush into the unconscious, no hallucinations or cosmic apercus;
just a pleasant but emotionally draining communion.
(Stevens, 1987: 289)

Indeed, researchers were at pains to distinguish MDMA from existing psychedelics, instead
coining new descriptors. MDMA was an ‘entactogen’, or even an ‘empathogen’ although
some researchers rejected the latter, suggesting that it might be unattractive to putative
psychiatric patients, and that anyway, ‘MDMA do[es] more than simply generate empathy’
(Adamson, 1985; Nichols, 1986: 307).
Writing in 1986, Jerome Beck and Patricia Morgan confrmed its multiple uses in the
Lone Star State; ‘[o]ne reason for its popularity in Texas was undoubtedly the open sales of
MDMA in well-patronized, mostly student-oriented bars and in gay bars’ (Beck and Mor-
gan, 1986: 291). Consumers continued to ascribe MDMA a number of diferent properties;
Newsweek reported that MDMA ‘has become popular over the last two years on college
campuses, where it is considered an aphrodisiac’, while others ‘described it as a “yuppie
psychedelic” whose popularity was spreading rapidly among educated professionals in their
thirties and forties’ (Beck and Morgan, 1986: 292). Indeed, Beck and Morgan concluded
that MDMA ‘seems to possess a multiple personality’ (Beck and Morgan, 1986: 290). And
despite its growing popularity, not everyone in Texas was having a wholly enjoyable time on
it either. The late musician and poet David Berman, a man not unaccustomed to a variety of
intoxicants, recounted his experiences in Austin the summer before ecstasy’s criminalisation
in 1985:

I can honestly say I’m glad it was outlawed. After three months of its use I had lost all
discretion and was prepared to trust just about anyone. Worse yet, it was turning me into
a joiner. That’s not who I am.
(Berman, 2002)

Beck and Morgan pointed out that, even at this juncture in the mid-1980s, ‘[a]lthough
MDMA has been described occasionally as a “party drug,” that is not its most common use
pattern’ (Beck and Morgan, 1986: 293). They allowed however that Dallas was an excep-
tion, and its nightclubs, most especially the one designed by architect Phillip Starck, would

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anticipate ecstasy’s primary use over the coming decades. The Starck Club was notable not
just for its chic design and high-profle guests, such as Grace Jones and Annie Lennox, but
because the intoxicant of choice amongst its clientele was overwhelmingly ecstasy. ‘X’ was
available at the bar, in common with many other clubs in Dallas where ‘[y]ou would order a
couple of cocktails and two hits of X and put it on your Master Card’ (Beck and Rosenbaum,
1994: 45). But at the Starck Club, the musical soundtrack was also signifcant, with the DJ’s
selections of synth-pop and electro foreshadowing the close association that MDMA would
develop with electronic music later in the decade (West, 1989; Gonsher, 2016).
But MDMA’s surging popularity in Texas was fast bringing it to the attention of the DEA
and local politicians. Senator Lloyd Bentsen petitioned the DEA in 1984 to make ecstasy
a Schedule 1 drug under the Controlled Substances Act, meaning that MDMA was now
considered a drug that ‘has high abuse potential, no accepted medical use and no accepted
safety for use’. The purported reason for this move was that MDA – MDMA’s close chemi-
cal analogue discussed earlier – had reportedly been shown to cause brain damage, and the
DEA declared that ‘[a]ll of the evidence … received shows that MDMA abuse has become
a nationwide problem and that it poses a serious health threat’ (Associated Press, 1985). An
emergency ban of MDMA took efect in June of 1985, and was made permanent the fol-
lowing year.
The criminalisation of MDMA had a number of ripple efects, some immediate, and
some longer-lasting. For the Starck Club, this meant a raid from the DEA on 7 August
1986, and a temporary revoking of its dance licence (Gonsher, 2016). In Dallas more widely,
according to Beck and Rosenbaum, ‘Ecstasy had become “last year’s fad”’ (Beck and Rosen-
baum, 1994: 46). But perhaps more signifcantly, an unintentional and long-term efect of
the Schedule 1 designation was to push ecstasy frmly into the category of an intoxicant, now
that medical and therapeutic research on the drug was no longer possible. No longer were
psychiatrists able to use it as an adjunct to psychotherapy, and its reputation as a recreational
drug was secured. While its criminalisation may have temporarily suppressed its use in Dal-
las, elsewhere it was only just taking of. Indeed, the pre-criminalisation scenes of hedonism
at the Starck Club had set a blueprint for ecstasy’s use globally.

‘E is for England’: ecstasy and dance culture in the UK, 1986–2009

Ecstasy’s frst major coverage in the British press was in style magazine The Face with two
articles over the space of year, which provide an insight into how its recent arrival in the
UK was greeted. The frst article, in October 1985, reported on its popularity in Texas, but
sounded a sceptical note about its efects, drawing unfavourable parallels with LSD in the
1960s:

Whatever it tells us of the times, its users generally agree MDMA is not “ecstasy”. It can
make you feel very close and empathetic – you might feel like hugging your friends –
but the afection it inspires is unlikely to send anyone into the frenzied raptures common
in the Haight/Ashbury district [of San Francisco] in 1967. Ecstasy is a misleading name;
the drug is so-called more for reasons of promotion than revolution.
(Naysmyth, 1985: 91)

Journalist Peter Naysmyth’s lukewarm tone was underlined by a DEA-afliated chemist

Ronald Siegel’s afrmation that he had ‘heard a report of someone locked in a foetal position
for three days’, although Siegel also conceded that other ‘people [have] loving, harmonious

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experiences’. There seemed little evidence of ecstasy successfully transitioning to British

nightlife; Naysmyth quoted an ‘anonymous member of [London’s] Soho club-land’ saying
‘[p]ersonally I fnd it boring … I used to do it when it frst came out a few years ago, but now
I fnd cocaine a better buzz… and it’s cheaper’. Ecstasy’s future in the UK seemed to be more
likely to be in the clinic than club-land; radical psychiatrist R.D. Laing complained, ‘it’s a
shame it’s been criminalised because it could have taken its place in the pharmacopoeia …
It made me feel how all of us would like to think we are anyway’ (Naysmyth, 1985: 91–92).
However, there was as little chance of MDMA being a therapeutic adjunct in the UK as there
was in the US. Ecstasy had been a Class A drug in the UK since 1977, covered by an amend-
ment to the generic provisions of the Misuse of Drugs Act 1971 for ‘other ring-substituted
phenylethylamines’ (Advisory Council on the Misuse of Drugs, 2009: 7).
Use in the UK was therefore very much set up to be on an illicit recreational basis, a
theme that Peter Naysmyth would return to in The Face in October 1986, precisely a year
after his original article. In this intervening period, ‘use of the drug Ecstasy has increased
tenfold’. Seemingly popular amongst the young and the fashionable, one ‘X-head’ inter-
viewed estimated that ‘of the main pop groups probably ten have tried it: fve have liked
it’. This ambivalence revealed a more complex picture than the unbridled enthusiasm that
would seemingly later sweep Britain. For this same interviewee, who had tried it frst in
New York, it was ‘simply the most brilliant thing I had ever taken … [but] the emphasis had
shifted from the experience of the drug to the circumstances of its use’. In other words, set
and setting were highly important; for Naysmyth, this provoked an unanswered question:
‘what about the other fve [pop] groups? If it’s so magical why didn’t they swallow it too?’
(Naysmyth, 1986: 53–54).
Naysmyth’s second article also addressed a persistent aspect of ecstasy’s early coverage in
Britain; its reputation as an aphrodisiac. A female ‘model in her early twenties’ was equivocal
about her experiences on ecstasy in general, but stated that ‘I think I only felt genuinely Ec-
static on it alone with my boyfriend … but it’s better for touching than for actual sex’ before
Naysmyth reminded readers that ‘[i]t’s a recognised medical fact that MDMA inhibits male
orgasm’ (Naysmyth, 1986: 54). This ‘fact’ would not prevent ecstasy being reported as a ‘sex
drug’ in many later newspaper stories about ecstasy and raves, as they traded on a classic tab-
loid combination of prurience and moral censoriousness. The most-quoted example of this
tendency is The Sun’s headline of 24 November 1988, ‘Acid Fiends Spike Page Three Girl’s
Drink’ but ecstasy was also described as a ‘sexual stimulant’ in early reporting by broadsheet
newspapers (Anon, 1987; Redhead, 1990: 4; Rietveld, 1993: 46). Such lurid headlines were
still very much in the future however, as Naysmyth concluded his article by noting that, ‘[a]
fter a year of Ecstasy in the UK, cynicism – that most persistent of British habits – still held
the day’ (Naysmyth, 1986: 55).
Nonetheless, this traditional British reserve was soon to be swept away, seemingly by a
visit to foreign shores and an imported Balearic culture. This, at least, is the creation myth of
raves and acid house, a holiday in Ibiza, a transformative experience with a potent mixture of
electronic music and powerful pills, and a desire to recreate some of that magic in London,
at clubs such as Shoom, Future and Clink Street (Collin, 1997: 47–74; Garratt, 1998: 87–117;
Reynolds, 1998: 58–66; Melville, 2020: 145–152). This metropole-centric tale has of course
been disputed by other accounts, which draw attention to the nascent house music scenes in
Manchester, Leeds or Shefeld (Anniss, 2020), but regardless of these origins, ‘the histories
of British House music and Ecstasy are inseparable’ (Metcalfe, 1997: 166). Indeed, it was this
pairing that took ecstasy from being a drug dabbled with by a fashionable minority to the
globalised mass intoxicant that it is today. A hitherto unremarked aspect of ecstasy was the

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energy that it gave users over a trip of between four and six hours. This drive, and the appar-
ently pleasurable combination of its euphoric efects with repetitive electronic music such as
‘acid house’, made it an intoxicant highly conducive to dancing.6
What started at small clubs in major cities was soon spilling out into rural and suburban
areas, bringing acid house and its attendant intoxicant frmly into the public eye. Restrictive
licencing laws meant that most clubs closed at 3 AM or earlier, and given how long it took
for ecstasy’s efects to wear of, this meant that alternative, unlicenced venues for parties
without curfew needed to be found. In places like Blackburn, proximal to the clubs of Man-
chester, this meant the disused factories left by post-industrial decline (Hemment, 1998).
Near London meanwhile, it meant improvised spaces of the M25, a major road that formed
an ‘orbital’ around the capital:

Over the course of 1989, promoters such as World Dance, Genesis, Helter Skelter, and
Energy succeeded in setting acid house nights free of the urban core’s constrictions,
staging ever more elaborate Orbital parties in borrowed and rented felds, the odd ware-
house, or some other similarly vacant megastructure.
(Clover, 2009: 64)

Such megastructures famously included White Waltham airfeld, near Maidenhead, where
‘11,000 youngsters [went] drug crazy at Britain’s biggest-ever Acid party’ in an ‘Ecstasy Air-
port’, according to the front page of The Sun newspaper (Kellaway and Hughes, 1989). The
same tabloid had the previous year warned its readers of ‘the evil of ecstasy’ and ‘the danger
drug that is sweeping discos and ruining lives’ (Evison and Willis, 1988), while questions in
the House of Commons were being raised about how the government aimed to respond to
this ‘acid house cult’ (Written Answers (Commons): Home Department ‘Acid House Cult’,
HC Deb 14 November 1988 vol. 140 c392W).
A ‘moral panic’ similar to that which had greeted previous subcultures was therefore un-
derway, with ecstasy and acid house as ‘folk devils’ in the minds of the British establishment
and media (Cohen, 1972). But while, no doubt, much of the tabloid hysteria was confected,
ecstasy had by the end of 1989 been implicated in the deaths of several young people, pro-
viding hard evidence of its dangers for those that sought it.7 Governmental campaigns, such
as The Efects Can Last Forever posters mentioned in the introduction of this chapter, therefore
played up the potential lethality of ecstasy, while legislation introduced in 1990 by Conser-
vative MP Graham Bright, ‘commonly known as the acid house party Bill’, attempted to
curb the spread of illegal raves (Graham Bright, ‘Increase of Penalties: England and Wales’
HC Deb, 27 April 1990, c652).
But as the introduction also detailed, such actions did little to curtail enthusiasm for
ecstasy consumption or raves. Popular culture was saturated with winking reference to the
drug. The techno-pop group The Shamen mischievously sneaked a song with a chorus that
sounded a lot like ‘Es are good’ onto Top of the Pops on BBC television (Garratt, 1998: 256),
while comedian Keith Allen attempted to include the lines ‘E is for England/England starts
with an E’ in New Order’s ‘World in Motion’, their ofcial song for the English football [soc-
cer] team at the 1990 World Cup (Russell, 2018). Organisers of raves would later assert that
‘Ecstasy united black, white, yellow, and brown people as one … an across-the-board mix-
ture of races holding hands and giving out total love and respect for one another’ (Anthony,
2002: 50). Further bold claims for the universalising afect and transformative efects of ec-
stasy included its role in ending football hooliganism, as members of rival ‘frms’ apparently
abandoned hostilities after dancing together in clubs (Saunders, 1993: 35–38; Collin, 1997:

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129–137). Even more improbably, some journalists suggested that ecstasy could play a part
in halting sectarian violence in Northern Ireland (Hollywood, 1997; Gilbert and Pearson,
1999: 4). Others believed that the changes brought by ecstasy were on a more personal level:

The freedom to behave as you want may not seem like a real revolution to fussy old
Marxist men … To have the opportunity to forget classifcation by race, class or gender
allows a close examination of what unites us rather than our diferences.
(Wright, 1998: 240)

The former comment by Mary Anna Wright might be read as a mild rebuke to her editor
George McKay, who had elsewhere sceptically suggested that many of the freedoms at-
tributed to rave and ecstasy were weak echoes of the sixties counterculture and just as likely
to be co-opted and nullifed by contemporary capitalism (McKay, 1996: 103–126). More
recently, media scholar Caspar Melville has contended that ‘we should treat such claims
for the world-changing nature of acid house and rave with caution. They can burden club
culture with a political and social signifcance that they are not able to support’ (Melville,
2020: 140). This slippage between ‘ecstasy’ and ‘acid house and rave’ reveals how intimately
the two are intertwined in accounts of the period, but it is also important to note that con-
temporary observers also questioned both the cultural diversity and supposed radical nature
of raves. Keir Starmer, at this time a young lawyer, would defend party organisers as part of
his role with the National Council for Civil Liberties, but also argued that the notion ‘that
the “acid house” phenomenon should be seen as subversive is particularly bizarre. A car, a
telephone and a fairly healthy bank account are essentials for the party-goer’ (Rose, 1989;
Starmer, 1990: 4).
But even if pills were priced at an average of £18, a reported 500,000 people were con-
tinuing to take ecstasy in Britain in 1993 (Anon, 1993). Subversive or not, ecstasy was now
frmly established in British nightlife; in 1995, The Guardian newspaper would comment
that ‘drug-taking has become an integral part of youth culture’ (Anon, 1995). While clubs
were still important venues for consumption, the Criminal Justice and Public Order Act of
1994 had, despite the eforts of a coalition of resistance and protests, efectively eradicated
large-scale outdoor raves (Huq, 1999; Alwakeel, 2010). The highly publicised death of Leah
Betts after celebrating her eighteenth birthday with a house party at which her parents were
present in the village of Latchingdon, near Basildon, Essex in late 1995 brought home how
quotidian ecstasy use had become, and how it had been decoupled from the dance culture
in which it emerged. This tragic incident of course also marked a revival of the moral panic
around ecstasy, with widespread news coverage and billboards, echoing those used in The
Efects Can Last Forever campaign, that warned ‘[ j]ust one ecstasy tablet took Leah Betts’
(Martin, 2005).
While highly visible at the time and much referenced since, it is questionable how much
longer-term impact Betts’ death had on public attitudes or private sensibilities (Anon, 1996;
Gilbert and Pearson, 1999: 2). In 2000, four years after providing expert witness for Betts’
inquest, and eight years after penning the article that warned users were engaged in a ‘dance
of death’, leading toxicologist John Henry would state, on comedian Sacha Baron Cohen’s
Da Ali G Show, that ‘some people can take two or three Es and [have] no problems’ (Baron
Cohen, 2000). Partly, this was due to the declining MDMA content of pills (Cole, 2014: 47),
but it was also an admission that the vast majority of users could do so relatively unprob-
lematically.8 A decline in MDMA content was also accompanied by a dramatic fall in street
price, such that pills could be bought for under £3 in most parts of Britain (Measham, 2004:

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314). Ecstasy by the latter half of the 1990s was therefore a cheap and accessible intoxicant
that was widely used by a variety of people, many of whom were not at all connected with
dance subcultures. Indeed, as this chapter has maintained, a focus on both the extreme harms
of ecstasy and its role in the so-called Second Summer of Love of 1988 has obscured the
varied contexts and experiences of its use as an intoxicant.
One of the more unusual users and most vociferous advocates of ecstasy during the 1990s
was a man in his ffties who had a strong distaste for raves and dance music, but who never-
theless became a cult fgure for many young people. Nicholas Saunders, described as the ‘Bud-
dha of euphoria’, was up until this point best-known as the author of countercultural guide
Alternative London, and the hippie entrepreneur of Neal’s Yard in Covent Garden, London
(Bellos, 1995). After his frst experience with ecstasy in 1988, in which he felt that the drug
had cured his ‘mild depression’ and made him feel ‘more positive and healthy’, Saunders began
to research the drug intensively (Saunders, 1993: 9). Dismayed at what he perceived to be the
lack of accurate or balanced information on ecstasy, he self-published three books on ecstasy
from 1993 onwards until his untimely death in a car accident in 1998. These books, including
the frst E is for Ecstasy which sold in the tens of thousands, were an eclectic mix of the latest
scientifc evidence, ethnographic and sociological observations, information on safe usage and
harm reduction, and advice on the potential physical and mental health impacts (Albery, 1998).
Saunders’ books also provided an indication of the wide range of users, exploring the personal
experiences of people who had used it for ‘problem solving’, ‘improving relationships’, a ‘mini
vacation’, ‘artistic expression’ and even spiritual purposes, citing a Benedictine monk who
noted that it had facilitated his meditation (Saunders, 1993: 20, 88–93).
But while there were clearly a range of users, not all of whom were connected to dance
cultures, clubbers remained ecstasy’s primary consumer group. And although, as we can see
from Henry’s unguarded comments, the drug began to be seen as relatively safe even by those
most initially alarmed by its popularity, it also began to decline in usage around the turn of
the millennium. Moral panics shifted to other psychoactive substances used in clubs such as
ketamine or 2-CB, and older intoxicants such as cocaine and alcohol returned to, or contin-
ued to rise in popularity (Measham, 2004). Indeed, supply problems, the result of seizures of
safrole or sassafras oil (a chemical precursor commonly used in MDMA production) in Cam-
bodia, brought an efective ‘ecstasy drought’ across Europe between 2008 and 2009 (Power,
2013; Kemprai et al., 2020). ‘Legal highs’ such as mephedrone (4-methylmethcathinone)
were used as alternative intoxicants, once again prompting tabloid newspapers to express
alarm at another apparently new drug harming young lives (Fleming, 2010).

Conclusion
The frst half of this chapter concentrated on the birth and reinvention of MDMA in Ger-
many and the US, while the second half has considered its arrival in Britain and entwinement
with the ‘rave’ scene. But while raves were most visible in late 1980s Britain, comparable
music and drug subcultures also developed in the two countries that might be considered
MDMA’s parents. In the US, ecstasy’s surging popularity was addressed in 2001 by then Sen-
ator Joe Biden’s Reducing Americans’ Vulnerability to Ecstasy (RAVE) Act, which, while
not entering the legislature, paved the way for 2003s Illicit Drug Anti-Proliferation Act
(Anderson, 2014, 2009). In Germany meanwhile, ecstasy played its part in the vibrant techno
culture which greeted the fall of the Wall in 1989, and the yearly Love Parade organised by
DJ Dr Motte, which attracted up to a million attendees at its height (Borneman and Senders,
2000; Denk and von Thülen, 2012). Berlin’s clubs remain an international destination for

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techno tourists (Rapp, 2009). These are of course just two examples of the global spread of
dance cultures. As Matthew Collin states, ‘from the nineties onwards, it became possible to
fnd DJs playing almost any style in any major city – dubstep in Istanbul, psytrance in Shang-
hai, foot-work in Belgrade’ (Collin, 2018: 6).
As Karen Joe-Laidler et al. point out, accompanying these globalised dance cultures are
globalised intoxicants; primarily ecstasy, but also ketamine, speed and other novel substances
clustered under the umbrella term of ‘club drugs’. And as they also suggest, the language that
young people use to express their feelings about their drug experiences is disarmingly similar
across disparate locales (Joe-Laidler et al., 2014). The apparently universalising afect of ecstasy
encourages a discourse that highlights this imagined connectivity, accentuating the similari-
ties between ecstasy consumers while neglecting their (important) diferences. As sociologist
Maria Pini has argued, there is a tendency to ‘write about ravers in terms of sexless, ageless,
raceless and otherwise non-specifc or unsituated generals’ (Pini, 2001: 7). This chapter has
however insisted that such impulses are resisted. It has argued, after Thaemlitz, that ecstasy is
in fact ‘hyper-specifc’. As well as highlighting some of the diferent contexts in which ecstasy
has been used, it has demonstrated that until the drug became so intimately associated with
the early rave scene, the drug was described in many diferent ways by its consumers, even as
‘boring’. Between the unfortunate fatalities and life-changing experiences of ‘ecstasy evange-
lists’ lay the vast majority of users, most of whom enjoyed the intoxicant, while some didn’t
(Shewan et al., 2000). Indeed, the point that this chapter has made is quite a simple one: that
is, for ecstasy to be considered just like any other intoxicant, where historical, geographical,
cultural and social contexts are important factors in its consumption.
This need for nuanced and critical historical research on ecstasy has arguably gained in
urgency over the last few years, as ecstasy has returned to public consciousness and popular
use in many countries in the Global North. In many ways, ecstasy users are better informed
than ever before, with home testing kits for pills available to order online, dedicated char-
ities such as The Loop in the UK providing harm reduction advice, and qualitative and
quantitative reviews of pills accessible from websites such as pillreports.com and at point of
sale on the darkweb (Power, 2013). Nevertheless, there have been rising numbers of deaths
associated with the so-called ‘super strength pills’; those that contain between 200 mg and
300 mg of MDMA, which provide a massive high but also increase the risk of overdose
(Coldwell, 2017). While these pills are of palpable concern to public health authorities and
harm reduction charities, their existence also invites historical refection on the nature of
intoxicants. It makes plain and obvious the point that this chapter has strived to explain; that
taking a pill at a festival in 2019 was not the same as taking a pill in 1989 at a rave, or in 1999
at a ‘super-club’, or even resorting to mephedrone during the ‘ecstasy drought’ of 2009. Even
within the relatively culturally homogenous British context, these are all radically diferent
historically and temporally contingent moments of intoxication. More histories exploring
these complex and specifc histories need to be written. ‘Set’ and ‘setting’ are as applicable to
ecstasy as they have been to other intoxicants.

Notes
1 While in this chapter I use the terms MDMA and ecstasy more or less interchangeably, there is a
literature that disputes their confation (Edland-Gryta, Sandberg and Pedersen, 2017).
2 Leckey’s video artwork, which traces a continuity from the amphetamine-fuelled Northern Soul
parties of the 1970s to the illegal raves of the late 1980s, is from 1999. Deller’s flm, originally
produced for Frieze in 2018, received wider screening on BBC4 in 2019. Whil placing rave in its
cultural and political context, it was signifcant for its underplaying of the role of ecstasy.

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3 Reynolds’ book was published under the title Generation Ecstasy for the US market.
4 Thaemlitz’s preferred pronouns are alternating ‘she/he’ and ‘her/his’.
5 PiHKAL also contains a fctionalised account of Shulgin’s rediscovery of MDMA, as well as de-
tailed information on the chemical composition and tasting notes of many other synthetic psycho-
active substances.
6 Acid house was so named because of the lysergic, trippy qualities of music made using the Roland
TB-303 bass synthesi, most notably Phuture’s Acid Trax, but also because LSD was the drug of
choice at the gay, Black clubs of Chicago where house music originated (Salkind, 2019). ‘Chicago
house went hand in hand with stimulants and hallucinogens’ (Reynolds, 1998: 26).
7 The deaths of two young–women Janet Mayes, in October 1988, and Claire Leighton in July
1989–received widespread media coverage, although they were in fact preceded by that of Ian
Larcombe, ‘who had swallowed a bag of eighteen tablets and sufered a fatal heart attack after being
stopped by police on the way to a club in June [1988]’ (Collin, 1997: 80).
8 Mean MDMA content of ecstasy pills fell from 103 mg in 1991 to 74 mg in 2000.

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 PART III

Intoxicating Settings
 9
THE SOCIAL WORK OF COFFEE
Cofee consumption in bosnia and herzegovina
and the bosnian diaspora

Ana Croegaert

Introduction
When I began to explore what it was like for refugees of the 1990s political violence in for-
mer Yugoslavia to be relocated to the United States, I didn’t anticipate how much I would
learn about the centrality of cofee drinking practices to those in this wartime diaspora.
Refugees who had been forced to leave their homes under the threat of violence had little
time to pack and prepare, and had to be selective about what to bring with them—only as
much as one could carry—and people often tried to include their traditional stove-top cof-
fee pots, džezve, and handmills, mlinovi, in their hastily packed suitcases. If these belongings
were lost, “disappeared,” or stolen during people’s escape, they were among the frst objects
people sought to replace once they had achieved a threshold of stability in their new home.
People preferred to purchase the fnely ground powder-like imported Yugoslav cofee
brands at the “ethnic” groceries in their new home towns (when available) rather than the
less expensive mass-produced American brands, or the much more expensive small-batch lo-
cally roasted artisanal cofee beans. Refugees who opened small cafes and eateries catering to
the diaspora distinguished their “American” cofee brewed with automated drip machines,
from “Bosnian” stove-top cofee, sometimes also glossed as “Turkish” cofee on their menus
(Croegaert 2011: 472). The elder generation used cofee invitations to establish and maintain
friendships, and reprimanded the younger generation for ordering cofees to-go rather than
sitting and savoring their cofee and conversation. In homes where Bosnian cofee was rarely
prepared, cofee service objects such as džezve, mlinovi, and fldžani—small porcelain cups
traditionally used to drink the cofee—were displayed along with other valued tableware
and family photographs in hutches and atop bufets. Cofee drinking rituals and associated
objects permeated everyday life and emerged as a major theme during the course of my re-
search (Figure 9.1).
Four of the six former Yugoslav republics appear in a list of the top 15 cofee-consum-
ing countries: Slovenia (4), Serbia (6), Bosnia-Herzegovina (11), and Croatia (14).1 Along
with Brazil and the Dominican Republic, the western Balkan countries are unique in this
cofee-consuming cohort as not belonging to the so-called “frst world” capitalist democra-
cies to emerge during the Cold War.2 Yugoslavia was sometimes considered “third world”
in the language of Cold War geopolitics, and, along with Egypt, Ghana, and Indonesia, was

DOI: 10.4324/9780429058141-13 143

 Ana Croegaert

Figure 9.1 Ismeta Bufet Display Qur’an Bosnian landscape painting džezva fldžan šešerluk

a founding member of the Non-Aligned Movement comprising the countries allied neither
with NATO, nor with the Soviet Union. However, unlike Brazil, the largest cofee producer
in the world, and the cofee-growing Dominican Republic, there is no domestic production
in the western Balkans. The region’s longstanding cofee culture relies on cofee imports.
Thus, as with the majority of the world’s top cofee-consuming countries, consumers in the
former Yugoslavia are separated from cofee producers along the commodity chain (Doane
2010, West 2012).
In this chapter, I explore the cofee-consuming cultures of one of these countries,
Bosnia-Herzegovina, including that of Bosnia’s refugee diaspora.3 Scholars looking to un-
derstand consumption practices attend to how people understand the relationship between
objects—including food—of consumption to their consumers. This leads to insights as to the
dynamic relational processes by which meanings are attributed to both objects and people
in acts of consumption, and during times of social and material changes these meanings may
take on increased signifcance as people seek to give shape and meaning to such society-wide
shifts (Caldwell 2009, Miller 1998, Patico 2009). Bosnia’s cofee cultures are shaped by its
histories as an Ottoman province from the late ffteenth to the late nineteenth centuries,
and a Habsburg province from 1878 to 1918. During the twentieth century, Bosnia was a
part of two countries that arose from the former Ottoman and then Habsburg states: the
Kingdom of Yugoslavia (1918–1941), and the former Socialist Federal Republic of Yugosla-
via (1945–1990s). In the political violence that erupted during conficts over post-Cold War
governance (1992–1995), fully half of the small country’s population of 4.4 million was forc-
ibly displaced, and some became part of a globally dispersed diaspora estimated at more than

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one million people (Halilovich et al. 2018).4 These refugees brought their cofee drinking
traditions with them.
This chapter focuses on the social practices and material culture of Bosnian cofee drink-
ing to explore connections between cofee drinking and power. Cofee scholarship shows
that consumption practices and patterns related to the beverage provide insight into politics
of class formations and status distinctions that are often expressed in frictions over social
norms. From the 1990s fourishing of gourmet cofee products in North America following
free trade deregulation of the international market that made the consumption of “small-
batch locally roasted” cofee a sign of “yuppie” status (Roseberry 1996), coincident “fair
trade” projects linked to Central and South American producers (Doane 2010), eforts to
forecast Turkey’s entry to the European Union (Gursel 2009), to Melanesian producers’
endeavors to expand and intensify their exchange relations throughout a cofee commodity
chain originating in Papua New Guinea extending to markets in Europe and Australia (West
2012), cofee drinking is embedded in systems of social inequality and saturated in notions
of morality. Looking at Bosnian cofee drinking practices ofers a view to the beverage’s role
as a critical symbolic place-maker in diasporic and culturally dynamic contexts (Low and
Lawrence-Zuñiga 2003).
I begin with a brief history of cofee and cofeehouses in the region and show that tracing
Bosnian cofee traditions delineates longstanding connections between Muslim and Chris-
tian Europeans and highlights shifting regional social norms. I then describe and discuss the
cofee memories shared by Mahira, who fed Bosnia’s capital city, Sarajevo, during the 1990s
siege when she was in her late sixties. Mahira’s recollections of cofee drinking show how the
practice is key to establishing and defning public space. Next, I look at the youth street cafe
cofee culture in a small town outside of post-confict Mostar, in the Herzegovina region,
in the late aughts. After the war in this small town, cofeehouses had emerged as ethnically
segregated spaces; yet, because the cofeehouses were spatially proximate, such separation
was undercut by routine visiting of friends from tables at the cofeehouse nearby. Finally, I
refect on the uses of cofee in a “nomadic monument” in Chicago, 2017, commemorating
the wartime genocide against Bosnian Muslims (Bosniaks). Here, Bosnian diaspora artist
Aida Šehović and her volunteer partners claim public space through an annual one-day in-
stallation of Bosnian cofee service.

Cofee as a Social Stimulant

Cofee’s capacity to stimulate the senses and sociality is remarked upon in accounts of cofee
drinking in the early modern era. During the sixteenth century across the Ottoman Em-
pire, for example, Yemeni Suf mystics used a cofee beverage understood to inspire the soul
during evening praise ceremonies (Hattox 1985, 24–25, 69). In these prayer rituals, called
dhikir/zikir among Muslim subjects in the Empire’s Balkan provinces, men gathered to-
gether and passed a communal bowl of cofee among their circle, each drinking in order to
generate collective stamina for engaging with divine energy—an intoxicating force. Similar
to the Eucharist practiced by Ottoman Christian subjects, dhikir cofee was understood as a
material, fgural conduit among participants, and between divine and human (Bynum 1987,
Hattox 1985).
During this same period, cofeehouses were established in cities across the empire. Cairo,
Mecca, Damascus, Istanbul and Sarajevo, for example, had cofeehouses where learned
men could gather and socialize outside of either the mosque or the tavern—where wine
was served. The association of cofee with intoxication among some Suf mystics, and the

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similarity of the cofeehouse to the tavern as a non-religious social space led some local reli-
gious Muslim authorities to declare cofee and cofeehouses as haram, to be avoided because
it was seen to violate interpretations of Islamic conduct that addressed intoxication. Ralph
Hattox describes how, in a series of episodic regional decrees issued at the beginning of the
sixteenth century, educated religious men (ulema) deemed to have the ability to interpret
Islamic texts and teachings proclaimed cofee drinking to be illegal and engaged in eforts to
sanction its social uses (Hattox 1985). Yet, prohibition did not prevail; cofee was regarded
as an acceptable social stimulant for observant Muslims, and gathering in the cofeehouse
would not automatically compromise one’s moral standing. The cofeehouse was established
extensively across the region with elaborately decorated leisure spaces for wealthy drinkers
and more modest structures for laborers.
Cofee drinking spread rapidly in cities throughout the empire and by the late seventeenth
century, the Ottomans had introduced cofee drinking to Central Europe (Kafadar 2014). Cof-
feehouses subsequently arose in cities such as Venice and Vienna and initially were also known
as social spaces of consumption primarily reserved for men of the emerging bourgeoisie. During
the nineteenth century, political unrest led both Ottoman and Habsburg empires to enact ad-
ministrative social reforms in eforts to demonstrate tolerance to their subjects and the institution
of the cofeehouse expanded, sometimes admitting women of similar status backgrounds as
patrons. Prior to this, women would have only been present as audience members when a cof-
feehouse hosted a performance for families, often during Ramadan (Kafadar 2014, 261). Cofee
drinking and cofeehouses, then, were both signs of status and power as well as sources with the
potential to ignite resistance to authority. They were seen to demonstrate the social order as well
as material with which to rework the social order, a phenomenon that continues today.
Hapsburg cofeehouses, for example, have been admired for their romantic aesthetics,
and the Viennese cofeehouse in 2011 was awarded the prized status of being recognized as a
U.N.E.S.C.O cultural heritage site deserving of protection, bringing international prestige
as well as resources to maintain the actual cofeehouses and ostensibly Viennese cultures of
cofee consumption.5 In her refections on the role of the Habsburg cofeehouse in various
urban heritage and tourist attractions in the city of Trieste, Giulia Caribelli demonstrates
that the cafes are a focal point projecting nostalgia both for a cosmopolitan Hapsburg im-
perial past and for an irredentist Italian nationalist one. In the latter, the imperial origins of
the cafes are downplayed and domesticated in tourist guides’ explanations, such as one who
ofers that Trieste’s cafes are infuenced by the imperial era, but are Italian because they are
“‘public living rooms,’ where one sits and chitchats (dove si va per ciacolare)” (Carabelli
2019, 384). Edin Hajdarpašić points to this processual and permeable potential of the built
environment in relation to meaning-making in his discussion of South-eastern Europe’s
Ottoman and Habsburg past. He includes cofeehouses among other sites such as, “mosques,
churches, synagogues, taverns, tombstones, gravesites,” whose meanings are not fxed in
time; rather, as enduring sites of social encounter and interaction, they are layered with shift-
ing and heterogeneous meanings and perspectives (Hajdarpašić 2008, 721).
Cofee drinking’s polysemous qualities have stimulated social belonging and wide-
ranging place-making practices throughout the region. In the aftermath of the 1990s wars in
former Yugoslavia, including among its diaspora, Bosnian cofee drinking was a way to cre-
ate space and claim time for pre-war memories of a Yugoslav past. The political confict over
post-Yugoslav governance was increasingly expressed through the language of “ethnicity,”
and during the 1990s erupted in violent campaigns of “ethnic cleansing” or “un-mixing”
that in Bosnia was primarily organized by an ethno-nationalist Bosnian Serb military with
assistance from Serbia (Hayden 1996). In addition, some Bosnian Croat militias organized

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similar campaigns in western Bosnia, including the southern Herzegovina region. As Bos-
nian Muslims and Bosnians in mixed families were the primary targets of these campaigns,
and, with no “national” homeland to which they could fee, these Bosnians also make up the
majority of the wartime diaspora.6 In the cofee stories that follow, I center the lives and the
experiences of Bosnian women from diverse age, regional, and ethnic backgrounds, ofering
what Maria Todorova has called “counterperceptions” to the ethnicity/confict/harmony
rubric that often guides representations of the Balkans (Todorova 2009). Cofee’s historic
connection to place-making emerges as a prominent theme in pre-war memories and a dy-
namic practice in people’s post-war lives.

“It Was in Sarajevo, on the Hill”

In the late 1800s, ethnographer and folklorist Antun Hangi traversed Bosnia to document
the “life and customs” of the country’s Muslim citizens. Hangi, a Croatia-born Catholic
who lived in Bosnia, published his observations frst as a series of essays (1900, Mostar)
and soon thereafter compiled in a single text (1906, Sarajevo) featuring numerous sketches
and photographs depicting scenes of everyday life. At the time, both Croatia and Bosnia-
Herzegovina were Habsburg provinces and Hangi’s accounts were meant to appeal to the
curiosity of administrators in the provincial capitals and in the imperial capital of Vienna
regarding the newly acquired former Ottoman province and its sizable Muslim population.
A grainy photograph on page 54 illustrates that cofee preparation and consumption is a
theme in Hangi’s book. The photo captures a scene on a historic embankment at a bend in
the Miljacka River called Bentbaša in the province’s capital city, Sarajevo. A two-story square
building with a porch and wooden fence provides the backdrop to a woman standing in the
water, bent over as she launders linens in the river, while others appear to be seated on the en-
closed porch, drinking cofee. The photograph’s caption reads: “cofee and Muslim houses on
Bendbaša [sic] above the Miljacka in Sarajevo,” and, in a parenthetical caption beneath this, the
reader is told how to interpret the signifcance of these activities and their emplacement: “See
how our Muslims are able to choose convenient places for their apartments and parties” (Hangi
1906, 54). While Bentbaša is among the historic sites of Sarajevo’s frst sixteenth-century cof-
feehouses, Mahira, born in Sarajevo 26 years after Hangi frst published his account, shared a
memory of drinking cofee in one of the city’s other famed cofeehouses.
On a hazy spring afternoon in 2015 in New Orleans, Louisiana, Mahira sat in a comfortable
armchair in her daughter’s living room. A soft-hued painting of a wooded meadow hung on the
wall above the chair and a platter of colorful fresh fruits sat atop a cofee table stationed in front
of the sofa to Mahira’s left, upon which sat her daughter’s friend, Tatjana, who was reading aloud
a question from a paper she’d placed on the table top near my voice recorder. Both women had
emigrated to the United States from the former Yugoslavia: Tatjana as a student from Croatia
during the 1980s, and Mahira as a refugee feeing the 1990s political violence (Figure 9.2).
When the violence began, Mahira was a widow of a mixed Muslim-Christian marriage,
in her sixties, and her adult daughter had emigrated to the United States in the 1980s. This
enabled Mahira to join her daughter at the beginning of the war and escape the four-year
siege of Sarajevo. Mahira and Tatjana were participants in a collaborative project that was
an outgrowth of my previous research on Bosnian refugees’ post-war lives in Chicago. The
“Gathering Grounds” project connects members of the 1990s diaspora across generations
through interviews about the traditional stove-top cofee drinking practices and aforemen-
tioned associated objects: džezve—stove-top carafes, fldžani—small porcelain cups, and
mlinovi—handmills (Figure 9.3).7

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Figure 9.2 Tatjana and Mahira interview

Near the end of the interview, Tatjana asked one of the fnal questions from the prompts
on the interview guide:

TATJANA: Would you share one of your memories about Bosnian cofee?
MAHIRA: There is nothing special that I remember. Only that we all enjoyed cofee—some
more, some less. I can recall one cofee I enjoyed and that I remember. It was in Sarajevo,
on the hill, there was an old café: Babića Bašča. And here, with my husband, I once
drank cofee. But it was before we were engaged. And that cofee, I remember.
TATJANA: Because it was connected to love?
MAHIRA: Perhaps it was tied to love, but also ambience. It was a garden, on a hill, and down
below, you could see Sarajevo. That cofee, I remember.

Mahira’s cofee memory places the drink in time and space, locating the cofee experience
in relation to the topographical and toponymic rather than human elements in the scene.
When Tatjana follows up on the reference to Mahira’s husband, surmising that it is the sug-
gestion of romantic love that makes this memory stay with Mahira, the elder woman further
emphasizes the signifcance of location in her explanation: “Perhaps,” she responds, giving
a nod to the potential of love’s signifcance, but then repeats, “it was a garden, on a hill,
and down below, you could see Sarajevo,” providing a multi-sensory account, not based on
the cofee’s taste, appearance, smell—we learn nothing of this—rather, she directs us to the
consumption site’s aura, its sensations, and how she experienced this. Cofee drinking is part
of an environmental ensemble here and it becomes a meaningful, lasting memory because it

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Figure 9.3 Mostar market stall with džezve, mlinovi, and souvenirs

belongs to this temporal assemblage that creates an ambient space in her former city: “That
cofee, I remember.”
This emplacement of her cofee memory gains signifcance when situated within
her forced migration. Earlier in the interview, Tatjana asks a question about handmills.
Mlinovi, džezve, and fldžani were family possessions, passed down from generations,
often as a part of wedding celebrations to help establish a new couple’s future kitchen
and demonstrate their capacity to host others in their own apartment (Bringa 1995).
When Tatjana asks if Mahira had a handmill, the elder woman remarks that she had
a beautiful one that she wishes she could have brought with her to the United States.
“Did it get lost?” Asks Tatjana, and Mahira replies that “It disappeared in the war.” As
objects of material and symbolic wealth, džezve and mlinovi were among the items ref-
ugees sought to bring with them, but they were also stolen or appropriated by those who
sought to force Bosnian Muslims and Bosnians in mixed families to leave. While Mahira
had been able to recover her Sarajevo apartment, making repairs and return visits after
the siege had ended, she had not been able to age there as she had desired. When Mahira
died two years later, her daughter carried out Mahira’s wish to be returned to Bosnia,
and arranged for her mother’s body to be fown back to Sarajevo for burial. Mahira’s
cofee interview incites memories of the pleasures of being in a particular place prior
to the social dislocations of the 1990s political violence. Outside of Mostar, a two-hour
drive southwest of Sarajevo, cofee was part of a diferent sort of place-making among
young people grappling with stalled post-war reconstruction.

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Cofee on the Street: Cafe Visits

During the late aughts in Stolac, a small historic town nestled in the Dinaric Alps, out-
door street cafes, kaf ći (s. kaf ć), were popular sites for young adults to socialize with
one another. At the time, things were quite difcult for this generation, many of whom
had been children or teenagers during the 1990s wars. After defending the city against
attacks by the Serb ethno-nationalist military, fghting broke out between Bosniaks and
Croats. The Croat ethno-nationalist militia sought to create a mono-ethnic territory for
Bosnian Croats. The people of Stolac, a Muslim-majority town before the war, had suf-
fered greatly; in 1993, the Croat nationalist militia forced thousands of Muslims from the
town and looted and destroyed their homes and neighborhoods (Kolind 2007). The work
of rebuilding the region’s social and material infrastructure began after the 1995 Dayton
Peace Agreement (DPA), but had stalled a decade later in part due to the ethnic consoci-
ational governance structure established by the DPA that re-emphasized ethno-national
divisions through an intra-country “entity” border that corresponded with areas seized
by the Serb nationalist military during the war, and by stipulating that many government
positions must be flled according to the proportions of Bosnia’s three majority eth-
nic groups: Bosnian Croats, Bosnian Serbs, and Bosnian Muslims.8 As Azra Hromadžić
notes, this post-war consociational democracy institutionalized ethnic separation and
resulted in a loss of spaces for ethnic groups to socially intermingle, in the local vernac-
ular, “miješanje” (mixing). Not surprisingly, cofee drinking fgures prominently in the
lack of spaces for ethnic intermingling—which would have been common, for example,
at worksites and social home visits prior to the war—as when a high school student re-
marked to Hromadžić, “How can we build long-lasting friendships when we do not even
have a space to drink cofee together?” (Hromadžić 2011, 278).
By the time I arrived in Stolac in summer 2009, the majority of municipal operations and
services in the region were segregated by ethnicity, often with Bosnian Catholics receiving
superior services. (During my time there, people used the terms “Catholic,” “Christian”
[meaning Orthodox], and “Muslim”; I rarely heard people use “Croat” “Serb,” or “Bos-
niak”). The two largest ethnic groups in the canton, Bosnian Catholics and Bosnian Mus-
lims, were directed to diferent medical facilities, and Bosnian Croat children entered the
schools’ front doors, while Bosnian Muslim children entered the back door. Catholic kids at-
tended school in the morning; Muslim kids attended in the afternoon.9 Further complicating
matters was the failed municipal election the previous year in Mostar, the canton’s capitol.
The city council was unable to pass a budget or elect a mayor, and had stopped paying city
workers: teachers, municipal workers, and construction workers and staf at publicly owned
companies had not been paid since March. As a whole, youth unemployment fgures (aged
15–24) in Bosnia were recorded at a staggering 48.72%.10 Individual households often relied
on remittances from those abroad to get by; yet, the global recession of 2008 made it increas-
ingly difcult for the diaspora to remit portions of their income to those who remained in
Bosnia. Despite these fraught political and economic circumstances, young people managed
to fnd ways to socialize, including across ethnic belonging.
I had come to Stolac to learn more about the transnational ties maintained by Bosnians
in the diaspora and those who remained in Bosnia and Ajla (Eye-la) was my primary guide
in Stolac. Ajla was the 23-year-old cousin of my friend Edin; Edin’s father was her mother’s
brother. Ajla’s and Edin’s families were among those forced to leave Stolac during the war,
and Edin’s family had emigrated as refugees to Chicago, while Ajla’s family had returned to
Stolac. She was a civil engineering student at the University of Mostar, a full-time caregiver

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for her mother who was sufering from a rare and severely debilitating auto-immune disease,
and enjoyed socializing at local kafći.
In Stolac, several kafći were located on the same small street near the town’s center,
and were open during the afternoons and into the evening when one could fnd multiple
groupings of three to four people sitting at outdoor tabletops covered with umbrellas adver-
tising German beer and Bosnian mineral water. The small cafes provided socially acceptable
places for young men and women to gather together, typically in same-gender groups rather
than in mixed groups or in male/female pairs; thus, the scene generally included several all-
women groupings, and several all-men groupings with perhaps one or two groupings that
included both. Tables were set apart by only a few feet and American pop music from the
1990s played in the background creating a sense of conviviality among those present. While
gender-mixing did occur in the space, women and men consumed diferent beverages.
A typical Stolac kafć did not sell food and the menu consisted of mineral water and a set
of stimulant-based beverages: cofee (traditional, espresso, or sweetened Nescafe packets),
sugar-sweetened fruit drinks, cedavita (a sweetened Vitamin C packet dissolved in water),
coca cola, and beer. Men tended to drink beer and I never saw a man drink a cedavita or one
of the fruit juices. However, women tended to drink cedavita, or fruit juice; I never saw a
woman customer drinking beer. Mineral water, cofee, and coca cola were ordered by both
men and women customers. Despite the political stalemate and the economic situation, it
was still summer at the height of Mostar’s tourism season, also the time of year when those
in the diaspora who could aford to might return for an extended visit: the kafći in Stolac
were full on the evenings when Ajla and I occasioned them.
While I was attuned to the gendered diferences at the kafć, I had initially missed the
ways in which the town’s kafći refected the post-war spatial ethnic separations. One eve-
ning, we were sitting at a kafć that was operated by one of Ajla’s friend’s brothers and
drinking cedavita when a young man at a diferent kafć across the street said Ajla’s name
and waved at her. “Tino!” she exclaimed, waving back, “he’s a funny guy,” she said to me, “I
know him from before, from school.” Tino was walking across the street toward us. He came
and stood near Ajla’s chair and the two of them chatted for a bit. He invited us to a party
later that week. As he walked away, I asked, “Did you want him to join us? He could have
sat down.” “He is Catholic…that kafć is where the Catholics go,” she replied, “So he didn’t
want to sit down?” I asked. Ajla paused, then said, “He could sit, but some people might say
things. He doesn’t care, and I don’t care; we are friends with everyone. But some people are
stupid.” I had originally assumed that Ajla took me to this kafć instead of the one across the
street because she knew the owner. But it was also because our kafć was known as a Mus-
lim space, and the other kafć was Catholic-operated. It occurred to me that I had observed
a number of these social exchanges—what I came to label “cafe visits”—over the previous
weeks (Croegaert 2020). I thought it had just been friends happening upon one another, but
then, why didn’t they just choose one of the kafć and sit there together? The visitor always
returned to their original seat after they’d conducted the social encounter.
These street-kafć social visits can be understood as a form of “trans-ethnic” social prac-
tices in the region (Hromadžić 2013). In these sorts of encounters, ethnic diference is not
ignored or glossed over, nor is ethnic diference celebrated or politicized. Rather, it is ac-
knowledged and then minimized through social exchange. These street visits were similar
to the practices of high school students with whom Hromadžić worked in Mostar. While
Hromadžić’s students grappled with post-war ethnic spatial restrictions by seeking out alter-
native places wherein they could socialize such as the school bathrooms, Ajla and her peers
used the interstitial zone of the street to cross over to the side of the ethnic “other,” entering

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their kafć space and remaining standing rather than sitting. This meant that they would not
drink their cofee together—a loss remarked upon by Hromadžić’s student, and alluded to
in Ajla’s explanation to me that many people might disapprove or gossip about her and Ti-
no’s inter-ethnic exchange but that they don’t care because “we are friends with everyone.”
These eforts to socialize across ethnic social boundaries point to the younger generation’s
desire for connection and collective belonging even as the war and the post-war governance
structure eliminated many of the places that had previously fostered such social relations.
With Mahira and Tatjana, we have visited Bosnian cofee practices in the home, and
through the Stolac outdoor kafć, we have observed Bosnian cofee practices along the street.
In the fnal section, I look to Bosnian American artist Aida Šehović’s annual nomadic mon-
ument, ŠTO TE NEMA, an artwork that brings Bosnian cofee’s symbolic associations with
the home into the public square in order to commemorate the genocide of Bosnian Muslims
during the 1990s wars.

Cofee as Mourning: Honoring the Dead

Food is often integral to practices that mark death and honor the dead. The Jewish tradition of sit-
ting shiva involves mourners bringing food to share with the bereaved as they commemorate the
passing of life (Slochower 1993). Certain Catholic and Voudou mourning rites involve imbibing
or symbolically ofering alcohol to saints, spirits, and the newly deceased in honor of their life and
to acknowledge that they have joined those who passed generations ago—the ancestors (Hurston
1931, 397, McCarthy-Brown 1991, 198). In the tradition of New Orleans Jazz funerals, those fol-
lowing the band’s walking parade in the “Second Line” take food and drink during “stops” along
the parade route in order to sustain their embodied performances of mourning and celebration of
life (Ehrenfeucht and Croegaert 2017). In Bosnia, Muslims traditionally bury their dead within
24 hours, and, during the next day or more will receive visits from neighbors who pay respects by
bringing gifts of valued foods, including cofee (Bringa 1995). Purposefully preventing members
of a group from participating in their rites of mourning, in how they attribute meaning to the
death of their community members, may be understood as a form of social violence that aims to
sever ties between the dead and the living, and between generations.
Thus, rituals of mourning gain particular signifcance in the aftermath of political vio-
lence involving genocide as in the case of the 1990s wars in Bosnia when Bosnian Muslims
were targeted for “ethnic cleansing” campaigns and killed by the VRS and afliated militia,
then callously denied burial rites and dumped in mass graves. The individuals who died in
mass killings at Srebrenica and Prijedor regions, among other sites, were purposefully mixed
together with other bodies in order to make it more difcult for survivors to identify their
loved ones. Their bodies, and, by extension, their families and communities, were often fur-
ther degraded by eforts to cover up the atrocities such as bulldozing grave sites, or moving
body parts to secondary and even tertiary mass graves. Survivors have been presented with
partial remains of their loved ones’ bodies, of which only bones and perhaps remnants of
the person’s clothing have endured. In some cases, human remains will never be found, or,
if found, may not be able to be identifed via a DNA match with the living (Wagner 2008).
This material fragmenting threatens the body’s integrity which under normal conditions
would be upheld by ritualistic washing and preparation for burial within 24 hours of death.
Artist Aida Šehović’s work challenges this type of dead-body violence, or “necroviolence”
that conducts violence against the living in acts intended to desecrate the dead, by ofering
intimacy, community, and ceremony to survivors through incorporating Bosnian cofee
rituals in what she describes as a “participatory public monument.”11

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Every year since 2006, Šehović has worked with survivors to mount a one-day public
art sculpture on the date commemorating the beginning of the killings that took place in a
United Nations “safe area” in the Srebrenica region, the largest documented massacre in the
wartime genocide. On July 11, ŠTO TE NEMA is assembled and disassembled by the artist
and a group of volunteers in a public square in a major city in Europe or North America.
Although not from the Srebrenica region, Šehović and her family were forced to fee their
homes in the city of Banja Luka, and her public social sculpture is meant to ofer a space to
mourn to all of those who have lost family, friends, and community members during the
war. The artwork draws on an enormous amount of volunteer labor that centers on the
practice of brewing and serving cofee for the war-dead, those who may never again drink
it among the living.
When I took part in the 2017 installation in Chicago’s Daley Plaza, there were more
than forty of us in the volunteer trainings that preceded the installation and during which
we were assigned roles such as setup, brewer, runner, greeter, and clean-up. In addition to
those of us who would be on-site for the day of assembly and disassembly were hundreds of
members of the diaspora who had throughout the previous year donated fldžani, džezve,
and cofee grounds as well as food and water to sustain the volunteers for our day’s work
under the hot July sun. The sculpture takes shape as greeters invite passersby to pour cofee
from a džezva of hot Bosnian cofee brewed in a work station located several yards away
into a fldžan and place it near the center of the plaza. A greeter provides the passerby with a
fldžan and tells them that each cofee cup is placed in memory of a person among the 8,372
men killed at Srebrenica, and that the cofee cup might also be placed in memory of someone
whose death the passerby would like to mark. This invitation both ofers a framework for
mourning collective victimization by providing a conduit to link the lives lost at Srebrenica
to grief participants may experience in relation to friends and family they lost to the political
violence in other parts of Bosnia, and disrupts the ethno-nationalist framing of victimization
by providing an opening for loss that may resonate for passersby who want to remember a
loved one who has died. Šehović’s installations have occasionally included participants of
Croatian and Serbian background, and her permitting applications specify that no national
emblems or signage may be used by participants, thereby delimiting eforts to weaponize
the dead for political gain (Croegaert and Kulašić 2016, Halilovich 2012, 170). As the day
progresses, the small porcelain cups are placed one next to another creating a sphere that
expands outward from where the frst cup is placed (Figure 9.4).
The collection of cups grows until a fldžan has been placed for every one of the 8,372
who have been identifed to date. In 2017, this number was 7,500.
The monument’s conceptual architecture draws on principles of hospitality and social in-
timacy in which cofee fgures prominently. For example, in our volunteer training, Šehović
reminded us that it was like we were “welcoming people into our home” when we invited
them to pour a cofee. In Bosnia, social visits between homes in a village or urban neighbor-
hood often involve women, including women of diferent ethnic backgrounds. Scholars have
written about this as an integral component of the Bosnian principle of komšije/neighbors,
or being neighborly that establishes familiarity through cofee service (Helms 2010, Sorabji
2008). Cofee drinking in this context may involve sharing information, opinions, or ofer-
ing emotional support.
The majority of volunteers in Chicago were Bosnian American young adults, those who
were children when their families arrived in the United States as refugees and often found it
difcult to connect with their parents’ generation, whose lives the political violence had dra-
matically altered. Due to language barriers and diferent accreditation systems, many adult

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 Ana Croegaert

Figure 9.4 ŠTO TE NEMA Chicago installation 2017

refugees were unable to work in their previous professions. Further, they had arrived in the
midst of 1990s neoliberal reforms to social welfare programs that severely reduced education,
language, and emotional supports for refugees, pushing them into low-wage employment
in the service sector within months of their arrival (Croegaert 2020, Franz 2003). Many
worked more than one job and some were severely depressed as a result of their wartime and
migration experiences and economic struggles in the United States. Being involved in the
public monument provided a space for the younger generation to interact with one another
and to engage in a ritual that was familiar and meaningful to their parents’ and grandparents’
generations among whom the monument also resonates. Not only did they connect with one
another over the course of the 2017 installation, but through their participation they were
also joining a growing community of volunteers from across the diaspora among whom
were those who participated in previous installations in the Hague, Toronto, Istanbul, and
future installations in Venice, and in its fnal iteration in this nomadic form, returning to the
Mothers of Srebrenica through the memorial center at Potočari in 2020.
Šehović gives her monument the title, “ŠTO TE NEMA,” a Bosnian phrase that trans-
lates literally as “Why aren’t you here?” but is better understood in this context as the desire
for a loved one’s return, “Where have you been? Why haven’t you returned?” The phrase
is also the title of a well-known song in the Bosnian musical form, sevdah/sevdalinka which
incorporates many genres, including songs that focus on melancholy sensibilities such as
longing for a loved one (Imamović 2013). The lyrics are attributed to a poem published
by Aleksa Šantić in 1897 and one of the most popular versions of the song among the last
Yugoslav generation is Jadranka Stojaković’s 1980s recording. By pairing this phrase with
the practice of brewing and serving Bosnian cofee, “the real cofee,” Šehović’s monument
indexes Bosnian histories that pre-date the modern nation-state: the region’s positioning
within Ottoman and Habsburg imperial regimes. This mnemonic feature of Bosnian cofee
service and the phrase from Santić’s poem within the sevdah song create what Kathleen
Adams describes as artworks’ potential “afecting presence” whereby objects are imbued
with meaning that resonates within individual and group identities—art, then, may be seen

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as an important site through which people seek to shape and contest aspects of intra- and
inter-group identity formations (Adams 2006, 11, 26).12 For Šehović Bosnian cofee, and its
adjacent objects, fldžani, džezve, serves as a way to return some care and dignity to those
who were killed at Srebrenica and to enact a sense of social belonging that extends to others
of varied proximity to that particular genocidal act.

Conclusion
From stimulating religious rites and reactionary prohibition to establishing cofee houses
that incubated political and intellectual solidarities, cofee served as an intoxicating force
for social movements in both Ottoman and Habsburg Europe. In Bosnia and Herzegovina,
an administrative region in both empires and members of their twentieth-century succes-
sor states, cofee and the material culture central to Bosnian cofee service is a spatializing
practice that the diaspora can draw on to share memories and imbue them with meaning by
locating themselves in a particular time and place. In the fraught social landscape brought
about by the aftermath of war and the structure of the DPA, young people seeking interac-
tions across lines of ethnic diference note the absence of spaces to drink cofee together and
creatively cultivate an in-between space by sending and receiving impromptu invitations to
cross the street and visit at another’s cafe. By serving—but not drinking—Bosnian cofee
in a European or North American urban public square, Aida Šehović makes cofee into an
artwork that insists on the humanity of victims of genocide, restores dignity to those who
survived war, and extends hospitality and kinship to those who want to prevent future
genocide.
What to make of these rememberings, minglings, and paying respects? How to under-
stand cofee’s centrality across time, in diverse spatial domains and sites of social practice—in
religious spaces, cafes, homes, the sidewalk cafe, the public square, and enacting devotion,
sensorially experiencing memory, extending sociality, and rites of mourning? Cofee’s ca-
pacity to stimulate bodies and incite sociality renders its consumption as key to establishing
sites of meaning-making, crucial to the production of social relations, and thus critical to
the study of everyday encounters wherein people evaluate their past and present circum-
stances and envision their futures. In social conditions where it is difcult to directly chal-
lenge authority or hegemonic forms of power, the consumption of beverages with symbolic
resonance such as cofee ofers a way to indirectly critique such systems. Attending to who
may sip cofee together, or not, ofers an alternative way to listen and to hear across lines of
diference.

Notes
1 Macedonia and Montenegro were the two other republics in the Socialist Federal Republic of
Yugoslavia (SFRY).
2 Measured by the amount of cofee consumed per capita according to market research data from
Euromonitor International. From frst to ffteenth, the top 15 are listed as Finland, Norway, Neth-
erlands, Slovenia, Austria, Serbia, Denmark, Germany, Belgium, Brazil, Bosnia-Herzegovina,
Estonia, Switzerland, Croatia, and Dominican Republic. Reported in https://www.cafeinein-
former.com/cafeine-what-the-world-drinks Last accessed 3.25.2021.
3 I use “Bosnia” and “Bosnia-Herzegovina” interchangeably in this chapter to refer to the medieval
and modern Bosnian state.
4 The report outlines some of the limitations with quantifying this diaspora. It also notes that while
the 1990s diaspora is the largest Bosnian diaspora to date, this diaspora joins earlier diasporas aris-
ing from the Ottoman-Austrian transfer (1878) and from the Yugoslav Kingdom.

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5 UNESCO, “Viennese Cofee House Culture: Social Practices in Vienna, inscribed 2011” https://
www.unesco.at/en/culture/intangible-cultural-heritage/austrian-inventory/detail-1/article/
viennese-cofee-house-culture Last accessed November 5, 2020.
6 Ofcially Bosnian Croats could fnd refuge in Croatia, and Bosnian Serbs in Serbia, although
many such refugees did not fnd themselves welcomed in their respective national “home” lands.
I use “Bosnian Muslim” and “Bosniak” interchangeably and according to people’s uses. For an
extensive discussion of the uses and meanings of “Bosniak,” see Edin Hajdarpašić Whose Bosnia?:
Nationalism and Political Imagination in the Balkans 1840–1914. Ithaca: Cornell University Press,
2015.
7 Project background and full interviews can be accessed at the Gathering Grounds project website,
dzezvacofee.com.
8 The European Court of Human Rights ruled in 2009 that Bosnia’s Constitution violates the rights
of Bosnians who do not belong to one of the three majority-prioritized ethnicities: Serb, Croat,
or Bosniak (Bosnian Muslim) by prohibiting “Others,” such as Jewish and Romany Bosnians,
from holding public ofce. As of this writing, the constitution has not been revised to address this
discrimination.
9 For an in-depth study of Mostar’s segregated school system, see Hromadžić 2015.
10 Ofcial unemployment fgures do not capture work in the informal economy, upon which many
at the time relied.
11 Building on Achille Mbembe’s discussion of “necropolitics” as an instrument of modern sover-
eignty, Jason De León describes “necroviolence” as “violence performed and produced through
the specifc treatment of corpses that is perceived to be ofensive, sacrilegious, or inhumane by the
perpetrator, the victim (and her or his cultural group), or both” (De León 2015: 69).
12 Adams is building here on Robert Plant Armstrong’s earlier work (1971).

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 10
EXPANDING INTOXICATION
What can drinking places (c. 1850–1950) tell us
about other intoxicants and other sites?

James Kneale

Introduction: expansive intoxication, unbounded drinking places

This chapter considers drinking places—sites primarily dedicated to the sale and public
consumption of alcoholic drinks—between about 1850 and 1950. It can be argued that this
period saw their increasing specialisation around the world, as commercial, regulatory and
social developments encouraged the separation of the production, retail and consumption of
alcohol from other sites like homes and workplaces (Kneale, 2021). In the process, drinking
places became more distinctive as a particular kind of site. At the same time, though, they
were rarely just places to drink alcohol; they were often also sites for the consumption of
other intoxicants like tobacco and cafeine, and of course for sociable interaction.
The journalist George Sala’s description of an anonymous East London beer-shop in the
1850s ofers us a useful example. This beer-shop is one of many pubs Sala shows his read-
ers on an imagined tour of ‘London’s Publics’, but it has surprisingly little to tell us about
alcohol.

Here is a beer-shop—a little, blinking, wall-eyed edifce, with red curtains in the win-
dow, and a bar squeezed up in one corner, as though it were ashamed of itself. From
the door of the tap-room which we open, comes forth a thick, compact body of smoke.
There are, perhaps, twenty people in the room, and they are all smoking like limekilns.
From a kiln at the upper extremity, comes forth the well-remembered notes of the old
trink-lied, ‘Am Rhein, am Rhein.’ We are in Vaterland at once. All these are Teutons—
German sugarbakers.
(Sala, 1859: 266)

Here, the bar is almost ‘ashamed of itself ’, while the most obvious intoxicant is probably
tobacco consumed in clay pipes, given the description of these smokers as ‘kilns’. Sala re-
minds us that drinking places were not exclusively focused on drinking; they also fostered
other kinds of intoxication as well as a valuable sociability. How might we expand our idea
of drinking places without losing sight of what it is that makes them distinctive from other
sociable, and sometimes intoxicating, spaces like cafes, street corners and lidos?

DOI: 10.4324/9780429058141-14 159

 James Kneale

The chapter seeks to explore these questions, expanding our understandings of drinking
places in three ways. First, it considers them as sites for the consumption of other intoxi-
cants besides alcohol. Studies of individual intoxicants can give the impression that sites of
consumption were reserved for one substance alone; discussions of the regulation of alcohol
often ignore nicotine and cafeine. Second, it follows recent calls for a broader understand-
ing of intoxication. If drinking places are public, social sites, intoxication may be some-
thing more than the collision of intoxicant and consumer, “not merely the physiological
and neurological efects of plants, beverages, and chemicals but also religious ecstasy, hyp-
notic trance, musical reverie, intense collective joy” (Withington, 2014: 12). The collective
consumption of Sala’s sugarbakers was visible in the ‘body of smoke’ they produced, for
example, and their singing might have intoxicated singers and listeners alike. This broader
understanding of intoxication draws connections between intoxicants and some of the social
characteristics of drinking places: publicness, sociability, commensality and hospitality. We
will look at these in turn. Finally, the chapter will suggest expanding our engagement with
these sites beyond our usual focus on drink and drinkers, while at the same time extending
the limits of drinking places themselves.
In considering these possibilities, the chapter engages with recent work in the felds of
material culture and ‘new materialisms’. Orthodox approaches to ‘consumption’ tend, via a
particular reading of Veblen (1915), to analyse objects for clues about their consumers’ iden-
tities (for a good example of work of this kind, see Holt, 2018). Sala’s journalism follows a
similar logic, as his tour of London’s pubs becomes a series of sketches of social ‘types’. The
sugarbakers’ beer-shop stands in for Whitechapel’s German quarter, for example, and the
description fts what one British author saw as the ‘three national characteristics’ of German
immigrants: ‘smoking, singing, and Sabbath-breaking’ (Apperson, 1914: 161). Elsewhere in
Whitechapel, Sala visited Jewish pubs where “Smoking is universal—cigars the rule, pipes
the exception”, which to Sala’s racialising eye marked these smokers out as “peculiar in their
amusements, as in everything else” (1859: 267).
This chapter takes a diferent approach. Rather than reading intoxicants as markers of
pre-existing identities, this engagement with intoxicating sites sees them as places where
new things might emerge. Through the sharing of intoxicants, other material things, and so-
cial practices, hospitality and generosity can be produced through commensal consumption.
Examined through the lens of the new materialisms, intoxication becomes something that
emerges out of the interaction of consumers, intoxicants, songs, light and visual spectacles,
and a wider afective atmosphere, which expands to fll much larger and more heterogeneous
spaces than Sala’s beer-shop. How did intoxicants, collective social practices of consumption
and their associated meanings, and material environments come together to make these sites
so important to their patrons?
The value of these ideas for our understanding of drinking places is explored across six
sections. The chapter begins by considering other intoxicants besides alcohol that were con-
sumed in some drinking places in this period, concentrating on tobacco. The second section
considers the relationship between intoxicants and the public sphere, opening up a discussion
of the qualities and social character of these sites. The third asks an important question, de-
veloping this investigation of the character of drinking places: if pubs, cafes and bookshops
can all be ‘good places’, as Ray Oldenburg described these vital sites of sociability (1989),
how important are intoxicants? What diference did alcohol, tobacco, cofee and tea make?
To answer this, we will consider the importance of sociability, commensality and hospitality
in Oldenburg’s good places.

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The fourth section of the chapter suggests that examining the material cultures of intox-
ication might show us how social relations between consumers are actively made, so that
cultural values like commensality, hospitality and generosity are materialised or objectifed.
Concentrating on those practices that involve gifting (Mauss, 1990), it’s clear that not only is
this more strongly associated with alcohol and tobacco than other intoxicants but may also
be a central part of what makes these places ‘good’. The ffth section re-thinks drinking
places, intoxicants and intoxication by drawing upon expanded senses of place, materiality
and meaning, and the sixth further expands our sense of the limits of drinking places, before
the chapter concludes.
We begin by looking at the intoxicants consumed in these sites over this period.

Drinking places and intoxicants, 1850–1950

By 1850, much of the world was already accustomed to David Courtwright’s ‘big three’
intoxicants: alcohol, cafeine and tobacco (2001). While Courtwright’s ‘little three’ (opium,
cannabis and coca) were consumed alongside alcohol, they are not as prominent in the his-
toriography of drinking places. By contrast, alcohol and tobacco were often taken together,
and were understood as everyday luxuries, part of ‘a community of goods’ (Withington,
2020a: 387) until the twentieth century. The relationship between cafeine and alcohol was
more complicated; they could be posed as alternatives—or even rivals—to one another, but
could also be consumed together, particularly as part of a meal. In consequence, cafés might
or might not be ‘alcoholized social spaces’ (Toner, 2015: 28), depending on where you were.
In Paris, Mexico City and Copenhagen, cafés ofered wine and spirits as part of a wider
range of beverages (Eriksen, 1999; Haine, 2003; Toner, 2015). British cofee- and tea-rooms
tended not to be licenced for the sale of alcoholic drinks in this period, however (Burnett,
1999, 2004). Some of these places were provided as alternatives to the pub, of course (Davi-
son, 2006), and the ‘improved’ pub of the frst half of the twentieth century also emphasised
the sale of tea, cofee and food (Greenaway, 1998; Gutzke, 2005). Restaurants, inns and
hotels ofered cafeinated drinks along with meals, alcoholic drinks and other services, much
as they had done in the eighteenth century, when “in most provincial towns, among its
many other functions, the inn was the cofee house” (Maudlin, 2019: 28), or indeed in the
late seventeenth century, when “provincial cofee rooms were hidden in alehouses and inns”
(Withington, 2020b: 74). Concentrating on tobacco, this section sets out to demonstrate the
close relationship between smoking and alcoholic drinking places.
In 1850, the British per capita consumption of tobacco stood at 2lbs per adult, a fgure
unchanged for two centuries; by 1950, this fgure had risen to 7lbs per adult, with the
machine-rolled cigarette dominating the market following its introduction in the 1880s
(Hilton, 2000: 2). Matthew Hilton’s focus on what he calls the ‘bourgeois-liberal context
of smoking’ (3), the product of ‘a minority smoking culture’ of gentlemanly smokers (22),
refects the difculty of fnding alternative accounts of the smoking habits of the majority
of British consumers. Despite this, “a more communal pleasure and use of smoking can be
discerned in the public houses frequented by the labouring classes in which the free issue of
clay pipes … suggested a certain traditional ritual of hospitality” (4). This is an important
insight, and one we will return to.
For many Victorian writers, though, the clay pipe served as a simple marker of class, and
smoking an index of the character of smokers and their drinking place. Charles Dickens’
description of a public house in Scotland Yard provides an early example, with its “lusty

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coalheavers, quafng large draughts of Barclay’s best, and pufng forth volumes of smoke,
which wreathed heavily above their heads, and involved the room in a thick dark cloud”
(1875: 407). This prodigious pipe-smoking matches their heavy drinking, both signs of mas-
culine physicality. The close connection between smoking and drinking was noted by many
British observers, often—but not always—by critics of one or both of these habits. A pam-
phlet produced by the Anti-Narcotic League quoted a Dr. James Hamilton on the topic, for
example: “Extinguish the pipes of London, and you will go far to shut up the public-houses”
(Hind Smith, undated: 6). The social investigator and journalist J. Ewing Ritchie described
a London pub patronised by “the most wretched men and women possible to imagine”,
noting, “They are drinking gin and smoking, and all have the appearance of confrmed
sots” (1858: 202). From this perspective, working-class use of these intoxicants suggested a
helpless, incontinent, consumption.
In other non-fction sources, the ordinary pipe is often simply described as ‘short’, as it
is in the American Temperance lecturer John B. Gough’s description of a Saturday night in
Whitechapel: “a combination of commerce, fun, frolic, cheating, begging, thieving, devil-
try, short pipes, thick sticks, mouldy umbrellas, dirty faces, and ragged coats. Here are gin
palaces in profusion” (1880: 101). Salvation Army co-founder William Booth’s In Darkest
England And The Way Out quoted another description of Whitechapel, where a woman
“horribly bloated with drink” argued with “Two dirty tramp-like men … smoking their
short cutty pipes”; giving up, she “took herself of, her mouth full of oaths and cursing, to
the public-house” (1890: 164–165).
However, the close association between pipe-smoking and drinking was also observed in
the case of higher-status smokers, as this humorous entry in the dictionary of Victorian slang
collected by novelist and playwright J. Redding Ware suggests:

Colour the meerschaum, To. Drinking to the extent of reddening the nose. … The phrase
arises from an association of ideas—those in the frst place of darkening the colour of a
meerschaum pipe by steady smoking, and in the second, intensifying the hue of the nose
by steady drinking.
(1909: 86).

Ware’s Dictionary is far less critical of drinking than these other sources, suggesting that the
close association between drinking and pipe-smoking could be viewed in a more even-
handed way.
The machine-rolled cigarette, which replaced the pipe as the dominant form of smoking
in Britain after the First World War (Hilton, 2000: 83–85), may have been associated with
the fall in alcohol consumption in Britain between the 1890s and the end of the Second
World War, as the cigarette ofered working-class smokers something to spend their income
on besides drink (Dingle, 1972). At the end of our period, the social research organisation
Mass Observation estimated that 81% of British men and 39% of women smoked (1949: 95).
While this meant that cigarettes and pipes could be found everywhere, “All smokers are
more likely to be pubgoers than non-smokers, and heavy smokers are more than twice as
likely to be so” (98). Bolton’s pubs were smoky places, with 46% of their patrons smoking at
any one time (Mass Observation, 1943: 203).
Where it was a new intoxicant, tobacco’s relation with existing social spaces varied around
the world. In Europe, smoking was stimulated by new sites like the cofeehouse, but where
the public consumption of tea and cofee was already well-established, tobacco ftted into
existing patterns of use. Cofee “whetted the appetites of Middle Eastern consumers for new

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tastes and recreations” like smoking (Grehan, 2006: 1358), with tobacco pipes in use from
the late seventeenth century (Bouzigard and Saidel, 2012). The water pipe or hookah suited
cofeehouses and bath houses because its bulkiness demanded ‘stationary leisure’ (Grehan,
2006: 1357, 1358). During the British occupation of Egypt, “observers of Cairene café cul-
ture reported the popularity of smoking the water pipe, drinking cofee, listening to Arabic
music” and gambling, and beer, wine and cocktails were also available in beerhalls, hotels
and bars (Fonder, 2013: 240, 40, 216). The bars and cofeehouses of early twentieth-century
Ottoman ports also served beer (Fuhrmann, 2009; Georgeon, 2002). In Qing China, to-
bacco and alcohol were already closely linked by the seventeenth century, and in many urban
areas, “pipe tobacco was simply added to the tea, alcohol, and snacks already ingested in …
semi-public arenas” like teahouses, theatres, courtesan houses and restaurants (Benedict
2011: 67–68, 69). In similar sites in diferent parts of the world, alcohol, tobacco and cafeine
mingled.
In the next section, we begin to investigate the arguments that have been made about the
connection between the character of these public spaces and the intoxicants consumed in
them. Is publicness a quality exclusively associated with cofee, for example?

Public places and intoxication

Alcoholic drinking places have long been associated with a cluster of ideas concern-
ing publicness, democracy and hospitality. In nineteenth-century Russia, the urban
tavern shared some of the character of the village commune (Transchel, 2006); the
nineteenth-century French café was the ‘church of the working class’, a ‘proletarian pub-
lic sphere’ (Haine, 1994: 16; 2006). Drinking places were also the most important sites
of working-class sociability in Germany (Roberts, 1984, 1991), and a signifcant rival to
the church in Wales and England (Harrison, 1973, Lambert, 1983). They provided news-
papers, hosted political discussions and radical meetings, literary and scientifc societies,
friendly societies and other manifestations of civil society (Kneale, 2021). In the 1930s,
Mass Observation argued that pubs represented “a temporally and spatially liberated
public sphere” (Hubble, 2006: 211).
Jurgen Habermas’s account of the emergence of a public sphere in the seventeenth and
eighteenth centuries describes English cofeehouses, French salons and German literary so-
cieties as the centres of this new public culture (1991). Concentrating on the connections
between print, literary and political criticism, and a growing consciousness of a wider pub-
lic, Habermas had little to say about the intoxicants that shared these spaces with the men
and women who constituted this new world. It has been left to others to suggest that—in
the English case—it might have been signifcant that it was cofee, and not alcohol, that
characterised these sites. Wolfgang Schivelbusch’s account of cofee as the ‘great soberer’
sees it as the Protestant work ethic in liquid form (1993: 18), for example, enrolled in a
post-Reformation campaign to drive alcohol from public life. This account of ‘the tavern de-
throned’, as Michelet put it (cited 35), strengthens the links between cofee, sobriety and an
emerging bourgeois subject. A similar reading of cofee as the solution to the problems posed
by alcohol is set out in Stallybrass and White’s The politics and poetics of transgression (1986, and
see Withington, 2020b for a wider survey).
Considering work on these European sites, Matthee concludes that “Cofeehouses in the
Middle East played a similar ‘modernizing’ role in the sense that they contributed to the
creation of a cultural public sphere separate from the mosque” (Matthee, 2014: 113, and see
Kömeçoğlu, 2005). However, while the elite might drink alcohol in private,

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alcohol in a Muslim environment could never become fully integrated into the idea of
good living… never become the subject of a public discourse, just as the tavern, operat-
ing in the shadows, could never become part of a quasi-public sphere, unlike the often
open and airy cofee house, a communal extension of the private home and the basis for
political action.
(Matthee, 2014: 104)

However, and as Matthee suggests, it is hard to map diferent intoxicants onto public and
private spaces and spheres. Phil Withington’s recent work suggests that cofee was far less
important to British cofeehouses than has been assumed (2020b). Following the commodity
rather than the institution, Withington concludes that cofee was relatively scarce in Britain
before the eighteenth century, which meant that what was consumed in the new cofee-
houses was just as likely to be another non-alcoholic or alcoholic drink; that cofeehouse
sociability covered just as many activities—and could be as rowdy—as tavern sociability;
and that some cofeehouses, particularly in the provinces, were simply rooms in alehouses.
Withington concludes, “Rather than a transformative drug … cofee emerges as a force
and feature of hybridity—of the mixed economies of cofeehouse, alehouse, and, latterly,
household, and of the range of practices, meanings, and tastes attendant to its consumption
in those places” (74).
It is also difcult to map intoxicants onto diferent senses of the public because part
of the appeal of many drinking places was their combination of characteristics usually as-
sociated with either the home or public space. Perry Duis described the US saloons as
‘semi-public city spaces’ (1983: 3), and W. Scott Haine suggested that patrons sought a
‘communal privacy’ in French cafés (1996: 55, and see Clement, 2020); British clubs of-
fered both elite and ordinary men a private place in the city (Milne-Smith, 2006, 2011;
Tremlett, 1987), while pubs could be ‘sites of surrogate domesticity’ (Booth, 2018: 290).
Similarly, in Istanbul, “the cofeehouse was indeed an extension of home, the street and
the market, resisting the easy and convenient distinction between the ‘public’ and the
‘private’ that has proved a pivotal ingredient of the debate on the emergence of the public
sphere in early modern Europe” (Kirli, 2016: 172).
It’s also worth emphasising Withington’s point that cofeehouses were not necessarily or-
derly spaces either. In mid-Victorian Britain, a Select Committee considering places of public
entertainment heard complaints from the Metropolitan Police that London’s cofeeshops—
unregulated, unlike pubs—witnessed “scenes of very great disorder and great mischief ”
(1852–1853: 13). The cofeehouses of Ottoman Istanbul were also closely surveilled (Kirli,
2016), and the Turkish Republic saw village cofeehouses as threats to rural productivity
and civil society (Öztürk, 2008). Alcoholised spaces were not straightforwardly ‘public’, and
cofee was not always associated with a sober, wakeful and rational activity.
If their appeal was not a consequence of their facilitation of public life, then perhaps
drinking places were valued for their welcoming character and association with hospitality?
We consider this in the next section.

Good places? Sociability, commensality and hospitality

While there might not be a straightforward relationship between intoxication and public-
ness, another infuential characterisation of these sites, from Ray Oldenburg’s The Great
Good Place (1989), can help us consider a cluster of social theoretical ideas sometimes associ-
ated with discussions of drinking places: sociability, commensality and hospitality.

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Arguing that America needed to revitalise its ‘third places’—sites between home and work,
which are “the core settings of informal public life” (16)—Oldenburg combined sociology,
history and folksy anecdote to set out the things that make these sites ‘good places’. He em-
phasised their openness, their nature as ‘neutral ground’ for all, dominated by conversation
and playful interaction, with a crowd of regulars helping to set the tone. Intoxication is not
essential, though, as bookshops and other urban spaces can also be good places. This wider
genre of spaces has more recently been described by the sociologist Eric Klinenberg as ‘social
infrastructure’ (2018), defned by Alan Latham and Jack Layton as “networks of spaces, facili-
ties, institutions, and groups that create afordances for social connection” (2019: 3). From this
perspective, drinking places and cafés are just one kind of commercial social infrastructure.
Georg Simmel seems to have been one of Oldenburg’s inspirations, so we might imagine
that in these places, we interact with others in ways that go beyond instrumental calculation,
where sociability is ‘the play form of association’ (Simmel, 1997: 122). This is very diferent
from Thorstein Veblen’s discussion of the habits of American journeymen printers, who
were well known for their “dram-drinking, ‘treating,’ [round-buying] and smoking in public
places” (1915: 90). For Veblen, this was not a moral failing but a form of conspicuous con-
sumption, a demonstration of the printer’s wealth, implying secure employment and skilled
labour. A printer who only socialised in order to advertise their own success and hear about
employment possibilities would be a poor drinking companion, however. For Simmel, so-
ciability must avoid both objective reality—drinking as a way of looking for work—and
‘the absolutely personal and subjective’, as it might if the printer treated the bartender as his
personal therapist (Simmel, 1997: 123). While we have still not established the importance of
intoxication in these sites, this note about sociability suggests that it might be worth exam-
ining two closely associated concepts: commensality and hospitality.
Commensality emphasises the importance of sharing a table, sharing food and drink with
others. Drawing again on Simmel, Claude Fischler reminds us that while eating is inevitably
individual—no one can eat what we are eating—we can at least share the act of consumption; “it
counteracts the essential, basic, biological, ‘exclusive selfshness of eating’ and turns it into, at the
very least, a collective, social experience” (2011: 531). While it can create exclusion and hierarchy
as well as inclusion and equality, commensality may well be one of the things that gives drinking
places their association with conviviality and openness. These sites also ofer hospitality, where
the instrumental calculations of the hospitality industry meet the kinds of ‘light-touch’ sociability
that make us feel welcome in otherwise anonymous urban environments (Bell, 2007). While
unconditional hospitality may not be possible, the work of Derrida and others indicates ways in
which drinking places might provide ‘hybrid’ forms of hospitality to the stranger, even in ‘staged’
encounters with the ‘afable barman’ who has been trained to provide a service (Bell, 2007: 17).
Returning to temperance eforts to create ‘alternatives to the pub’, for example, it is
clear that reformers sought alcohol-free commensality and hospitality. Temperance banquets
brought hundreds of men and women of diferent classes together in orderly feasts to con-
sume tea and cakes, for example (Rappaport, 2013). While tea had widely varying meanings
for its consumers, these commensal events created both hierarchy and conviviality, as ban-
quets were often chaired by local worthies or representatives of temperance societies, and
friends and strangers ate and drank together.
Sociability, commensality and hospitality are found in other sites and do not depend
on intoxication, so this can only explain part of the link between drinking places and the
welcoming publicness of the ‘great good place’. To understand the relationship between
intoxicants and hospitality, we need to examine their shared material culture and the idea
of the gift.

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‘With Beer One Tanks’: intoxicants and the gif

While publicness, sociability, commensality and hospitality were often associated with
drinking places, they are not dependent on the intoxicants consumed in these sites. Turn-
ing to insights developed in material culture studies allows us to fnd closer links between
intoxicants and these social practices. In this section, we return to publicness, sociability,
commensality and hospitality to argue that while they are not unique to drinking places,
their strong association with these sites is the result of specifc social practices and material
cultures.
The importance of the gift in experiences of intoxication has not had as much attention
as it deserves. Building upon a saying from 1872, however—“With beer one thanks, but
with money one pays” (cited in Harrison, 1971: 55)—Mariana Adler has suggested that,
“Through the giving and exchange of drinks social ties of obligation and reciprocity were
established” (1991: 382). Money converted sociability into purely instrumental action, but
the gift of a drink meant something more. As Marcel Mauss noted, “the thing received is
not inactive. Even when it has been abandoned by the giver, it still possesses something of
him” (1990: 15). A gifted drink creates the obligation to respond in kind, adding “a moral
or ethical dimension to gift exchange that is fundamentally irreducible to economic calcu-
lation” (Pawlett, 2011: 659). A gift does more than express the relationship between giver
and receiver; it produces that relationship. And as gifts create not only relationships between
individuals, but also relations with wider cultural ideas like charity or generosity, the gift of
a drink connects giver and receiver to a broader ethic of hospitality. In other words, the gift
of a drink helps create the character of drinking places.
In Britain and the US in this period, buying drinks for others was called ‘treating’. Some-
times, a treat was reciprocated, often through the buying of rounds of drinks, suggesting an
equal relationship. Mass Observation noted that men sometimes completed a round, each
member of a group buying their share, even though they did not want to drink that much
or could not really aford to (1943). Elsewhere, some drinkers bought more than others,
though. Dennis et al.’s study of a West Yorkshire mining community found that higher
earners bought other workers drinks, suggesting that this was a form of ‘capital destruction’
which narrowed diferences in income and status between diferent groups of men (1956).
As this suggests, of course, this gift might create hierarchy as well as conviviality. As Dietler
notes, “commensal hospitality … like the exchange of gifts, serves to establish and reproduce
social relations”, and these relations can be antagonistic just as gift exchanges can be (2001:
74). Skilled workers in Soviet Russia demanded vodka as ‘pay’ for the informal apprentice-
ship of new factory workers, and as this ‘booty’ was shared with their superiors, it fowed
upwards like a tithe, creating bonds with the managers above them rather than the workers
below them (Transchel, 2006: 134–135). Gifts of drink created both egalitarian and hierar-
chical environments.
What Mauss called ‘the obligation to reciprocate’ can be seen in Mass Observation’s
description of round-buying: “the strong social compulsion for its observance, the stigma
attached to those who do not carry it out, and the resentment expressed by anyone accused
of doing so” (1943: 177). Bolton’s drinkers were judged on their generosity, their adoption
of an ethic of hospitality. These practices created a connection between drinking places
and intoxicants, and trust, sociability, hospitality and commensality. According to his bi-
ographer, Mass Observation’s Tom Harrisson agreed with this understanding of drinking:
“It was, he felt, the only way to know a man or to learn if you could trust him” (Heimann,
2003: 22). A similar ‘code’ was observed in saloons in the United States at the turn of the

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century: “men who did each other the honor of drinking together also were expected to
celebrate and reinforce their special bond through the swapping of drinks, favors, small
loans, and other gestures of mutual assistance and friendship” (Powers, 1994: 1). The saloon
‘regular’ was loyal to the rules that bound the group—“constancy, conformity, conviviality,
commonality”—guiding the ways in which drinkers interacted with one another (Powers,
1998: 21). The ‘good’ qualities of drinking places were actively produced in these exchanges
of material things, and the sites in which they happened took on those characteristics.
Less attention has been paid to the commensal consumption of other intoxicants. One
English tobacco trade publication estimated that each publican gave away 80–100 gross of
clay pipes to their customers every year, which “further suggests the importance of hos-
pitality in the smoking ritual” (Hilton, 2000: 49). This gift from the publican might have
been at small cost to them at one or two shillings per gross (British Weekly, 1889: 70), but
it still suggests something more than canny marketing. Against the tendency of smokers to
describe their consumption as a solitary, contemplative, pleasure, there are many indications
that these gifted pipes could be commensally smoked, like the ‘body of smoke’ created by
Sala’s sugarbakers or the smoking of Dickens’ coalheavers. This description of a ‘smoking
parliament’ in London in the 1850s presents another example: “pipes were always placed
on the table after dinner, together with screws of shag tobacco, and a smoking parliament
moistened with hot or cold punch according to the seasons, was generally held during the
following hour” (Apperson, 1914: 163).
This commensality could also be a gift between smokers. In the twentieth century, one
German critic of the cigarette nonetheless recognised its value “as the symbol of a hospita-
ble home when time does not permit that anything else be ofered” (cited in Schivelbusch,
1993: 116). Mass Observation recorded cigarette ‘rounds’ in pubs and other drinking places;
this “helped defne the group, it enclosed a community to the exclusion of non-smokers and
continued the public, communal mode of consumption” (Hilton, 2000: 130). Mass Observ-
ers estimated that only half of the groups they observed in ordinary post-war cafés ofered
cigarettes around, which they thought was actually a sign of ‘cigarette close-fstedness’; “it
takes the more relaxed and social atmosphere of the pub to persuade the smoker to regard his
cigarettes with a less possessive eye; in the pubs packets are more freely ofered round” (1949:
128–129). This identifcation of ‘close-fstedness’ echoed criticism of the ‘slow-motion peo-
ple’ who were last to ofer to buy a round of drinks (1943: 178), again indicating the obliga-
tion to reciprocate. Victorian smokers made similar complaints about ‘tobacco-cadgers’ who
exploited the custom of sharing tobacco by taking more than one pipe’s ‘charge’ when it was
ofered, or not reciprocating (Wright, 1867: 93–94). In one of W. W. Jacobs’ short stories,
an unpopular Londoner is described as “The sort of man that ‘ad always left his baccy-box at
‘ome, but always ‘ad a big pipe in ‘is pocket” (1919: 84). Treating might also have prompted
greater consumption, as smokers reported smoking more in company; “smoking in the social
relaxation of the pub is about three times as frequent as smoking in lunch-time cafes, buses,
dance halls, queues or the street” (Mass Observation, 1949: 145). However, Observers saw
pub smoking as “a way of underlining and embellishing enjoyment that is already there”
(145). Either way, smoking was strongly associated with sociability.
This association with gifting and sharing was visible elsewhere too. In interwar Egypt,
cigarette advertising “expressed the same sense of social familiarity earlier associated with
the habit of the water-pipe”, showing the cigarette as “a means to keep company, to connect,
rather than as a way to portray individualism… In ads, smokers ofered a cigarette to a friend,
or lit a cigarette for a companion as a token of camaraderie and respect” (Shecter, 2005: 488).
In China, tobacco was already part of the hospitality hosts were obliged to ofer, “join[ing]

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tea as the quintessential expression of hospitality when receiving guests … Cordially ofering
visitors a pipe along with tea, snacks, or alcohol signaled one’s generosity, good manners,
and refnement” (Benedict, 2011: 68). In twentieth-century Chengdu teahouses supplied
patrons with tobacco, pipes and cigarettes, much as British pubs did (Wang, 2008: 127). Wu
Zuxiang’s 1944 essay ‘Yan’ (Tobacco) considers the changing importance of sharing tobacco;
“there are no rituals one can engage in to replicate the kind of intimate sharing implied by
passing along the hookah. Instead, all one can do is open a pack and ofer a mass-produced
stick to the other” (Benedict, 2011: 192). However even as a degraded form of hospitality,
cigarette sharing was still important for masculine social networks at the end of the twenti-
eth century (247).
Approaching the consumption of alcohol and tobacco as a form of material culture allows
us to locate some of the characteristics of drinking places in particular practices and material
things, rather than seeing them as part of a more nebulous association of ideas and specifc
places. In pre-industrial Russia, for example, a gift of vodka could create symbolic capital in
diferent ways: for the parents of the bride at village weddings; as payment for contributors
to pomochi (work parties for road building or harvesting); or as a fne or compensation for
wrongdoing (Transchel, 2006: 17–19). Communal generosity, collective labour and justice
were associated with village life, rather than drinking places, but once these practices be-
came established in urban taverns, they took on some of the positively valued character of
the commune. Drinking place sociability produced commensality, hospitality and generosity,
just as contemporary home decoration actively makes homes, genders and classes (Gullestad,
1993). A gifted drink or cigarette materialises or objectifes these qualities. But does it matter
that these practices and things intoxicate?

Material engagements, intoxicating atmospheres

What role does alcohol play within ‘social infrastructure’? Mass Observation saw something
like drunkenness without alcohol in football and holiday crowds and other contemporary
forms of excitement: “the hysterical forms of revivalism and mass enthusiasm produce sub-
stantially the same efects as drink in an industrialized culture, and tend to replace altogether
the need for alcohol in the individuals concerned” (1943: 252–253). Do we need to privilege
sociability over intoxication, though? Bruno Latour suggested that social scientists tend to
see objects as “mere receptacles for human categories” (1993: 52); from that perspective, al-
cohol and tobacco simply represent hospitality or intoxication. On the other side of the divide,
natural scientists assume that intoxicants are strong and society is weak, turning “humans
into so many puppets manipulated by objective forces” (53).
To get beyond the stale dichotomy Latour identifed, we might turn to recent work in
what is sometimes described as the ‘new materialism’. A useful demonstration of the value
of these ideas comes from Alan Latham and Derek McCormack’s discussion of the ‘psycho-
active socialities’ intoxicants help create in cities (2004). Drawing on Deleuze and others,
they consider bodies, alcohol and other elements of city life as assemblages rather than ‘solid’
and singular objects. Rather than a powerful, external force acting upon us, “the fuid and
volatile liquidity of alcohol confronts us with the difculty of apprehending its material-
ity as an object” (715). This is because things do not have innate properties but develop
capacities through their interactions with other things. Alcohol is one thing in a bottle
and another in the bloodstream, but it remains lively, possessing the capacity to change, to
become new things. It could be very difcult to make alcohol-free temperance drinks in
the nineteenth century, for example. A British report on ginger, herb and botanic beers of

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this kind conducted in 1906 found that 37% of them contained more than 2% alcohol by
volume (ABV), the level at which the law defned them as alcoholic drinks; around 13%
of the total contained 4–6% ABV, and the strongest 3% ranged between 6 and 9.5% ABV.
While some may have been misleadingly labelled by unscrupulous producers, it is more
likely that their strength was the result of accidental fermentation caused by poor storage or
the use of very strong alcohol to make the essences that gave them their favour (Pratt, 1907:
223–224). The ‘Bishop’s Beer’ sold in Bishop Fallows’s temperance ‘Home Salon’ in Chicago
was non-alcoholic only for the frst two weeks after brewing, at which point fermentation
(and disqualifcation as a temperance drink) became a real possibility (Calkins, 1901: 226).
These lively concoctions seem to ft Jane Bennett’s idea of ‘vital materialism’, which considers
“the capacity of things—edibles, commodities, storms, metals—not only to impede or block the
will and design of humans but also to act as quasi agents or forces with trajectories, propensities,
or tendencies of their own” (2010: xiii). Alcohol has the capacity to do diferent things as it forms
relations with us, acting as an antiseptic bactericide in hand sanitiser gel, or intoxicating us when
consumed, much as Bennett considers eating as the addition of food to a ‘non-linear’ assemblage
(our bodies) with unpredictable and emergent efects (2010: 42). As Courtwright noted, the ar-
rival of new substances—sugar (and the spirits made from it), tobacco, cofee, tea—from Europe’s
colonies triggered a ‘psychoactive revolution’ that changed not only tastes but also bodies, feel-
ings and thoughts (2001). Sugar made new relations possible in the eighteenth century, quickly
joining tea and cofee in British cups and encouraging rituals of gentlemanly sociability around
the punchbowl (Harvey, 2012). In late nineteenth-century France, the availability of cheap sugar
made from beets just as phylloxera was destroying the nation’s vineyards encouraged a new taste
for brandies and spirit drinks like absinthe, and a new commensal ritual, the aperitif (Prestwich,
1988). Fittingly, one of Latham and McCormack’s examples of “the active, afective role played
by the nonhuman (or inhuman) in shaping emergent materialities” is the sweetness of that 1990s
folk devil, the ‘alcopop’ (2004: 717). Sugar and alcohol turn out to be lively substances, good mix-
ers, entering into highly productive relationships with all kinds of other assemblages, including
our bodies and social spaces.
But if we are looking for assemblages, for collections of things, people and afect, why stop
with intoxicants, when we might see drinking places themselves as intoxicating? The material
form of drinking places and the objects they contain have been thought to encourage alcohol
consumption, like the ‘perpendicular drinking’ associated with nineteenth-century bars without
seats in both London and Mexico City, or the encouragement that open, undivided bars appar-
ently gave to drinking, as acquaintances saw and treated one another (Kneale, 1999, 2012; Toner,
2011). We might also think of the afective ‘atmospheres’ of intoxication, with atmospheres un-
derstood as “aesthetic and afective spaces”, “spaces not so much as three-dimensional containers
for activity, but as shifting confgurations of bodies, materials, and ideas taking place with difer-
ent degrees of afective intensity and duration” (McCormack 2013: 59, 60). The intoxicating at-
mospheres of drinking places emerge from the interaction of humans and non-humans, including
less apparently material things like light and shadow, or the intensity and rhythm of sound (Duf,
2012; Wilton and Moreno, 2012; Shaw, 2014; Wilkinson, 2017).
Thinking historically, Dickens’ famous description of an early London gin palace, orig-
inally published in 1835 ( Jackson, 2019: 6), is often read for the contrast it draws between
the opulence of this site and the poverty of its patrons, but it also suggests an intoxicating
atmosphere:

All is light and brilliancy. The hum of many voices issues from that splendid gin-shop …
the gay building with the fantastically ornamented parapet, the illuminated clock, the

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 James Kneale

plate-glass windows surrounded by stucco rosettes, and its profusion of gas-lights in

richly-gilt burners, is perfectly dazzling when contrasted with the darkness and dirt
we have just left… A bar of French-polished mahogany, elegantly carved, extends the
whole width of the place; and there are two side-aisles of great casks, painted green and
gold, enclosed within a light brass rail…
(1875: 166)

Not all drinking places could ofer the etched and coloured glass, mirrors, polished metal
and wood, marble, tiles, gas lights, and shining bottles and glasses that were found in gin
palaces or cabarets, but they would all have some kind of atmosphere: smoke and other
smells, fragrant and otherwise; talk, laughter, music, contemplative or hostile silences.
Diferent spaces might have their own specifc atmospheres like the snug (private, cosy)
and the open bar (public, lively); Stella Moss reads Mass Observation’s study of types of
rooms in Bolton’s pubs as productive of diferent masculinities in a similar fashion (2016).
Clearly, alcohol played an important part in these assemblages, and so did human bodies,
but the intoxicating atmosphere of these venues belongs to the assemblage, not to those
two elements alone. Cameron Duf ’s description of a rather diferent example makes
a similar point. “The young man about to consume a tablet of ecstasy in a downtown
warehouse party is not the only agent involved in this consumption”, Duf suggests; we
should also consider the text messages that connect him to friends and others; the music,
the equipment that provides it and the skills of the DJ in creating and playing his set; the
furniture and carefully calibrated design of spaces within the club; even the new trainers
he is looking forward to testing on the dance foor (2012: 150). For Duf, this approach
ofers another way of thinking about the contexts of consumption: “What if one were
to prioritise analysis of the event of consumption rather than the drug user?” (2014: 636,
emphasis in original). The task of the researcher who is also part of this event is then
to refect on the shared experience of it, or the ‘common-sense’ of this intoxication as
Thomas Thurnell-Read puts it (2011: 46), a collective sensory engagement with laughter,
music or the smells of vodka and vomit.
This consideration of the event of consumption goes beyond the idea of ‘drunken de-
portment’ (MacAndrew and Edgerton, 1969) because it refuses to divide intoxication into
‘physiological’ and ‘cultural’ elements, while decentring drunkenness and the ‘efects’ of
consumption. Sala’s description of the sugarbakers’ beer-shop takes in the smoke, the smok-
ers and their song—the atmosphere as he encountered it—and alcohol is just another el-
ement. Other forms of intoxication emerge from these environments. Perhaps the short
pipes that marked out working-class smokers were short for a reason, for example. While
“Smoking was a mobile activity that might be combined with working as well as leisure
and sociability” (Owens et al., 2010: 220), the long-stemmed ‘churchwarden’s pipe’ was, for
G. L. Apperson, intended for smokers “of what I might call a sedentary nature. You could
not even walk while holding a long churchwarden in your mouth… Labourers smoked short
clays when out of doors, and churchwardens when they rested from their labours and took
their ease in their inn in the evenings” (1914: 164–165). While the origins of its name remain
obscure, there are suggestions that the churchwarden’s long stem also made it the best pipe to
smoke while reading, so it could be a solitary pipe as well as a sociable one. Seen as an event
of consumption, as a coming together of practice, mobility and materiality, the churchwar-
den required a seat or at least somewhere to stand still, while the short pipe, like the cigarette
that replaced it, needed fewer accessories.

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 Expanding intoxication

Expanded sites, mobile objects

As a fnal consideration, we might explode these drinking places even further, following
their material and afective components away from the sites themselves. British drink-
ers circulated from pub to pub, weaving connections between drinking places, homes,
workplaces and other sites. Objects travelled with them: the clay pipes publicans gave
away, the bottles, buckets, jugs or ‘growlers’ that carried pub-poured beer into homes,
the drinking and smoking paraphernalia deliberately or absent-mindedly taken from the
bar. We know that the fow of alcohol out of drinking places worried British reformers
because the Child Messenger Act of 1901 restricted children to carrying beer home to
their parents in containers sealed or corked after flling; after the 1908 Children’s Act,
only premises with a dedicated of-sales or ‘ jug-and-bottle’ counter could sell beer to
children (Moss, 2009; Jennings, 2016). Alcohol spilling out of pubs contaminated sur-
rounding spaces (Croll, 1999; Kneale, 1999; Kneale, 2001), afecting even those charged
with protecting society against it, as Richard Robinson’s account of Brighton’s drunken
policemen shows (2016). In the US, the women and children who ‘rushed the growler’,
carrying pails of beer from the salon, blurred the distinction between supposedly public
and private spaces, but drink was also highly mobile throughout the city as beer peddlers
sold bottles from wagons (Duis, 1983).
We can follow these objects, tracing their biographies and trajectories (Appadurai, 1986,
and see Cook, 2004). Archaeologists, historians and historical geographers have suggested
that the material culture of intoxicant consumption is ubiquitous in many urban sites. We
would expect the remains of clay pipes and drinking vessels to make up a signifcant part of
eighteenth- and early nineteenth-century American and British drinking place assemblages
(Pearce, 2000), but it is more interesting when they turn up in rubbish left by households in
Victorian Limehouse:

Discarded household objects, often marked by years of wear and tear, draw attention
to the minutiae of daily domestic routines: the preparation of food and drink and the
coming together of people at diferent times of the day for their consumption; the grind
of household chores; the care of children; or the moments of sociability, pleasure and
release ofered by alcohol and tobacco.
(Owens et al., 2010: 214).

These objects included a pewter vessel engraved with the name of the nearby Spread Eagle
pub (Owens and Jeferies, 2016), and many well-smoked pipes, possibly given away in this or
another local drinking place. Elsewhere in London, this team found ‘moralising china’ din-
ner services, some with temperance connotations, alongside large numbers of wine bottles
( Jefries et al., 2009). The contradictory nature of these assemblages emphasises the fuidity
and complexity of these mobile material worlds. Tavern fasks, jugs, tankards and mugs are
found in other domestic assemblages in Lambeth, alongside pipes (Tyler, 2004) and in the
Kent village of Guston discarded jugs were probably used to carry beer from the Plough to
labourers’ cottages (Licence, 2015). If we can ‘follow’ these objects—like the Spread Eagle’s
pewter (Owens and Jeferies, 2016), the glass bottles the Biucchi brothers sold in Clerkenwell
( Jefries, 2009), the beer bottles thrown away by a Shropshire postman (Licence, 2015) and
the bottles that evaded Prohibition restrictions at six sites in California (Mosher and Wilkie,
2010)—we can connect homes, workplaces and drinking places.

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Archaeological work of this kind, coupled with a historical attention to traces of material
things in archives, allows us to expand our sense of these sites, in much the same way that
Ruth Slatter has approached London’s Methodist chapels. The material spaces of these cha-
pels expanded and shifted as cups, saucers, cutlery, tables and chairs travelled up and down
the steep hill of Archway Road, or as a communion service was given from one East London
chapel to another (2019b). These mobile, material things and spaces were as much a part of
Methodist religious experience (Slatter, 2019a) as seats and gas-lights were part of the intox-
icating atmosphere of the gin palace. Seeing sites as ‘becoming’, on the verge of turning into
something else or held together by practices of care, restoration and co-habitation (Edensor,
2011), extends our apprehension of them in both time and space.

Conclusions
This chapter has suggested that we might expand our understanding of drinking places,
chiefy by extending our understanding of intoxication to include other substances as well as
the wider contexts, sites and meanings of consumption, and by more closely examining the
relationship between intoxication and the associations drinking places have with sociability,
commensality and hospitality. As mobile and expansive assemblages of afects, bodies and
objects, these sites turn out to be much more difuse places than we might have expected
them to be, and much less dominated by drinking and alcohol as opposed to other practices
and materials.
However, it is worth considering some of the new questions that might emerge from
the synthesis of these perspectives on intoxication and place. One of the key problems here
is the tension between the human-centred approach of material culture studies and the
post-humanist arguments of many forms of new materialism. If a cigarette ofered to a
fellow smoker simply signifes hospitality, for example, does it matter that it is a cigarette
and not something else? Powers notes that saloon bartenders were not allowed to accept a
customer’s ofer of a drink; asking for cash instead was thought to be ‘baldly mercenary’ but
it was acceptable to take a cigar, because both had the same money value and “treating with
tobacco was regarded as a sociable and roughly comparable gesture to treating with alcohol”
(1994: 5). From this perspective, the intoxicating capacities of beer and cigarettes are less
important than their equivalence as gifts.
However, we might see intoxication as a key part of this sociability, as an afective out-
come closely bound up with feelings of commensality and hospitality. Dietler sees intoxica-
tion as a special form of commensality precisely because these materials form new relations
with their consumers:

Alcoholic beverages frequently have a privileged role in the feasting context because
they are essentially food with certain psychoactive properties resulting from an alterna-
tive means of preparation that tend to amplify their signifcance in the important drama-
turgical aspects of ritual… Moreover, this property of fermentation as a quasi-magical
transformation of food into a substance that, in turn, transforms human consciousness
augments the symbolic value of alcohol in the common liminal aspects of rituals.
(2001: 72–73).

The transformation of food into alcohol is not simply a change in meaning but a change in
food’s capacities. Working on the ways in which these approaches contradict and complement
each other might help to draw out the importance that the special charge of intoxication, as

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a more-than-human outcome, has for what we tend to think of as purely human forms of
sociability.
The second issue concerns critical insights that have not been explored in this chapter, but
which remain of utmost importance. Much of the work on drinking places drawn upon here
is concerned with social diference—class, gender, sexuality, race, age and more. Practices
and substances of commensality and generosity can exclude or dominate just as easily as they
bring equals together, and a consumption event or assemblage can create outcomes that di-
vide and exclude. For Valerie Hey, masculine pub sociability was driven by a ‘taboo against
unbonding’, for example, where men’s commensal, hospitable experience is threatened by
women (1986). Similarly, Mass Observation’s discussion of British smoking noted that “Post-
war wage increases have gone for the most part to the man of the house rather than to the
housewife, and have been used by him largely to balance the extra cost of tobacco” (Mass
Observation, 1949: 3).
Pub smoking, like the drinking discussed by Moss (2016), clearly created very diferent kinds
of experiences. It also shaped other kinds of relationships. The nineteenth-century pipes bought
so cheaply by the publican and freely given away to customers, the majority of them men, were
made by women working at home; “Clay pipes are difcult to make, and require a great deal
of practice. Sixteen must be made to the dozen, for many break, and many are imperfect. …
And after all this, the pipes are sold [to the publican] at less than a farthing each!” (British Weekly,
1889: 70–71). In this way, masculine enjoyment of commensal smoking in ‘great good places’
depended in part on free pipes produced by women’s poorly paid domestic labour.
Still, tracing these contradictions and connections is entirely in keeping with the argu-
ment that we should be looking at these and other spaces with a new eye for the things that
emerge from them, often unexpectedly. A broader examination of drinking places may well
generate entirely new questions for researchers interested in intoxication.

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 11
JOIN US FOR DRINKS
Intoxication, work and academic conferences
Helen Keane

Introduction
In medical and public health discourse, intoxication is viewed as a pathological state that is
both physically harmful and morally suspect (Hunt & Frank, 2017; Keane, 2009). Drunken-
ness is the iconic state of pathological and risky intoxication, marked by disinhibition, mood
lability, impaired judgement, inappropriate behaviour and other signs of diminished physical
or mental control (American Psychiatric Association, 2013, pp. 485, 497). This version of
intoxication is visible and easily observable. Legal defnitions refect medical defnitions in
their focus on the obviously disorderly, as operationalised in laws related to the ‘responsible
service of alcohol’. Bar staf are expected to identify intoxication in patrons through signs
such as ‘becoming bad-tempered or aggressive’, ‘swaying and staggering’ and ‘rambling or
unintelligible conversation’ (Pennay, 2014).
However, there is a broader and less medicalised understanding of intoxication which
incorporates more subtle changes in consciousness and comportment than obvious
drunkenness. For example, Sociologist Angus Bancroft states that, ‘Whether smoking
cigarettes, drinking alcohol and cofee, or taking illicit drugs, for the majority of society’s
members, some kind of intoxication is a regular, often daily practice’ (2009, p. 5). By
expanding the category to include substance-related changes in the relationship between
the self and the world, whatever their intensity, Bancroft (2009) normalises the experi-
ence of, and the desire for, intoxication. As he states, intoxication in this mode is a reg-
ular and routine practice, rather than an event outside of normal life. Another expansive
defnition of intoxication is the use of substances to alter consciousness (Hunt & Frank,
2017, p. 323). ‘Altered consciousness’ is usually interpreted to entail the experience of a
level of awareness signifcantly divergent from an ordinary or normal state. However,
consciousness can be shifted in relatively mild and transient ways, such as a few minutes
daydreaming at one’s desk.
As I have argued elsewhere, smoking (and nicotine consumption in general) is an example
of an intoxicating practice that induces relatively subtle but nevertheless highly rewarding
alterations in mood and attention (Keane, 2020). In the words of the National Institute on
Drug Abuse, ‘A transient surge of endorphins in the reward circuits of the brain causes a
slight, brief euphoria when nicotine is administered’ (NIDA, 2018, p. 7). The notion of a

178 DOI: 10.4324/9780429058141-15

 Join us for drinks

‘slight’ euphoria seems oxymoronic at frst glance, but it captures the particular capacity
of cigarettes to create a brief opening in the smoker’s day which is a minor, but sustaining
enhancement of routine.
This form of slight or minor intoxication, combined with the convenience and porta-
bility of the cigarette, enabled smoking to become a tool of productivity, self-regulation
and self-control in the twentieth century (Hughes, 2003). In this context, ‘substance de-
pendence’ became an ally of the virtues and disciplined forms of conduct that it is usually
regarded as undermining. In particular, smoking as a practice was coordinated with work for
many, as a method of coping with boredom and fatigue, and enhancing concentration, until
tobacco control regulation rendered indoor spaces smoke-free.
In this chapter, my aim is to examine the experience and efects of such forms of minor
and productive intoxication in relation to alcohol consumed at work or at work-related
events. These forms of intoxication disrupt the conventional opposition between moderation
and intoxication as they incorporate forms of alcohol consumption that are intoxicating but
also socially accepted as sensible and moderate (Yeomans, 2013). This is not to deny that
alcohol intoxication as it is addressed in medicine, public health and the law can be harmful
to the self and others. Rather, it is to highlight common and normalised social practices in
which an intoxicating drug efect is valued and sought out, yet almost taken for granted.
My focus in the second part of the chapter is academic conferences. These events involve
frequent temporal and spatial transitions between sessions and breaks, with attendant shifts
in atmosphere that are in part produced through the provision of food and drink (Mair &
Frew, 2018). Conferences are sites of demanding and high stakes identity management. They
require the simultaneous performance of collegiality and competition within a context of
strong cultural norms and social hierarchies (Lipton, 2020). In this chapter, I am particularly
interested in the way conferences bring together two elements that are usually understood as
oppositional in contemporary neoliberal organisations: intoxication and the responsibilities
and goals of the enterprising professional subject. I suggest that in the networking prac-
tices of academic conferences, we can see minor intoxication as itself a form of work. This
raises important questions about the inclusivity of such events, given increasing awareness
of non-drinking as a cultural and religious practice and an individual choice (Pennay et al.,
2019; Savic et al., 2016; Valentine et al., 2010).

Drinking at work, drinking as work

Social scientifc research on alcohol use in the workplace developed in the 1980s and 1990s.
The early work in this subfeld tended to focus on drinking among men in blue-collar oc-
cupations such as construction and factory work, with an emphasis on the problems, risks
and harms of workplace drinking (Ames & Janes, 1992). ‘Problem drinking among workers’
was conceptualised as a response to powerlessness and alienation, as well as being shaped by
workplace cultures and subcultures (Ames & Janes, 1992; Seeman et al., 1988).
More recently, research from an organisational perspective has investigated alcohol as an
element of food and drink rituals in the workplace (Flores-Pereira et al., 2008; Plester, 2015;
Walker & Bridgman, 2013). In contrast to the literature that addresses drinking as a form
of employee resistance to workplace regulations, this research draws attention to the use
of alcohol by organisations to encourage positive feelings and a sense of belonging among
workers. As Plester argues, food and drink practices have powerful social and symbolic
meanings. They provide insights into organisational culture and climate, especially since
ingesting ‘treats’ supplied by the workplace ‘is a potent way to bodily interact with and

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actually embody organizational culture’ (2015, p. 265). Regularly occurring rituals such
as after-work drinks create afective relations not only between workers, but also between
workers and the organisation.
Plester’s study of food/drink rituals in four organisations from diferent industries high-
lights the value employees placed on opportunities for ‘bonding’, ‘unwinding’ and ‘relaxing’
with colleagues at events, both with and without alcohol (p. 260). However, the intoxicating
and mood altering efects of alcohol were identifed by participants as part of the warmth
and pleasure of memorable events. One participant, a lawyer working at a prestigious law
frm, explained that

There is always lots of fun to be had. This is going to sound really bad but lots of the
funny stuf that happens around here is when we’re drinking socially and someone gets
a bit drunk and does silly things.
(2015, p. 262)

This comment demonstrates the ambiguity of such rituals, in that ‘a bit drunk’ and ‘silly
things’ can be light-hearted and fun, or risky and harmful, or indeed both simultaneously.
As Plester notes, some individuals resisted workplace drinking rituals, and identifed them
as a source of potential discomfort. Plester also identifes an interplay between control and
freedom in these practices: the rituals may be relaxed and even raucous, but they are also
controlled and managed by the organisation, and employees can be coerced into drinking
(p. 264). And as in all rituals of belonging, inclusion depends on the exclusion of those who
cannot or will not participate (Buvik, 2020).
Thus, from a critical perspective, organisationally endorsed and sponsored drinking can be
interpreted as an intensifcation and extension of expected attachments to work, one of the
characteristic features of post-Fordist capitalism (Adkins & Dever, 2016). Melissa Gregg argues
that the contemporary professional workplace permits only a limited range of afective states
and subjectivities and yet also demands ‘appropriate collegial connection’ through obligatory
social events (Gregg, 2010, p. 253). In her incisive analysis of workplace afects, such forms of
compulsory sociality and afection mask the reality of capitalist labour relations (including long
hours and precarity) while also undermining other less alienated connections between workers.
Such accounts of workplace and work-related drinking add an important dimension to
the extensive research on socialising and intoxication in night-time and leisure contexts.
Night-time economies are frequently identifed as spaces where individuals seek the loos-
ening of the social constraints, conventions and expectations associated with daytime roles,
such as ‘professional’ or ‘responsible student’ (Bianchini, 1995; Brain et al., 2000). While
workplace drinking rituals do entail the alteration of behavioural norms and notable shifts in
feelings, mood and atmosphere, participants are still inhabiting their professional identities
and are still ‘at work’. This can result in experiences of ambiguity and tension (Flores-Perera
et al., 2008; Gusfeld, 2003; Walker & Bridgman, 2013).
According to recent research with Norwegian employees and employers, situations such
as Christmas parties, work celebrations, work-related travel and drinking with colleagues
after work produce challenges and dilemmas related to obligatory participation, pressure to
drink, the balancing of work and personal time, and the management of formal and informal
drinking rules (Sagvaag et al., 2019). Sagvaag et al. conceptualise these issues as the naviga-
tion of a ‘grey zone’ between leisure and work. They argue that the ‘grey zone’ is in fact a
continuum, from voluntary events primarily driven by leisure, to those that are efectively
compulsory, experienced as ‘drinking while working’ (p. 79).

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Investigating the grey zone between leisure and work demonstrates that intoxication,
especially in its minor or subtle forms, can readily co-exist with expectations of responsibil-
ity, productivity and the maintenance of control (at least in cultures where ‘moderate’ and
‘social’ drinking is normalised). Indeed, in accounts of workplace drinking, the ability to
manifest a suitably informal, light-hearted and mildly intoxicated self at appropriate times
and places is part of being an ideal worker and organisational citizen (Gregg, 2010). The
boundaries of ‘proper’ drinking at work will vary according to situation and professional and
local cultures, but individuals are expected to avoid excess and loss of control, in whatever
way these states are characterised (Rolando et al., 2014).
As well as an embodiment of organisational culture, alcohol consumption can be a more
direct feature of successful work performance, for example, in relation to networking and
the development of positive relationships with clients (Walker & Bridgman, 2013). Walker
and Bridgman’s study of young employees in a professional services frm illustrates the way
organisations can ‘prompt’ drinking by workers (2013, p. 603). One of their participants is
explicit about the training she received from the company on how to use alcohol as a prop:

You actually get taught to use, drink in the left hand shake with your right. So there’s
etiquette around it. If we were to be networking in a room and I just met you, and we
were having a conversation, and I noticed your drink was low, and we’d been having a
conversation, and there were a couple of other people in the room that I wanted to talk
to, I might say, ‘oh I see you’re out of a drink’ or ‘do you want a top up can I get you
one?’, bring it back and say ‘here you go, it’s been really lovely talking with you but I’m
just going to take the opportunity to go and talk to others’…
(p. 602)

I quote this response at length, frst because it describes an unremarkable exchange in which
alcohol (as an object, not just its efects) is used to ‘ease the process of speaking to unfamil-
iar individuals’ in a work context (Walker & Bridgeman, p. 602). As well as the actions
of the respondent, the excerpt reveals how the recipient of the drink is also tied into a
work-related drinking exchange. In addition, the response is specifcally related to the prac-
tice of ‘networking’, which is central to the following discussion of the normative intoxica-
tion of academic conferences.
As I outline in the next section, the ubiquity of drinking at academic conferences is rec-
ognised in research and popular literature, but is not usually considered in relation to the
concept and experience of intoxication. The exception is the small but growing literature
on bad conference behaviour (and how to reduce it) but here my concern is primarily with
the accepted use of alcohol rather than its role in producing misconduct (Foxx et al., 2019).
I argue that academic conferences are fruitful sites for the study of work-related drinking
because they combine work, the hope of future work and escape from work in a particularly
intense, and many would say, exhausting and anxiety-producing way. In addition, one of the
key practices of conferences, networking, is routinely enabled by alcohol consumption and
its intoxicating efects.

Academic conferences as drinking sites1

Academic conferences are temporally and spatially intense events in which work, profes-
sional development, career building, knowledge exchange, socialising and leisure are com-
bined. Conferences are diverse in terms of size, structure, formality and location, but they

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are inevitably sites where individuals develop and perform their academic identities, and
attempt to build reputation and status in their feld while also exercising judgement over
others’ professional performance (Henderson, 2015; Walters, 2018). Attendees are usually
removed from their normal workplace; however, they are on ‘university business’, fulflling
performance objectives and representing their institutions. As Bell and King state, academic
conferences can be usefully studied as ‘inter-corporeal’ and pedagogic spaces where ‘tech-
niques, skills and dispositions’ are acquired and academic power relations are constructed
and enacted (2010, p. 429). Crucially, conferences provide the opportunity for novices to
demonstrate confdence and profciency in both the formal and informal elements of ‘being
an academic’.
Conferences are sites where structures of inequality within academia are readily rein-
forced (Biggs, 2018). Attendance costs money and time (often substantial amounts of both).
Inequities of access have been increasingly highlighted, especially for those with caring
responsibilities or without secure employment (Black et al., 2020; Lipton, 2019). Access is
not just a matter of getting to the conference, but also relates to diferent levels and experi-
ences of participation. For instance, while some conference attendees experience a sense of
freedom from routine demands and roles, attendees with caring responsibilities at home are
often managing a difcult state of being ‘in two places at once’ (Henderson, 2019).
The activities, practices, encounters and atmospheres that make up a typical academic
conference range from the banal to the sublime and/or devastating. Henderson’s account
emphasises the embodied experience of the conference attendee: ‘…we eat snatched meals,
sandwiches with unnameable fllings balanced on paper plates; we navigate more or less
boozy dinners, drink endless cofee and tea to combat the drowsiness provoked by excessive
heating or the chill of air conditioning…’ (2015, p. 914). Spicer’s sketch of the ‘reality’ of
conferences combines bodily discomfort with the nastiness of academic politics: ‘Indiferent
food. Petty controversy of the latest theory. Many glasses of the local liquor. Extra-marital
afairs. Verbal violence. Arrogant grunts. Closed circles. Dashed hopes. Petty promotional-
ism. Scholastic policing. Grinding headaches. Boredom. Body pain’ (2005, p. 21). As these
descriptions suggest, the consumption of psychoactive substances is an expected and nor-
malised feature of the conference schedule – cofee at regular points during the day and
alcohol in the evening. In addition, international participants who have travelled over many
time zones often resort to prescription drugs or alternative remedies to manage their sleep/
wake cycle. This is not to say that all delegates consume these substances, but that the pro-
vision of cofee/cafeine and drinks/alcohol is part of the organisation, structure and diverse
atmospheres of the conference.
As well as the ‘more or less boozy dinner’, the reception with beer, wine and fnger food
is a key transition point in the conference day. At the conferences I have recently attended, I
have been struck by the shift in atmosphere, mood and bodily comportment signalled by the
announcement ‘time for drinks!’. By 4 p.m., delegates are tired and struggling to pay atten-
tion to the last presentations of the day; at 5.30 p.m., they are enlivened, seemingly keen to
chat and laugh, move around and socialise. The successful conference drinks session prompts
this transition in comportment by bringing into being a lively, light-hearted and hopeful
afective atmosphere, experienced as tangibly diferent from the earlier conference schedule,
even if it takes place in the same building or room.
The concept of afective atmosphere helps us attend to intoxication as a varied and col-
lective experience which emerges in a shared space and time ( Jayne et al., 2010). As recent
geographical research has emphasised, atmospheres are generated by bodies gathered in space
but their corporeal, sensorial and emotional efects exceed the bodies they emerge from

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(Anderson, 2009; Bissell, 2010). This insight has produced accounts of night-time and night-
out socialising that highlight the ‘priming’ efects of diferent atmospheres on the actions and
conduct of individuals (Duf & Moore, 2015; Shaw, 2014). Conference drinks events have
their own atmospheric priming efects on participants, enhancing individuals’ inclination
to be open, polite and friendly to others beyond their friends and colleagues. The limited
choice of food and drink, provided without direct payment, masks diferences in income
and taste in favour of commensality and togetherness. The circulation of wait staf with trays
of mainly alcoholic drinks and food around a space with limited seating encourages mild
intoxication, conversation and mingling.
However, personal experiences of the collective atmosphere of the drinks event vary accord-
ing to embodied identities (such as gender, ethnicity, age, sexuality and disability) and embodied
states (such as tiredness, hunger and anxiety) (Jayne et al., 2010). In addition, the socialising that
occurs in these events involves particular challenges of etiquette and afective self-management
because of the need to transition more or less smoothly between interactions with old friends,
colleagues we see every day and people we hardly know or have never met (Thompson, 2012).
Despite the convivial atmosphere, hierarchies of power and status remain salient. The negotia-
tion of the drinks reception requires specifc forms of professionalism and competence, with the
attendant afective labour of managing the feelings of oneself and others.
Much of this socialising incorporates networking, which in the context of academic con-
ferences is a form of labour which is commonly entangled with intoxication. Networking
is generally understood as social interaction related to the development of benefcial profes-
sional relationships, contacts and opportunities. Notions of networking range from the ruth-
lessly instrumental process of ‘working the room’ to a more organic building of supportive
and meaningful relationships over time (Petre & Rugg, 2010). Whether targeted or organic,
networking is about the accrual and demonstration of social and cultural capital (de Janasz &
Sullivan, 2004). The burgeoning advice literature aimed at doctoral students and early career
researchers emphasises the vital role of efective network building to career success in the
competitive and uncertain higher education market (Matthiesen & Binder, 2009).
In the academic advice literature, doctoral students and junior academics are exhorted to
attend conferences because of the unique range of in-person networking opportunities they
provide. In a recent Chronicle of Higher Education advice column on conference attendance,
Manya Whitaker writes that ‘networking is the whole point’, and that maximising your net-
working opportunities means ‘positioning yourself to meet people’. In her words,

Early-career academics at conferences should be primarily focused on networking.

Rather than attend four sessions a day where you sit quietly and then rush out, seek
opportunities to genuinely talk with other scholars. Most of those opportunities are
embedded in preconference events and in gatherings after the day’s sessions are over.

These gatherings include the cocktail party/reception where ‘you get the chance to chat with
faculty members you may never have met, meet alumni, and, in general, build your social
capital’.
Initiating and performing this style of complex social interaction, often with high status
strangers, can be daunting and stressful, especially for newcomers and those who are mar-
ginalised or feel like outsiders (Matthiesen & Binder, 2009). It entails managing encounters
that are ostensibly informal, spontaneous and reciprocal (in a space that is supposedly dedi-
cated to relaxation and having a good time) while maintaining an entrepreneurial focus on
professional goals and demonstrating one’s employability. For the precariously employed,

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under-employed or yet to be employed, networking is one of the many forms of ‘unpaid

hope labour’ or ‘unpaid work-for-labour’ that proliferate in contemporary academia (Mauri,
2019). This is work ‘undertaken in the present for a better position down the road’ and in the
case of networking, it is usually invisible as work, as well as often being carried out for free
during periods of supposed ‘time-out’ or leisure (Mauri 2019, p. 197). To return to Savaag et
al.’s conceptualisation, these encounters take place in a grey zone between leisure and work,
with no guarantee that the participants have a common understanding of where they are
located in that zone (2019). A networking conversation can be both a relaxing time out from
work for a senior scholar and crucial career-building labour for an early career academic.
Given these demands and tensions, it is not surprising that mildly intoxicating alcohol
efects are commonly involved in conference networking. As qualitative research on social
drinking demonstrates, alcohol can facilitate feelings of togetherness, closeness and sharing
among both friends and strangers, thereby blurring social boundaries ( Jayne et al., 2010).
The positive experience of nightlife drinking includes ‘friendships that emerge for just a few
minutes’ (p. 546). While the context is obviously diferent, the transmission and circulation
of positive afects between bodies allow networking to feel authentic and joyful rather than
cold and efortful. In her Inside Higher Education essay on networking, Rebekah Layton ad-
vises readers that the aim is to connect with your interlocutor ‘as a person rather than as an
accomplished professional’ (Layton, 2019). The ideal is ‘two connected human beings build-
ing a relationship’ rather than a ‘transactional process of trying to prove your immediate
value to someone of greater experience or stature’ (Layton, 2019). The time constraints of
the typical conference networking encounter further increase the usefulness of alcohol as a
tool which speeds up intimacy and produces short-lived feelings of connection.
Stepney’s research on drinking among British women’s friendship groups provides an-
other insight into the value of alcohol efects in constructing and managing networking
encounters. Among her young participants, she found that rather than straightforwardly
producing closeness, drinking alcohol was a means of achieving both proximity and dis-
tance in relation to others (2014). In particular, her respondents valued alcohol because it
enhanced their ability to do ‘small talk’, sustaining a ‘superfcial form of cooperation and
“getting along”’ (2014, p. 108). This balancing of proximity and distance resonates with the
work of networking, which requires connections that are experienced as genuine but remain
work-focused rather than personal or confessional. While the person desiring the network-
ing connection may well be anxious, resentful and envious of the higher status other, any
sense of confrontation or hostility must be avoided, and negative afects kept at bay.
Mild intoxication is readily incorporated into events which combine socialising and
work. In fact, the case of networking demonstrates how intoxication can become work
because of its potentially vitalising efect on transpersonal relations. Intoxication can recruit
conference participants into networks which promote professional and institutional ends.
This is not just a matter of material efects, but also engages the symbolic meaning of alcohol
as a sign of conviviality and celebration. However, as mentioned earlier, intoxication must
remain within the bounds of the proper and the normal in order to augment professional
identity and performance (Mair & Frew, 2018). As Mair and Frew note, there are defnite
risks to ‘over-indulging’ at conference social events (2018, p. 2164).

Challenging and changing intoxication practices

As historians and sociologists have argued, the boundaries of moderate drinking, and the
line between acceptable and unacceptable intoxication at work vary over time and space

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(Gusfeld, 2003; Yeomans, 2013). Anecdotal evidence supports the view that norms and
practices of drinking in academic life have become more restrictive over recent decades,
although published research on this specifc topic is sparse (Donald, 2016). A US article on
‘chemical dependency’ among faculty published 30 years ago provides evidence of a signif-
icant change in relevant conditions of academic labour (Donovan, 1990). The article argues
that a workplace culture of freedom and privacy, and the self-paced nature of academic
work, allows obvious substance use problems to fourish. It states that ‘remarkable tolerance
often greets the boozy or pot-smoking professor whose drug use, dull or threatening in other
contexts, exalts this eccentric as a campus character and folk hero’ (Donovan, 1990, p. 21,
emphasis in original).
While this account of laissez-faire tolerance of the ‘colorfully alcoholic colleague’ may be
an overstatement (Donovan, 1990, p. 21), the professorial freedom it describes is a striking
contrast to the working environment of academics in the twenty-frst century. Academic
work has been transformed by the rise of the corporatised and managerial university (Gill,
2009; Lipton, 2020). The regulated forms of academic subjectivity produced by performance
measurement and the demand for ever-increasing productivity and entrepreneurship are a
long way from the autonomous, self-directed and securely tenured professors invoked in
Donovan’s 1990 article (Morrissey, 2015). Performance and conduct expectations are now
explicit and substance misuse at work (including alcohol consumption) is regulated by work,
health and safety policies and staf codes of conduct.
Alongside institutional eforts to limit the risks produced by substance-using staf, aca-
demic drinking culture has also become a topic of critical discussion in public discourse. The
Chronicle of Higher Education and Inside Higher Education have featured career advice essays on
how to manage the ‘omnipresence of alcohol’ at professional events (Kreuter, 2011; Lund-
steen, 2019). On social media, especially twitter, non-drinking academics have highlighted
the challenges of navigating academic life while sober and called for a change to the routine
centring of alcohol at work and social events. This critical discourse has also highlighted
the exclusionary efects of normative expectations of alcohol consumption and their risks
in terms of health and safety, especially in relation to sexual harassment and violence (Co-
hen, 2017; Jaschik, 2018; Pettit, 2019). More broadly, socially obligatory drinking has been
undermined by the rise of discourses of individual choice related to consumption, diet and
health (Caluzzi et al., 2020; Yeomans, 2019). Although abstinence from alcohol may remain
deviant in some social contexts, the decision to abstain, whether temporarily or perma-
nently, is increasingly understood as an element of positive self-formation, especially among
young people (Paton-Simpson, 2001; Törrönen et al., 2019).
Increasing recognition of the prevalence and impact of sexual harassment and violence
in academia and the growing prominence of gender equity as a strategic organisational
goal has also promoted critical refection on the role of alcohol consumption at academic
events. Drunkenness is increasingly constituted as a health and safety issue, not just for
the individual but also in terms of harms to others. In STEM felds in particular, con-
ference codes of conduct are advocated as a tool for promoting a safe environment for
all (Foxx et al., 2019). While conference codes of conduct may not explicitly mention
alcohol consumption, the targeting of unwelcome sexual behaviour, incivility and ‘un-
acceptable’ conduct problematises intoxication as a risk. In setting out the need for codes
of conduct, Foxx et al. highlight the risks to women of evening networking conversa-
tions involving alcohol, ‘Women have reported instances of men distorting after-hours
networking events for predatory purposes to lodge unwanted sexual advances, drug-
gings, and sexual assault’ (2019; p. 14932).

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The risk of gendered and sexual harm is not the only equity issue faced by conference
organisers. The assumption that attendees are more or less homogenous in their require-
ments and desires tends to reproduce and reinforce existing academic hierarchies (Mair &
Frew, 2018; Walters, 2018). As Briony Lipton observes, conferences labelled ‘international’
and ‘global’ still tend to have a homogenising efect in their unquestioned centring and
celebration of Anglo-American, English-speaking academic culture (2020). The belief that
everyone enjoys the standard conference reception and feels at home within its culturally
specifc consumption rituals is part of this dominant culture.
It is uncertain to what extent these concerns about harm, equity and inclusion will re-
shape the typical conference drinks event, but it is clear that the aim of making all partic-
ipants feel welcome at a conference requires abandoning the assumption that comfort, fun
and pleasure are the same for everyone. While I have argued that the provision of alcohol
and the efects of mild intoxication are central to the atmosphere of the drinks event, the
embodied and afective experiences of non-drinking participants deserve more attention
(Buvik, 2020; Kreuter, 2011).

Conclusion
Dominant medical and legal accounts of intoxication tend to focus on the pathological, dra-
matic and forid, such as the physical and emotional manifestations of drunkenness. While
the feld of drug and alcohol studies has produced an extensive literature on more diverse ex-
periences of intoxication, there is still a tendency to think of intoxicating efects as naturally
linked to ‘time out’ and leisure. This chapter has instead discussed the place of normative
drinking and mild intoxication in work-related events and places.
My focus has been on drinking that is incorporated into the demands of work and the
performance of workplace identities. Organisational research reveals the signifcance of food
and drink rituals in creating afective ties between workers, and between workers and the
organisation (Plester, 2015). But while these rituals are experienced positively by many,
they can also produce discomfort and exclusion. Workers may appreciate the conviviality
and fun of social events, but the obligation to drink and to conform to a model of sociable
subjectivity can represent an unwelcome encroachment of work into personal space and time
(Sagvaag et al., 2019). In the contemporary landscape of post-Fordist labour, appropriately
timed, sociable intoxication (such as at after-work drinks) can become an obligation as well
as a reward. Although intoxication is usually understood as the opposite of ideals of modera-
tion and discipline, mild intoxication is readily incorporated into expectations of productiv-
ity, fexibility and afective attachment to work (Gregg, 2010).
To explore a specifc form of work-related drinking, the second part of the chapter exam-
ined academic conferences. The provision of alcohol is an expected and taken-for-granted
feature of the typical conference schedule. Drinking contributes to the varied embodied
experiences of conference attendance, including the sense of belonging or being out of place.
I have discussed professional networking in particular as a practice that is routinely entan-
gled with drinking. Both the individual efects of mild intoxication and the shared afective
atmosphere invoked by the drinks session promote the quick production of feelings of con-
nection which aligns with the goals of networking. The example of networking demon-
strates how intoxication can itself become work in contexts where expectations of informal
spontaneity are combined with the pursuit of professional goals.
Like all cultural norms of consumption, the boundaries of acceptable work-related drink-
ing are subject to change over time. It does seem that we are in an era of increasing restraint

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in relation to the expected workplace conduct of ‘white collar’ professionals. In 2017, the
insurance market Lloyd’s of London banned alcohol consumption during working hours,
following an analysis of grievance and disciplinary procedures which found that many in-
cidents involved alcohol (Addley, 2017). The Lloyd’s drinking ban was widely reported as a
blow to the City of London’s culture of ‘boozy’ business lunches, which was already on the
wane (Ralph, 2017).
In academia, there is also increasing awareness of the negative efects of obligatory and
routinised work-related drinking, especially in relation to equity and inclusiveness. The
blurring of work and leisure has diferential efects and consequences depending on indi-
vidual circumstances. For many, having a few drinks at the end of the day is an enlivening
antidote to the emotional, social and physical demands of conference attendance (Mair &
Frew, 2018). But atmospheres of conviviality and hospitality can obscure the demanding
forms of ‘unpaid work for labour’ that continue at events that are categorised as ‘time-out’.
The assumption that everyone drinks and enjoys alcohol can also act as a barrier to equal
participation.
Conference organisers should be encouraged to think more creatively about how positive
and light-hearted afective atmospheres in collective spaces can be (and are) fostered without
reliance on alcohol. However, rather than making recommendations about conference or-
ganisation, the main aim of this chapter is to contribute to an expansion in understandings
of everyday intoxication and its range of efects, intensities and functions. In particular,
more empirical research is needed on experiences of intoxication in diferent work settings.
As Bancroft and others have argued, psychoactive substances are used in targeted ways to
‘change the self in the world’; they fulfl a range of functions, including increased productiv-
ity and social efcacy (2009, p. 147; Hunt & Frank, 2017). But as well as investigating why
and how individuals seek intoxication, we should also examine the way organisations and
institutions use the shared embodied experience of intoxication to create atmospheres and
produce afective bonds.

Note
1 This chapter was written in 2019, before the global coronavirus pandemic and its impact on ac-
ademic conferences (and on work in general). The rise of the online conference is likely to alter
future conference formats and experiences.

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 12
EXPLORING THE MOTIVATIONS
AND SOCIAL ORGANISATION
OF INTOXICATION IN
PRISON SETTINGS
Torsten Kolind and Karen Duke

Introduction
Within the existing literature on substance use and prisons, the topic of ‘intoxication’ in
prison settings has rarely been explored. For example, how is intoxication diferent in pris-
ons? What are the motivations for intoxication in prisons? How does the prison setting shape
the choice of substance and intoxication? How is intoxication experienced and organised
in prison environments? Is there a relationship between intoxication and pleasure within
prisons?
Based on the existing literature and an application of theoretical perspectives from pe-
nology and drug studies, we aim to explore these questions.1 First, we will investigate pris-
oners’ motivations for drug use and intoxication in prisons, looking especially at the impact
of the ‘pains of imprisonment’ on drug use. Second, the chapter will investigate the role
that drugs play as part of the social organisation of people in prisons. In particular, we will
argue that the prison context difers from outside life in many diferent ways and thereby
determines not only what kind of drug use is possible in prisons, but also how intoxication
is experienced and socially organised. Finally, we discuss the possible relationship between
intoxication and pleasure in a prison context. However, before we look into prisoners’ moti-
vations for drug use and the role drugs play in prison contexts, we will ofer an overview of
prevalence rates of drug use before, during and after prison to set the context for our analysis.
Due to the paucity of research on alcohol use in prison settings, this chapter mainly focuses
on illicit substances.

Prevalence of drug use before, during and afer imprisonment

In 2020, there were 1.5 million people imprisoned in the penal institutions of the Council of
Europe member states, which corresponds to a prison population rate of 103.2 inmates per
100,000 inhabitants (Aebi and Tiago, 2021). The median age of this population is 36 years
and the vast majority (95%) are men. Twenty-two per cent (22%) are not serving a fnal sen-
tence, but are pre-trial detainees. The rest are mainly serving sentences from one to less than
three years (22%), from three to less than fve years (19%) and from fve to less than ten years
(20%). Drug-related crime is an important category of ofence with 18% sentenced European

DOI: 10.4324/9780429058141-16 191

 Torsten Kolind and Karen Duke

prisoners convicted for drug ofences. In several countries, including Turkey, Estonia, Geor-
gia, Cyprus, Albania, Azerbaijan and Greece, prisoners sentenced for drug ofences represent
more than one quarter of the prison population (Aebi and Tiago, 2021).
Prison populations are overrepresented by people who have been adversely afected by
deprivation, trauma, poor physical and mental health, unemployment, low education levels
and homelessness (de Andrade, 2018; EMCDDA, 2012). People in prison are much more
likely to have used drugs, to use drugs on a regular basis and to have problems with drug use
than people in the community and they are also more likely to have an alcohol use disorder
(Fazel et al., 2017). Due to the disadvantages and deprivation that they have experienced,
people in prison sufer from a number of complex health and social care needs. Their needs
are further exacerbated by overcrowding, insanitary conditions and inadequate healthcare in
some European prisons (Aebi and Tiago, 2021; EMCDDA, 2012; Sturup-Toft et al., 2018;
WHO, 2014).
In general, there is a lack of data on the prevalence of substance use before, during and
after imprisonment in Europe. Van de Baan et al.’s (2021) review of studies on the prevalence
of illicit drug use prior to imprisonment in European countries found high rates of lifetime
prevalence before imprisonment (60.6% pooled average estimate); last year prevalence (57.4%
pooled average estimate) and last six month prevalence (43.3%). The highest rates of use were
reported for cannabis, cocaine and amphetamines and to a lesser extent heroin and other
drugs. Prevalence prior to imprisonment was particularly high among women in prison. In
relation to injecting drug use before imprisonment, lifetime prevalence rates are higher in
prison populations than the general population in most countries (Azbel and Altice, 2018).
Higher rates of alcohol use and dependence are also observed in justice-involved populations
across the globe (Seal et al., 2018).
Available data on substance use in prison has substantial heterogeneity in the methods
of assessment both within and between countries, which hinder comparability (Carpentier
et al., 2018; EMCDDA, 2012; 2021). A comprehensive review of 59 studies across the globe
conducted by Carpentier et al. (2018) reveals high levels of drug consumption within prisons.
The proportion of people having ever used an illicit drug in prison lies between 20% and
45% in most studies and cannabis was the drug used most frequently, followed by cocaine,
heroin and amphetamines. The review found that those reporting having used an illicit
drug in prison in the past year represent 2–67% of the surveyed prison population. Those
using drugs in the past month in prison ranged from 0.7% to 65%. Regular use on a daily
basis in prison was around 10% in the few European studies measuring frequency of use in
prison. People who report injecting in prison represent around 10% or less of the prison
population (Carpentier et al., 2018). Milloy’s international review of retrospective surveys of
once-incarcerated drug users in community settings revealed a substantial proportion of in-
dividuals report injecting while incarcerated and this increased risk factors of BBV transmis-
sion in prison due to increases in the likelihood of syringe sharing and injecting in an unsafe
manner (Milloy, 2018). In relation to alcohol use in prisons, there has been limited research
and wide variability in prevalence rates in the studies that do exist (Carpentier et al., 2018).
There have been very few studies of substance use on release from prison. Larney et al.
(2018) reviewed the research on post-release substance use and found numerous design and
methodological limitations, including sampling problems, low follow-up rates, biased attri-
tion and variations around how substance use on release is measured. However, the available
evidence suggests that many people return very quickly to harmful substance use on release
(Larney et al., 2018). The use of substances may change due to increased access and availabil-
ity of diferent substances. Release from prison can be a risky time due to lower tolerance

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 Exploring the motivations

levels and increased use of substances heightens the risk of overdose and drug-related death
(Farrell and Marsden, 2008). Qualitative research conducted by Lloyd et al. (2017, 2019)
examined the transition from prison to the community for those who had been in treat-
ment in prisons. It showed how the aspirations and goals for their recovery on release which
they had set in prison were quickly abandoned on release due to lack of resettlement sup-
port. At follow-up, few had entirely given up drinking and drug use, a substantial group
had reduced or moderated their drug use and a large group had made few changes to their
pre-imprisonment levels.
Following this overview of drug use before, during and after imprisonment, we will
examine prisoners’ motives for drug use in prisons, their experiences of intoxication and
the social organisation of drug use and drug sale in prison in the remainder of the chapter.

Motivations for drug use: the pains of imprisonment

As Zinberg (1984) powerfully argued, not only the pharmacological properties of a drug and
the psychology of the person who uses drugs, but also the social setting of drug use plays an
important role in determining users’ reasons for engaging in drug use and for the subjective
experiences of intoxication (see also Gossop, 2000). Zinberg’s insight is also highly relevant
for understanding intoxication in prison settings. Often, a person’s choice of drug changes
when they are incarcerated as diferent efects are sought in a prison setting compared to the
outside community (Tompkins and Wright, 2012). In addition, the individual psychology of
the individual can play a central role in the way intoxication is experienced in prisons and
also for the choice of drugs. Their previous experiences with drugs over a life course and
the diferent positive and negative associations (through learning about drugs; Becker, 1953)
with this use play a role for what the individual expects, aims for and experiences (Gossop,
2000). Finally, the prison setting, which in many ways can be framed as a ‘risk environment’2
(Rhodes, 2009; see also Duke and Kolind, 2020; Wilson et al., 2007), infuences individual’s
motives for starting, continuing or discontinuing drug use (Frank et al., 2015). Although
prison settings may difer considerably both between countries and in countries, they can
afect individual’s motives and experiences greatly. In this section, diferent motivations for
drug use in a prison context will be considered. In particular, we will consider the pains of
imprisonment experienced by prisoners.
Not all that takes place within a prison setting can be explained by intra-institutional
processes and infuences. Individuals’ pre-prison lives, their personalities and their social net-
works outside the walls play important roles in how incarceration is experienced (Cohen and
Taylor, 1972; Irwin, 1970; Jacobs, 1983). Nevertheless, research has convincingly showed
that prison environments have some intrinsic characteristics infuencing the experiences of
incarceration. A generic process of institutionalisation takes place (Gofman, 1961), a range
of deprivations are experienced by most people imprisoned (Sykes, 1958; Toch, 1977) and
individuals’ acts of both prisonisation (Clemmer, 1940) and resistance (Mathiesen, 1965) are
often more or less determined by the institutional logic of the prison.
Among the most common prison deprivations documented are loss of liberty, loss of so-
cial relations, loss of personal autonomy due to a heavily controlled setting, loss of privacy,
(fear of ) violence and boredom (Gofman, 1961; Sykes, 1958; Toch, 1977). Moreover, some
deprivations may be culturally specifc as has been documented in the ‘exceptional’ and
‘soft’ Nordic prisons (Shammas, 2014; Ugelvik 2014). Crewe (2011) revisited Sykes’s (1958)
original pains of imprisonment and argues that contemporary penal practices in the UK
have created new deprivations for people in prison, including the pains of uncertainty and

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indeterminacy, pains of psychological assessment and pains of self-government. The pains

of indeterminacy relate to the insecurities stemming from a discretionary and inconsistent
style of governance. For example, those serving indeterminate sentences have uncertainty
about how long they will be inside which creates frustration as they cannot make plans
and experience changing goalposts regarding what is required for their release. The pains
of psychological assessment relate to the increasing emphasis on risk management where
prisoners are placed in aggregate risk categories with little control over the process. In
this case, use of drugs, drug dependence and drug dealing are considered ‘risks’ which
must be managed and controlled within the prison setting through increased security and
surveillance measures to detect and disrupt the supply of drugs, mandatory drug testing
procedures and referrals into drug treatment. Contemporary imprisonment also creates
pains of self-government where prisoners are subjected to more levers of compliance and
regulation. A key example of this is mandatory drug testing which is a tool to deter and
discipline those who take drugs in prisons. Those prisoners who come up positive on a
mandatory drug test are sanctioned with penalties and this process was designed to act as
a deterrent to drug use (see also Kolind et al., 2013). Crewe (2011: 524) concludes that
penal power in the UK prisons is exercised more softly and the ‘carceral experience is less
directly oppressive, but more gripping – lighter but tighter’. The experience of a tighter
prison may have a number of unintended consequences whereby those who have problems
with drug use are reluctant to seek treatment and drug-related harms are increased due to
fears of increased surveillance and punishments. For example, those who inject drugs may
do so in an unsafe manner or there may be a reluctance to seek help for suspected overdoses
due to fear of additional sanctions.
Looking at individuals’ (strategic) practices of intoxication in prisons, these can then to
a certain extent be explained by or related to these deprivations experienced as a result of
incarceration. That is, prison drug use can be understood as the individual’s way of coping
with the emotional stress of being in prison (Keene, 1997). In fact, one can see illegal drug
use as a way of self-medicating (Bullock, 2003; Crewe 2005; Mjåland, 2016; Ritter et al.,
2013). In this way, drugs, which in outside settings may be used and experienced as pleasur-
able intoxicants, can in prison ontologically change into a substitute medicine (Kolind et al.,
2016). Prisons, then, can be seen as risky environments encouraging individuals to use drugs
or take up drug use after being incarcerated (Boys et al., 2002; Swann and James, 1998).
Again, the individuals’ pre-prison lives, their pre-prison pattern of drug use and their psy-
chology also play a part in explaining prison drug use (Strang et al., 2006), as does research
which shows that a history of drug dependence is likely to increase the risk of being impris-
oned (Liebling, 1999; Stöver and Michels, 2010). As Wheatley precisely sums up: ‘Inmates’
outside vulnerabilities such as drug and alcohol misuse, psychosocial problems, and poor
coping skills combined with a detrimental prison environment can promote drug misuse in
prisons’ (Wheatley, 2007: 403).
As an example of individuals’ strategic use of intoxication in prison as self-medication
in a high-risk environment, we see how they use drugs to manage and even manipulate
time. In order to counter the feeling that time in prisons is void of content and meaning,
Cope (2003) found that drugs were used deliberately in order to manipulate time. By using
sedating drugs, especially cannabis, the feelings and illusions were created that prison time
goes faster. More correctly, perhaps, intoxication was intentionally sought in order to create
a kind of time vacuum for the individuals so that their lives and identities outside prisons
were not infuenced and contaminated by time inside, as time inside was associated with a
degraded self-identity and meaninglessness. Intoxication, in this way, helped them to create

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an illusion of life that is not their real identity. This also relates to Toch’s central insight about
the experience of being incarcerated:

What appears to be totally unacceptable is the idea that one´s life is experienced in
prison. One may be serving life, but one is not serving ‘my life’.
(1972: 93)

Since 2015, there has been growing concern about the use of NPS (new psychoactive sub-
stances) in European prisons, particularly around the increasing use of synthetic cannabinoid
receptor agonists (SCRAs) in some countries (Duke, 2020; EMCDDA, 2018; 2021; Grace
et al., 2020; Ralphs et al., 2017). For example, 30% of prisoners reported last month use of
SCRAs (known as ‘Spice’ or ‘Mamba’) in some UK prisons (User Voice, 2016). Accordingly,
SCRA use has grown popular in prisons because it, like cannabis, can help in escaping the
realities and boredom of prison life and they are often used for self-medication for men-
tal health problems or due to lack of prescribed medication (Blackman and Bradley, 2017;
Grace, Lloyd et al., 2020; Reuter and Pardo, 2017). Moreover, its popularity also relates to
the fact that the use of SCRAs was not initially picked up by urine testing regimes or by
snifer dogs, it does not smell like normal cannabis and is therefore more difcult to detect,
they are perceived to be legal substances and, fnally, they are easy to smuggle into prisons
(for instance, it can be impregnated on to clothes or on a letter and then later dissolved by
the use of acetone) (EMCDDA, 2018). In sum, these features contribute to making SCRAs
a ‘perfect’ ‘prison drug’. Grace and colleagues (2020) found that fewer of their respondents
used SCRAs before custody or after release; hence, synthetic cannabinoids serve specifc
prison-related functions that might not necessarily relate to life in the community.
In the same way, some prisoners may strategically switch from cannabis to heroin while
imprisoned as heroin is less detectable than cannabis in mandatory urine testing (Singleton
et al., 2005, 2008; Stöver and Kastelic, 2014). Studies have also argued that the reasons for
seeking intoxication change in prison context. That is, the pharmacological properties of
the individual drug interact with the prison setting so that prisoners when incarcerated, for
instance, often prefer drugs with calming and sedative efects compared to stimulants (Bull-
ock, 2003; Ritter et al., 2013). Hence, drugs like cannabis, heroin and, recently, SCRAs are
more popular than stimulants like, for instance, amphetamine and cocaine (Boys et al., 2002;
Tompkins and Wright, 2012). In fact, in some European countries, the estimated level of
cannabis use among inmates is relatively high and, moreover, is clearly a part of the daily life
in prisons as it helps to relieve stress, facilitate sleep, prevent violence (i.e. social pacifer) and,
ultimately, to relieve imprisonment (Keene, 1997; Kolind, 2015; Ritter et al., 2013). In addi-
tion, as cannabis use tends to help keep people calm and quiet, upholding institutional order
is made easier for prison ofcers, and, hence, ofcers may turn a blind eye to inmates’ canna-
bis use (Carlin, 2005; Duke, 2003; Kolind, 2015; Ritter et al., 2013). It should also be noted
that price and availability can also be important considerations in the choice of substances in
prison settings, rather than personal preferences (EMCDDA, 2018). Moreover, the level and
efectiveness of drugs control shape the availability of diferent types of substances in prison.
The prison environment – the setting – then, plays a central role in making some drugs and
some kinds of intoxication popular inside the walls. Hence, prison can, in a broader sense, be
seen as merely another context in which people develop their drug problems (Keene, 1997;
see also Gillespie, 2005: 226).
Although the prison setting can cause individuals to start using drugs, increase their drug
use or adjust their choice of drugs while incarcerated, some people will also cease to use

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drugs during imprisonment (Bullock, 2003; Dillon, 2001; Stöver et al., 2008; Swann and
James, 1998; Turnbull et al., 2000). For some individuals, the time inside is a welcome relief
from the drugs scene on the outside. The period of imprisonment may be restorative and sta-
bilising in the sense that their physical and mental health can improve and social relationships
can be repaired (Crewe, 2005). In addition, Tompkins (2013) reported how prisoners’ cessa-
tion of injecting drugs when in prisons was multi-factorial and infuenced by, for instance,
limited availability of sterile needles and equipment, a concern with one’s reputation, and
the idea that prison could be used as ‘an opportunity’ for discontinuation. Moreover, a prison
sentence can present an opportunity for assessment, referral and treatment of substance use
problems. Individuals may then start drug treatment programmes inside prisons because they
want to discontinue their drug use. However, their motives may also be more pragmatic. For
instance, individuals may ‘escape’ to drug treatment wings because they are experienced as
less violent and safer than regular wings, they may be seen as ofering better terms of incar-
ceration, or starting in drug treatment while incarcerated may look good in one’s ‘papers’
for parole (Frank et al., 2015). Nevertheless, even if individuals manage to terminate their
drug use while imprisoned, after release they may resume drug use as drugs can be key com-
ponents of people’s social lives and connected with sociability, pleasure and celebration. For
instance, Lloyd et al. (2017) found that for those who did not identify as alcohol dependent,
alcohol consumption was part of post-release celebrations and part of their social lives. Sim-
ilarly, for some prisoners, cannabis played important functions in their post-release lives in
terms of regulating emotions and a key activity in their social networks (Ibid).

Social organisation and drugs: the prisoner society

Intoxication in prisons then is heavily related to the risk environment and the pains of im-
prisonment produced by prisons. As part of the risk environment is also the so-called ‘pris-
oner society’. This section will focus on how intoxication relates to the prisoner society and
the values and codes produced by this community. Stated otherwise, the section overviews
the role drugs play as part of the social organisation of the prisoners.
Several older classic prison ethnographies found that people in prison tended to produce
some common moral values and a culture of its own related to their common experiences
of imprisonment and deprivation. These moral values informed and steered the conduct of
those in prison by emphasising, among other things, honesty, autonomy, solidarity and op-
positional attitudes to the prison ofcers – the so-called ‘inmate culture’ (see e.g. Clemmer,
1940; Irwin and Cressey, 1962). With the increase of drugs in prisons, studies, especially
from the US, documented an erosion of these moral values and the inmate culture. Instead,
the importance of oppositional prison gangs grew, gangs that were linked with subcultures
outside the prison. Hence, the culture and organisation of prison and street life became in-
extricably intertwined (Hunt et al., 1993; Trammell, 2009; see also Slade and Azbel, 2020:
3). Moreover, as Skarbek (2014) has demonstrated, in prisons where the ofcial governance
is weak, gangs tend to develop prisoner-led systems of governance often with clear links to
the outside criminal world.
Similarly, recent studies from the UK have illustrated how the increase of drugs in prisons
has afected and eroded the prisoner’s society (Crewe, 2005, 2006). Moreover, partly due
to the strengthening of prison drug policy measures, increasingly framing drug problems
as crime problems and installing a zero-tolerance policy (Duke, 2003; Duke and Kolind,
2019), a proftable prison drug economy has been created. Although a strict sanctioning
prison drug policy does not in itself create the drug markets in prisons, people in prison react

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strategically to and may exploit such policy initiatives for their own beneft (Bögelein and
Meier, 2018). In consequence, some individuals gain economically by engaging with drug
selling and smuggling in a highly controlled environment. Importantly however, not only
do they proft economically, they also exploit the drug situation in prisons to create presti-
gious social identities as drug selling is becoming increasingly bound up with masculinity,
self-identity, emotions and internal hierarchies (Crewe, 2005, 2006). Crewe’s study on drug
dealing in the UK prisons shows that although the fnancial power of drugs is important,
drug dealing in prisons must be understood as more than simply an economic activity. Drug
dealing can enhance the dealers’ status and symbolic capital, for instance, by being able to
bring drugs into prisons, making connections to outside drug and criminal networks, and
displaying courage. Moreover, engaging in the prison drug economy can add to the feeling
among inmates that they are part of a larger social group. Finally, drug dealing is, as depicted
in the study by Crewe, and contrary to the US studies cited above, for everyone regardless of
prior status (e.g. gang afliation) as long as they can gain access to drugs. As Slade and Azbel
(2020: 3) sum up the situation in the UK prisons: ‘…drugs acted as a social equalizer’. This
is not to say that these drug markets were not violent and threatening. As Tompkins found
in her study (2016), also from the UK, some people who were not traditionally involved in
the drug market reacted to the prison environment and their present situation by (slowly)
drifting into drug selling or drug supply seeing this as an opportunity within the prison.
Besides being linked to individual entrepreneurship, intoxication and drug selling can
also carry subversive meanings for those in a highly controlled and stigmatised environment
(Mjåland, 2016). That is, intoxication or drug selling by those imprisoned can be reinter-
preted as symbolic acts of resistance towards a highly controlling system. In this way, we see
how intoxication in prisons once again derives meaning from the prison context in which
it takes place.
Even though the drug economy in the UK is not completely enmeshed in gang or ethni-
cally based networks linked to outside social groups, as indicated in the above studies, drug
use and drug selling – and even drug abstinence – can in prisons still be strongly linked to
ethnicity. A study from Denmark shows how on a daily basis people in prison reinforce
and essentialise ethnic diferences by, for instance, linking a prestigious hyper-masculinity
and an entrepreneurial approach related to drug selling in prisons to ethnicity (Haller and
Kolind, 2018).
Summing up so far, alongside the increasing importance of the drug economy in prisons,
we see an increasingly fragmented prison where the role of common prisoner values has
diminished and where individual drug enterprises based on ad hoc (ethnic) social groupings
dominate. Such development is also documented in Germany (Bögelein and Meier, 2018),
and in several post-Soviet countries in which the drug economy has led to a commercialisa-
tion of prison social life and has disrupted existing traditional prisoner hierarchies and values
(Slade and Azbel, 2020: 3–4).
However, the efect of drug use and drug selling should not be seen as only disrupting the
prisoner society. Intoxication and the drug economy in prison are not only related to individual
identity or to selfsh proft-seeking behaviour, nor to resistance. Intoxication and drug selling
can also be linked to communitarianism, solidarity and can at times produce stable social
systems. This is demonstrated in a study from Kyrgyzstan prisons in which Slade and Azbel
(2020) document how heroin was distributed through mutual aid funds according to need,
work and social status within the prisoner society. The aid funds were managed by the ‘highest
caste’ of prisoners (in budgetary units, a legacy of the Gulag) and built on a traditional thieves
fund using a ritualised form of distribution of heroin in which pay-outs (heroin) from this fund

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were not necessarily commensurate to the amount paid in. In this way, the authors conclude,
distribution, sale and use of heroin were not primarily governed by the logic of the market,
but more by a logic of redistribution (ibid. 9). Moreover, the prisoner hierarchy was able to ban
drug dealing and to establish gangs based on ethnicity or geographic origin. As a consequence
of the importance, dominance and working of this system of redistribution, those in treatment
also rejected formal methadone treatment as they preferred the heroin handouts of the prisoner
society. That is, they opted for the socially embodied positions of power and agency which
heroin distribution represented (Rhodes et al., 2019).
Similarly, in a study from Norway, Mjåland (2014) fnds the existence of a ‘culture of
sharing’ in prisons in which doses of buprenorphine (i.e. opioid substitution treatment) was
illegally shared in a ‘gift economy’ built on reciprocity (cf. Mauss, 1990) rather than through
a market logic. In this way, drug use and drug sharing in prisons contributed to build-
ing and maintaining friendships and relationships (Mjåland, 2016; see also Sandøy, 2015).
Moreover, Mjåland’s study documents how the prisoner society was efective in creating
intra-institutional codes and moral values. It should be noted that the culture of sharing
was backed up by system of sanctions such as humiliations, exclusion or, at times, violence.
Although the ‘culture of sharing’ was built on values like compassion and solidarity, the gift
economy still allowed for self-interest. That is, the more one gives away, the more drugs
one can expect in return and the more often one can expect to get intoxicated. Finally, it
should be noted that despite the functioning of such extra-legal systems of governance and
that these prisoner societies are not built on the logic of the market, they can still be highly
violent and brutal (see e.g. Symkovych, 2018).

Discussion – and the role of pleasure?

As Vasilou (2020) has pointed out, research has neglected any examination of pleasure in
prison to avoid the risk of romanticising punishment. This is also the case for research on
drug use in prisons. Most research depicts the prison as a site of pain, hardship and struggle
and highlights how imprisonment exacerbates physical and mental health problems, includ-
ing drug use, self-harm and suicide. Drug use in prison is problematised as a response to the
pains of imprisonment, a means to escape the brutal reality of the prison space, a mechanism
to suspend time and a part of the social organisation of people in prison. However, could
those imprisoned derive pleasure from the use of drugs and involvement in the drugs mar-
ket? Could drugs in prison acquire diferent meanings? Drawing on queer theory, Vasilou
(2020) argues that prison life may produce feelings of pleasure. In relation to drugs, strate-
gies of resistance can take the form of pleasure. For example, Crewe’s study of drug dealing
points to the excitement and pleasure of drug dealing as a form of resistance. The enormous
difculties getting illicit drugs into prison mean that pleasure and satisfaction are derived
from obtaining something which is banned and getting around the measures to detect and
intercept drugs put in place by the authorities in prison (see also Mjåland, 2016). Being in-
volved in this game of ‘cat and mouse’ provides excitement and thrills helping to pass the
time and boredom of the sentence. Moreover, the ability to sell and trade drugs in prison
brings material benefts and pleasures to those in position of power in the prison hierarchy
(Crewe, 2006). Furthermore, if one compares the motivations ofered by individuals for en-
gaging in intoxication while imprisoned, some of these motives may resemble those that, for
instance, club goers highlight when accounting for their drug use. Hunt (2008) found that
club goers narrated their ecstasy use in relation to the drug’s ability to change the ordinary
and mundane into something that was extraordinary. In this way, part of the pleasure in

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taking drugs derived from its ability to ‘break the routine’ of life, remove the ecstasy user
from normal times and spaces and transform mundane activities and interactions into ones
that were deeply pleasurable, satisfying and exciting. Even though there are many important
diferences in the lives of club goers and prisoners, as well as in their motivations for drug
use, we also fnd similarities in their desire for escaping the everyday and ‘normal’, and the
mundane routines of their lives (Cohen and Taylor, 1976).
Finally, when discussing the possible aspects of pleasure related to drug use in prison, it
is relevant to notice that with the exception of a few qualitative studies (Lloyd et al., 2017,
2019), there has been little in-depth exploration of the motivations and meanings for use prior
to imprisonment and after imprisonment. For example, we do not know if people are using
drugs mainly for recreational or pleasurable purposes or in more problematic ways before
they are imprisoned. We know that they often switch to more sedating drugs like cannabis
and heroin in prison, but on the outside, we have little information about if they were using
drugs to mainly enhance pleasure and recreational experiences in clubs or pubs, for example,
or if they were using drugs due to dependence and/or wanting to escape from their lives.
Similarly, there is a paucity of research on the ways in which substance use changes on release
from prison and the motivations and meanings given for use. In general, there is a clear need
for more qualitative research on individuals’ trajectories of substance use over time, in difer-
ent places and institutions, and throughout the life course. For people who are imprisoned,
we especially need more examination of the key phases of drug use before prison, during im-
prisonment and after release and the meanings and motivations given to use (for inspiration
on addiction trajectories, see Raikhel and Garriott, 2013). Not only could such knowledge
aid our theoretical understandings of, for instance, the relation between diferent kinds of
drug use and prisoners lives inside/outside prisons. It could also help addressing more ho-
listically the diferent problems experienced by prisoners who use drugs and the help they
might need in diferent phases of their lives and across institutional contexts. Demographic
diferences relating to age, gender, sexuality, ethnicity, religion and other variables such as
employment, housing and recovery capital (i.e. social networks and family support) also need
to be explored in greater depth.

Notes
1 The chapter is based on both authors’ long-term engagement with prison studies and drug re-
search. While we do not claim to have included all existing literature on the subject, we do believe
that the literature referred to covers the most relevant topics within the feld of prison and drug
research to address the key questions set out in this chapter.
2 The term ‘risk environment’ focuses on the drug harms produced by social and political institu-
tions in the interaction with the individual. In this way, the responsibility for drug harms is shifted
from the individual alone to also include the social context (Rhodes, 2009).

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 13
HOW METHADONE BECOMES
AN INTOXICANT
Te making of methadone within prisons
in the Kyrgyz Republic

Lyu Azbel and Frederick L. Altice

Introduction
Methadone maintenance treatment—prolonged treatment with an opioid agonist—is pro-
moted within evidence-based research as an efective way to treat patients diagnosed with
opioid use disorder and prevent the transmission of blood-borne infections such as hepatitis
C and HIV among people who inject drugs (MacArthur et al., 2012, Platt et al., 2017). Peo-
ple who inject drugs in prison, and who are infected with HIV or Hepatitis C, may transmit
these infections to others by sharing non-sterile injection equipment. But transmission can
be prevented with the increased uptake of needle and syringe programs and opioid agonist
treatment in the community as well as in prisons and after release and hence decreased in-
jection (Altice, 2015).
The promotion of opioid agonist treatment has been the primary policy adopted by in-
ternational health agencies, such as the World Health Organization, to combat the twin
epidemics of addiction and associated HIV concentrated in prisons (World Health Orga-
nization, 2012). Methadone treatment within prisons, similar to community settings, has
been evidenced to have the potential to treat addiction and prevent HIV and hepatitis C
transmission (Boucher, 2003). The implementation of methadone treatment is therefore part
and parcel of the worldwide response to HIV. Randomized controlled trials from prisons
evidence the efectiveness of methadone treatment in reducing opioid injection, especially
when initiated before release from prison (Kinlock et al., 2009, 2007).
Methadone’s global promise hinges on sufcient coverage among people who inject opi-
oids to signifcantly reduce HIV transmission on a population level (Larney et al., 2017). Yet,
methadone treatment is unavailable in most prison systems worldwide due to its political
unpopularity; when available, coverage among prisoners who use opioids is low (Altice et al.,
2016, LaMonaca et al., 2019).
From the time the Kyrgyz government introduced methadone treatment into prisons
with the support of international donors in 2008, the program has retained few patients and
remained largely unpopular (Azbel et al., 2016a, 2016b, 2018). Nationally, following initial
growth in methadone treatment uptake, the number of methadone patients has remained
stable over the past fve years (This amounts to 476 people in 6 of 11 prisons) (Borisova,

DOI: 10.4324/9780429058141-17 203

 Lyu Azbel and Frederick L. Altice

2018). To reach the standards of coverage the World Health Organization deems necessary to
signifcantly reduce the number of new HIV infections, 1,224 prisoners in Kyrgyz Republic
would have to receive methadone (Azbel, 2020).
Given the challenge that implementation of methadone treatment into prisons presents,
the unique availability of methadone treatment in prisons in the Kyrgyz Republic (hereafter
Kyrgyzstan) presents an important case study. The methadone treatment program, launched
in the community in 2002 and in prisons in 2008, marks an exception in the region—
making Kyrgyzstan the only country in Central Asia and one of a handful in the world to
ofer methadone treatment in prisons (Bielen et al., 2018). This policy move is celebrated
within global health networks, which highlight Kyrgyzstan as yielding particular promise
in implementing evidence-based interventions (Ancker and Rechel, 2015, Latypov, 2011).
Despite championing methadone treatment in Kyrgyzstan as an outstanding achievement,
researchers and international policymakers are concerned that performance indicators (e.g.
coverage) are not being met by local implementers (Larney et al., 2017).
Studies of drug use and addiction treatment among prisoners in Eastern Europe and Cen-
tral Asia have been dominated by quantitative analyses (Altice et al, 2016, Azbel et al., 2016a,
2016b). Qualitative studies addressing methadone implementation in Eastern Europe and
Central Asia are sparse, mostly adapting an evidence-based medicine framework, and none
have been carried out in prisons (Bojko et al., 2016, Marcus et al., 2018, Mazhnaya et al.,
2016). While qualitative studies addressing methadone implementation in Eastern Europe
and Central Asia are sparse, mostly adapting an evidence-based medicine framework, none
have been conducted in prisons (Bojko et al., 2016, Marcus et al., 2018, Mazhnaya et al.,
2016). And where studies have been done in prisons, for example, studying implementation
with prisoners in Moldova (Polonsky, Azbel, et al., 2016a, 2016b) and with both prisoners
(Polonsky, Rozanova, et al., 2016) and prison personnel (Polonsky et al., 2015) in Ukraine,
none have been qualitative nor focused on Central Asia.
In this chapter, we adopt a critical social science approach which looks to the ontology
of objects in translation to illustrate their diferent efects in diferent times and places. This
approach moves beyond the evidence-based framework, to open up space for a critical anal-
ysis of how medical technologies travel (i.e., adoption), here with methadone treatment as an
example, without taking for granted that the evidencing of intervention is fxed and trans-
portable to the same efect potential across contexts (Rhodes and Abdool, 2016). To under-
stand drug efects, researchers within this tradition move away from studying substances as
self-evident objects with inherent properties whose representations are afected by discourse.
Rather, they emphasize the way that material, social, cultural, and discursive elements—
such as the instruments used to administer drugs and the processes of drug administration—
come together to produce substances and their efects (Dennis, 2016, Duf, 2013, Keane, 2018,
Lancaster et al., 2017, Moore, 2018).
Studies in this tradition have examined diferent ways that intoxicants have been evi-
denced, and why they can produce unexpected efects. Research has lent scrutiny to the way
drug-objects and -subjects are constituted by—rather than pre-exist—the way that we, as
researchers and policymakers, intervene to address drug problems (Bacchi, 2017, Lancaster
et al., 2017). In her seminal study of the object of methadone within clinical trials, Gomart
provides an account of how diferent methadones are produced through the inscriptions
of these trials (Gomart, 2002). Through the processes of two diferent clinical trials, the
same apparent substance produces fundamentally diferent material efects. She observes that
methadone is a series of “efects in search of a substance” (Gomart, 2002). The performance
of a substance does not precede but is made through its implementation events. Also Rhodes’

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studies of methadone in Kenya draw attention to how the methadone-in-practice, a metha-

done of recovery hope, is distinct from the methadone-in-policy (Rhodes, 2018), a solution
to HIV-linked drug injection. This methadone is evidenced as enabling normalcy through
its dynamics of delivery, including the witnessing of bodily material change among its users
toward a recovered-body. Rhodes concludes, “Methadone treatment is far from a singular
evidence-based intervention translated into multiple settings, but a local practice of emer-
gent ‘evidence-making’ interventions” (Rhodes, 2018). Other social studies of methadone
have also brought methadone objects into view that are diferent from those traditionally ev-
idenced in literature: methadones of pain relief (Keane, 2013), addiction recovery (Berridge,
2012), and, in Ukraine, a means of disciplining the subject (Carroll, 2016).
We begin to see that we cannot take the efects of a substance for granted. Given difer-
ent practices surrounding the implementation of medical interventions, the efects on the
body can vary widely. This lens opens up new avenues of questioning that are productive for
illuminating a methadone with diferent efect potential from the one evidenced in public
health research. Indeed, the evidencing of methadone in the biomedical sciences has been
characterized by a move to tease it apart from illicit opioids as a way of drawing out the ther-
apeutic qualities of the former (Acker, 2004). Such discourses commonly draw a distinction
between a drug of addiction, characterized by compulsive use, and a treatment, charac-
terized by stabilizing efects (Keane, 2013). In this chapter, we analyze methadone’s prac-
tices of use to bring a diferent methadone into view. While medical literature and clinical
guidelines work to separate methadone from illicit drugs, we will show how its practices of
use in Kyrgyz prisons produce methadone as a compulsive drug of addiction, while heroin,
administered by prisoners in line with practices of harm reduction, produces health.

Teoretical approach
To understand why methadone treatment administered in Kyrgyz prisons sufers from low
uptake, we, in the tradition of the aforementioned studies, do not take a singular metha-
done for granted (in this case, the methadone of public health: a treatment for the chronic
and relapsing brain disease of addiction). Rather, we allow ourselves to consider that other
methadones with difering efects may be present in Kyrgyz prisons, methadones which are
not separate from but made within the practices of implementation. To do this, we look at
methadone as an efect of the practices of its use.
To carry out this analysis, we turn to an analytical tool within critical drug studies—
actor-network theory (Deleuze and Guattari, 1987, Latour, 2005). This tool is conceptually
useful for understanding the way that objects we assume are stable are actually multiple, or, in
other words, producing diferent efects in diferent places and times. This multiplicity can
be referred to as multiple “objectivizations.” As Paul Veyne (1997, cited in Bacchi and Good-
win, 2016) writes, “there are no natural objects…there are only multiple ‘objectivizations.’”
Accordingly, in this chapter, we discuss multiple methadone objects—the umbrella term—
which can take the form of a methadone treatment or a methadone drug. Actor-network
theory is therefore particularly well-suited for attending to how substances, including those
unexpected, come about. It rests on the supposition that new objects, including intoxicants,
are made through a multitude of relations, including the relations between humans, animals,
things, and matter, which are in and of themselves never stable but shifting (Bennett, 2010).
Actor takes the practices of implementation as the unit of analysis to observe what kinds
of objects emerge from implementation events. This can involve any practice of imple-
mentation, including the space where methadone is implemented, what tools are used to

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administer it, the way that users talk about its efects, or merely the act of observing bodies
that have imbibed methadone. For example, in their study of the daily experience of ac-
cessing methadone treatment in Australia, Fraser and valentine (2008) draw attention to the
human and non-human actors that constitute the methadone subject. They redirect inquiry,
rather, to the relations and practices that make objects and subjects. They argue that relations
between human and non-human actors work to materialize a particular kind of subject. In
their example, the arrangement of the methadone dosing site, which necessitates the line of
clients to wait outside of it, creates a “methadone client” who is most commonly “considered
undesirable in modern liberal societies” (Fraser and valentine, 2008: 92).
Important here is that attention is drawn not to attitudes about a substance or other such
human behaviors but, also, the non-human elements such as the material spaces where med-
icines are administered. Indeed, actor-network theory focuses our attention to how human
and non-human actors come together diferently at diferent times to produce diferent in-
terventions (DeLanda, 2006, Deleuze and Guattari, 1987, Latour, 2005, Law and Hassard,
1999). In our feldwork in Kyrgyz prisons where our research team was tackling the chal-
lenges to methadone implementation from a biomedical perspective, we began to notice that
something else was at play, beyond the methadone profered in evidence-based research. We
repeatedly came up against the way that methadone was used diferently than prescribed,
particularly alongside other substances. Methadone’s relations with other substances made it
something diferent than the “evidence-based” methadone we expected (i.e., how metha-
done’s unexpected efects were a product of its use alongside some substances as well as its
non-use with other substances).

Methods
In what follows, we utilize actor-network theory to ask, what kind of methadone object is
produced through the relations of diferent drugs within the Kyrgyz prison environment? To
do this, we draw on qualitative data from two studies supported by the U.S. National Insti-
tute on Drug Abuse, which explored how prison environments shape opioid addiction treat-
ment. Interviews were conducted after written consent from October 2016 to September
2018 with prisoners who inject drugs before (n = 24) and after (n = 20) release from prison
in two male high-security prisons in Kyrgyzstan. Our team at the Yale University School
of Medicine had been carrying out qualitative and quantitative studies in Kyrgyz prisons for
fve years and had developed a relationship with the Prison Department that allowed us ac-
cess to potential participants within prison. The Prison Department provided us with a list of
all prisoners with a release date within six months so that we could follow up with prisoners
after release in case we had further questions. Initially, we chose randomly from the list and
a representative from the prison administration called the participants on the loudspeaker in
the prison yard (this is a common practice in the prison and the times when the speaker is of
are less common than when it is on). Participant recruitment into the study, or “sampling,”1
for this study was purposive (Corbin & Strauss, 1998), with attention to diverse incarceration
experience, age, status within the prisoner hierarchy, drug treatment history, and ethnicity.
We met privately with potential participants, described the purpose of the study, empha-
sized that our work was unrelated to that of the prison administration, that interviews were
voluntary and anonymous, and informed potential participants that they would face no con-
sequences for non-participation. Participants interested in the study received an information
sheet about the study and the consent form, requiring a signature. We asked participants
to read the information sheet and inform us if they were interested in participating. If they

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agreed to take part, they signed the consent form. Interviews were recorded using an Olym-
pus digital voice recorder and lasted 58 minutes on average. The interviews were in-depth
and followed the lead of the participant to discuss issues such as drug use, health, prisoner
society, and practices of methadone and drug administration. After completion, participants
were reimbursed for their time with a package of hygienic goods (containing toothpaste,
soap, shampoo, etc.), totaling eight dollars, commensurate with other studies in public health
carried out by non-governmental organizations in Kyrgyzstan. They were also provided
with a list of organizations working with released prisoners in need of housing, medical ser-
vices, and bureaucratic services such as passport and housing registration.
Interviews were redacted to remove any potential identifying information and stored on a
secure server (Yale File Transfer), transcribed and translated by an agency in Kyiv, Ukraine.
Using Dedoose (SocioCultural Research Consultants, 2018), the research team (three peo-
ple) coded 22 interviews (all of which the frst author reviewed), and the frst author coded
the remaining 61 interviews to shape the analytic frame that “generates the bones” of our
analysis (Charmaz, 2006: 46). The frst author, who speaks Russian fuently, opted for cod-
ing the Russian language transcripts to stay closer to the original.
The data generation, coding, and analyses were simultaneous processes throughout the course
of the study that were driven by a focus on material practices. That is, rather than focusing on the
symbolic value of human behavior in constructing the meaning of methadone, we instead drew
the interviewing and analysis deeper into the minutiae of the relations between the body, intox-
icants, and methods of drug administration. We were interested in how material relationships
with and within the prison space were formed (Alaimo and Hekman, 2008). The material re-
lationships we were particularly interested in included the bodily practices surrounding heroin
and methadone distribution as well as governing rituals, such as how methadone and heroin
are distributed among prisoners, including the utensils used and the location of the paths in the
prison yard that lead to the distribution points. In the interviews, the frst author questioned the
“pervasive and mundane acts” (Mol, 2002: 39) of everyday life, including which path prisoners
followed through the prison yard to obtain methadone and heroin, how methadone and heroin
were administered, what it looked like when punishments or rewards were meted out, how their
bodies felt and looked after taking the substances, among others.
To code the interview transcripts, L.A. carried out a “Poststructural Interview Analysis”
(Bonham et al., 2015). Drawing on Foucauldian concepts of governmentality (Foucault,
1991), this methodology is useful for considering the production of subjects and objects
through practices. The relations between things in interview texts are treated as practices
with governing potential. Take, for example, the relations between the length of a sub-
stance’s withdrawal symptoms, the mode of its administration, the high (i.e., euphoria), and
the punitive consequences of its use. These elements in an interview text interact (i.e., the
longer the withdrawal symptoms, the stronger the punitive response) to make a substance
into a particular kind of substance. In this case: an illicit drug. Following this approach, we
were not interested in arriving at a participant’s access to an “inner truth” about their inten-
tions or experiences with drugs. We were, rather, interested in the politics of what is said,
meaning, how things said establish normative ways to be. This is because, in paying attention
to what is said, rather than the intentions of the speaker, we can start to unpack what under-
standings were in place to make those things sayable. For example, “madness” emerged as an
object of thought in accordance with what criteria the authorities used to defne it (Bacchi
and Goodwin, 2016: 33). Accordingly, the frst author used the coding framework as a form
of analysis to map the entangled web of relations that set limits on the kinds of methadones
and methadone subjects were possible in the Kyrgyz prison.

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With a view of what “things said” do, the frst author traced how normative implica-
tions of what participants said generated ways to be. Put diferently, this form of analysis
treats “things said” as productive since it is through the relations within discursive prac-
tices that subjects and objects are continually formed (Bacchi and Goodwin, 2016: 118). As
Bacchi and Goodwin emphasize, “hence, they [discursive practices] need to be studied in
terms of what they produce, or constitute, rather than in terms of what they ‘mean’” (Bac-
chi and Goodwin, 2016: 118). The frst author examined the efects of the way that pris-
oners talked about the use of intoxicants in their communal drug use rituals. Rather than
treating their words as “attitudes” toward drugs that generate meaning, we looked at what
was said in terms of how it afected what objects can be and do. The frst author coded for
objects and subjects that fell within the confnes of prisoners’ communal property versus
objects and subjects that fell outside of it. For example, methadone was excluded from pris-
oners’ communal distribution practices whereas heroin was included. L.A. coded for the
normative assumptions that made what was said “sayable” (Foucault, 1991: 59). In other
words, “what meanings need to be in place for particular ‘things said’ to be intelligible”
(Bacchi and Goodwin, 2016: 117)? The normative assumption here was that the materials
owned and distributed collectively by prisoners to prisoners confer health. The subject
position that emerged was clear: the physically ft prisoner was someone who received
heroin treatment while the ailing prisoner took methadone. In this way, “Poststructural
Interview Analysis” allowed me to harness “what is said” to examine the processes through
which heroin and methadone are diferentiated.

Analysis
Leveraging science and technology studies into how medical technologies are produced
through local practices (Mol, 2002), we will in the following analysis describe how metha-
done is inextricably tangled up with local drug use practices. We will show how the meth-
adone produced within local practices of the Kyrgyz prison is an intoxicant—a substance
diferent to the one evidenced as harm-reducing in public health research. To do this, we
focus on methadone’s relations with two substances in particular: heroin and Dimedrol (ge-
neric name: diphenhydramine, known as Benadryl® in the United States), an antihistamine
used sometimes for allergies and occasionally sleep as it can be sedating. First, we describe
how prisoners relate methadone to heroin: prisoners’ accounts make up methadone as a sub-
stance inferior in terms of its health-producing and pleasurable efects. Second, we focus on
methadone’s use alongside Dimedrol as a way to re-enact the experience of heroin. Lastly,
we delineate how these three substances entangle to produce ill health in terms of their ef-
fects on the prisoner body and in its perception by others.

Methadone: the anti-heroin object

In opposition to the notion that methadone is health-producing as can be seen within
global health accounts (World Health Organization, 2012), local methadone disrupts the
well-being of the body in multiple distinct ways, with efects extending to the moral charac-
ter of individuals and entire social groups. Methadone’s harms are made in relation to a local
manifestation of heroin-as-harm-reduction, with the most pronounced efects of methadone
being a dependence on a “drug” and, correspondingly, withdrawal, stronger than induced
by heroin. In what follows, we outline these local manifestations of methadone as they relate
to heroin in Kyrgyz prisons.

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Methadone in relation to heroin: an overpowering force

Within participants’ accounts, methadone is made relationally to heroin; the two substances
perform related work on the body. This “work”—these material efects—are emergent from
the relations within a “drug assemblage,” in which heroin is a key actor. Global health dis-
course presents methadone as distinct from heroin. Heroin is a drug while methadone is a
medical treatment because the latter reduces the ability to perceive intoxication, normalizes
conduct, and fosters recovery from addiction (Berridge, 2012, Fraser and valentine, 2008,
Keane, 2013). Users of methadone, in turn, are re-fashioned as more normal, healthy, and
productive than those who use heroin (Bourgois, 2000).
Participants’ accounts too make up the substance and efects of methadone relationally
to heroin, but in the opposite direction: heroin is a necessary “treatment,” enacting stabil-
ity, normalcy, and health, whereas methadone is a toxic drug, leading to a breakdown of
the body. Key to these relations is methadone’s “neutralizing” efect on heroin: methadone
messes with heroin’s materialization as treatment. Through participant’s accounts, we see
that methadone and heroin are linked in their materialization, the former working to erase
the latter. Below, we unpack the relations of the methadone-heroin assemblage.
Within participants’ accounts, there is an acute sense that methadone is a more potent
substance than heroin, as Victor, for example, says: “Methadone has stronger cravings, it
is stronger.” Methadone is constituted as a drug that, once started, is nearly impossible to
discontinue, engendering a stronger dependency than heroin, as Bashir and Zheenbek say:

It is possible to give up heroin, but methadone addiction is much stronger, much worse.
[Bashir]

It creates stronger dependency than heroin…When you’re taking heroin, if you quit, you’re
recovering for a month. Whereas with methadone, it took me six months to recover.
[Zheenbek]

And stronger dependence goes hand in hand with a more physically and psychologically
intense, or “stronger,” withdrawal, a point emphasized by Umar in the following quote:

Last time I managed to stay away [from methadone] for seven days. But could not stand
it anymore. The longer you stay away, the worse the withdrawals. When methadone is
washed out of the system, I experimented, to see how long I would be able to stand it. It
turned out, after heroin it gets better with every passing day, but after methadone…After
methadone, ten days is not enough to fght physical withdrawals. Even with medicine.
They gave me a drip here. They gave me Relanium. It was as useless as an udder on a bull.

The fear elicited by even the thought of withdrawal is palpable. There is a strong sense of
helplessness, with users succumbing to the power of the drug. The body is talked of as being
overburdened by methadone, its capacity overextended, caving into the lethal power of the
substance, as Sergei, for example, explains:

Withdrawal from methadone, a person can’t get through it. If I was to just quit it cold
turkey right now…as I quit heroin, where I’m sick for a week and that’s it. With this,
it won’t work. I’ll die. My body won’t be able to take it…the methadone withdrawal.
[Sergei]

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Again, heroin is the point of comparison—albeit a point that is also shifting. Heroin can be
overcome, if needed, bringing one closer to healing. Methadone, in contrast, is an impossible
obstacle, further degrading the body.
Methadone’s strength is materialized through the “overtaking” of heroin; there is a sense
that methadone, through its power of acting, diminishes heroin. Repeatedly, participants
recount the “blocking” efects of methadone: those taking methadone are no longer able to
experience heroin, as Sergey and Anton, for example, say:

They cannot understand heroin, even when they use it, they cannot understand it…
There is no efect. Methadone neutralizes, counter-balances it.
Everybody knows full well that methadone knocks down the heroin concentration,
you drink a sip and then you shoot up, useless, well useless.

What, then, are the efects on the body when methadone pushes heroin out of the way? In
other words, what work does methadone accomplish in taking the place of heroin?

Methadone as taking over the body

The relationship of methadone and heroin is one of incorporation, with methadone swal-
lowing heroin so that its efects are masked. We saw that heroin is enacted as a treatment.
Methadone’s efect of blocking heroin treatment produces a body bereft of healing. Accounts
invoke methadone’s potency through its mechanism of acting on the body, wherein metha-
done becomes entangled with the user’s body.
Participants’ narratives emphasize how the very material of one’s body fuses together with
the substance, becoming one:

First, it all builds up inside, right, and the heart sufers, and the liver, and urine, and
everything, basically it’s the living dead, what’s the sense?
[Aigul’]

Methadone becomes a sort of entrapment. Longer-term users, unable to look back or quit,
describe methadone as the building block of their bodies and bones:

I told them…I’ve been on methadone for 15 years, my bones are already made of metha-
done, I won’t be able to quit, it’s okay, you’ll quit, he said, others in worse positions quit.
[Timur]

Interview accounts constitute methadone as seeping through body, to the point that it is flled
up with it. For example, Alim notes that:

When a person begins taking methadone, he gets a high. He’s high from it, right, until
his body is flled with methadone. It even has the property of flling up, right, metha-
done flls you up. He gets high, and the larger the dose, the more, basically, the better he
feels. And then they don’t understand themselves, i.e. they themselves don’t notice how
they end up, right? Drinking 300 grams, while he weighs 40 kilograms, 50 max. What’s
that? He can barely walk, and he’s drinking 300 there. Basically, I know, I’m not stupid,
I’ve read online what this drug is made of, and that people, if they abuse it, methadone,
it really degenerates, they degenerate right before your eyes. They don’t read, they don’t
develop, they, well, in general, they are aberrations.

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Methadone is described as “taking over” the body, transforming the healthy body into a
methadone-body. The body becomes made of methadone.
But the interaction between the heroin and methadone and the efects they produce are
not the only signifcant relations in the drug assemblage. Methadone is often taken together
with another substance, an antihistamine called Dimedrol that is available in pill form. In
what follows, I explore the constitution and efects of methadone through its interaction
with Dimedrol. Although emerging from accounts as the most signifcant player in the
drug assemblage, Dimedrol use has only recently been explored in research (Meyer, 2020).
Below, we explore how methadone is produced in particular ways through its relations with
Dimedrol.

Te methadone-Dimedrol object

A faint trace of “solitary” Dimedrol

Today, Dimedrol in Kyrgyz prisons is commonly used in combination with methadone to
achieve a high. Some time after drinking methadone (about 20 minutes), Sergey explains
how the pills are “crushed, shaken with water, drawn up [into a syringe]. Let’s say, fve tablets
in fve mL, and so you shoot up these fve mL.” He continues to explain how shooting up
Dimedrol, rather than oral consumption, produces a much stronger high. While there are
accounts of Dimedrol use predating the introduction of methadone into Kyrgyzstan, our
interviewees narrated how Dimedrol at this time was used sparingly and mostly to reduce
nausea associated with heroin use.
Present Dimedrol use is, however, a phenomenon that is perceived to go hand in hand
with methadone. A cheaper alternative to heroin, it is precisely the reaction between the
two that is the sought-after euphoria. This connection is so strong that Dimedrol only
registers as a substance in participants’ accounts in concert with the introduction of
methadone:

Especially now that they’ve introduced methadone there. Now there’s methadone and
Dimedrol, it’s such a mess with everything.
[Taalaibek]

Basically, Dimedrol was available before, but it wasn’t the same consistency as now.
Starting in 2010, when the methadone program was set up, the way methadone and
Dimedrol interact, and this reaction created a miracle, it proved to be better than
heroin.
[Salamat]

It’s new, it’s methadone and Dimedrol. I haven’t noticed this before. Before there was just
khanka [home-made injection opioid from poppy straw] and heroin, as far as I remember
in all prisons, now there’s this methadone. People are simply dying, after a while they
pass away. I was ofered to join methadone, no, I didn’t agree to it and I won’t.
[Esenbek]

Some accounts go as far as to say that Dimedrol was ushered in by methadone. These ac-
counts create a narrative that prior to methadone, Dimedrol barely existed. A separable
Dimedrol is a faint memory, currently non-existent, and exerting no efect on the body.

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 Lyu Azbel and Frederick L. Altice

Dimedrol: a way to re-enact the heroin experience

This high stands above the high aforded by other substances. As Maksim stated, “How can
I explain it? Heroin has this tinge, this favor, when the wave is about to start. It’s our kind
of high [prikhod po nashemu]. You can taste it. It’s a completely diferent high, just completely
diferent.” And Kyrgyzstan is the country with the best quality: “In the whole world, again,
we have the best opium, again, we have the best marijuana. We have it here in Kyrgyzstan.”
But heroin is not regularly and readily available for all. Dimedrol becomes the surest path to
this “sober” high “[with Dimedrol] the brain starts to work faster. This feeling of reality, you
get a crisper image. And then it ends, and you’re not high anymore.”
So unlike methadone’s implementations elsewhere, and in contrast to its portrayals in pol-
icy as a solution to the problem of HIV, we found that methadone in Kyrgyz prisons often is
used in combination with Dimedrol. This is done to turn methadone, normally a substance
described as providing no euphoria when chronically used for treatment, as a gateway to
euphoria, not unlike a heroin high, as Sultan says:

Methadone without Dimedrol doesn’t get you high. It just takes away the withdrawal,
stops you from being sick. But with Dimedrol, there’s some kind of reaction that takes
place. … It’s like heroin, as though you’ve injected heroin.
[Sultan]

Methadone without Dimedrol is understood as constituting a dull “robotic” existence. Add-

ing Dimedrol re-ignites life:

I drink methadone, I’m going down a tunnel, I see nothing… I get Dimedrol, I shoot it
up and I see a white light, birds chirping. It turns out I’m alive.
[Kalmurat]

Methadone is enacted, in terms of the high it afords, in relation to both heroin and Di-
medrol. Indeed, these substances interact. Methadone blocks heroin, eliminating the high.
Dimedrol, however, provides an alternative pathway to the heroin experience by activating
the high that methadone makes absent:

It seems the brain remembers that heroin trip, and Dimedrol gives this trip. But not for
long. That’s why the Dimedrol dose keeps growing.
[Semen]

Yes, and this [Dimedrol and methadone] is better than heroin, the high is stronger… You get
this wave all over your body, that’s twice as good as heroin. You drink methadone and you
go and shake fve pills, shoot them up, and there you go, the same as heroin.
[Salamat]

Dimedrol, in a sense, works to restore the heroin high that methadone erases.

Te entanglement of methadone and Dimedrol

By following “what is said” in participants’ accounts, we see that the practices of substance
use contaminate the relative “purity” of methadone by Dimedrol. Dimedrol is a banned

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 How methadone becomes an intoxicant

substance, according to the informal rules guiding life within prison, which is even “worse”
than methadone in relation to the casting of moral position and administrative and bodily
power. Methadone’s entanglement with Dimedrol disrupts the notion of “methadone as
treatment” as profered by global health, making it a drug. The narrative that cuts across par-
ticipants’ accounts is that of methadone’s inextricability from Dimedrol. Daniiar, a partici-
pant on methadone, recognizing the problem with Dimedrol, states that “the only way to get
rid of Dimedrol is to get rid of methadone.” This fips the traditional public health response
to the problem on its head: instead of decoupling Dimedrol from methadone to preserve the
purity of the latter, only with the full erasure of methadone can Dimedrol disappear.
Before turning to the bodily materializations of Dimedrol and methadone, let us frst
pause for a closer look at how these terms are used. Accounts oscillate between referring
to the substances as going hand in hand. For example, Ali says, “if there wasn’t methadone,
he wouldn’t be looking for Dimedrol.” Other accounts, such as those of Kamal and Kairat,
respectively, attribute the same efects to both substances:

People die, right? I don’t know, as far as I understand it’s from methadone. But they also
take Dimedrol. Those methadone-dimedrolers, it’s just horrible!

As Kairat explains, “Dimedrol or methadone, it’s the same thing. This is the reason why
I don’t want to go on this methadone, because I know what happens… A person begins
to transform from a human into an animal.” The two substances are so intertwined in
our participants’ narratives that the words “methadone” and “Dimedrol” can be used
interchangeably to refer to the same thing, disrupting any clear demarcation between
the two. Methadone, through its incorporations, becomes multiple things and has mul-
tiple efects. Below, I look at the practices of methadone-Dimedrol to outline how these
materializes. Through its practices of use, as accounted by participants, the efects of
engaging with this methadone-Dimedrol complex are dehumanizing: the self transforms
into an animal.

Methadone-Dimedrol practices
The interaction between methadone and Dimedrol is inordinately powerful, described as
both a “miracle” and a “poison,” and evidenced by its practices of administration, the high,
and the body of its users. Let’s take a look at each of these practices, in turn.
First, instances of Dimedrol’s use constitute a toxic drug of addiction—an intoxication.
Dimedrol tablets are banned but available illicitly (much like heroin was previously). They
are crushed, dissolved in water, and injected around the time of drinking methadone; this
injection process is repeated several times throughout the day. The procedure of Dimedrol
use is repeatedly emphasized as unimaginable. As Kalmurat states, “Can you imagine? Six
pills at once into the vein, into the bloodstream.” Bakyi further explains this process, “You
inject 40 pills a day. Can you imagine?” Barat seconds this, “They take Dimedrol by the
sheets So from 9 a.m. to 5 p.m., it’s 50 tablets, can you imagine what was happening? I don’t
even know how I’m alive still.” This excessive dosing denotes an unnaturalness; such large
quantities are not conducive to “natural” human life. Those continuing to live while inject-
ing are an abhorrent marvel.
Dimedrol promises a euphoria stronger than heroin: “Experience has shown that it’s even
better than heroin. It’s a very strong high” [Nikolai]. But this Dimedrol high has a fip side
much like that of heroin: addiction: “frst it’s euphoria, then it’s some kind of addiction to

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 Lyu Azbel and Frederick L. Altice

Dimedrol, too” [Zheenbek]. Addiction, here, is evidenced by an ever-increasing need for

Dimedrol: “Because they also get addicted. Later, a tablet, two, it’s too little, they start tak-
ing fve tablets” [Mirlan]. Like with the high, the addiction is described as being even stron-
ger than in the case of heroin. The overwhelming nature of Dimedrol addiction is repeatedly
emphasized by users. When I asked Salamat what can be done to change the practice of
combining Dimedrol with methadone, he responded with the following scenario:

Well you’ll have to say that it’s the end of the world in an hour, maybe then something
might happen [laughter]. Otherwise, they don’t care, they wouldn’t even care if it’s
the end of the world. I’ve seen a person who was on methadone, he was taking a large
dose and decided one fne day to quit everything, on the spot in one day. I just saw his
reaction, what started happening to him…He began losing his mind right away. Af-
terwards he was caught in the prohibited zone and was killed, that’s that…Perhaps it’s
withdrawal, or something else, that a person begins losing his mind, he begins pouring
soup on himself and so on, begins talking in a non-human tongue, well if, well I don’t
know what to make of it.

The force of methadone appears to seem beyond reason by some. The extreme practices of
its use and efects have equally extreme consequences: loss of control, humanity, and even-
tually death.
To understand prisoners’ decisions surrounding methadone, it is important to consider how
the practices of methadone’s use produce methadone-using subjects. In the next section, we ex-
plore the production of the dehumanized methadone-Dimedrol subject, focusing particularly on
how practices of methadone-Dimedrol use make evidence about this particular subject.

Te dehumanized methadone mind

At the same time as ofering a “way out” of the banality of the methadone routine via a re-
routed heroin experience, accounts equate Dimedrol to a complete loss of moral decency.
We can glimpse this in the unpredictability related to the methadone subjects who are made
up through the accounts of prisoners with varying methadone experiences:

It’s like a monkey house. People are already not normal… It [Dimedrol] causes hal-
lucinations, it closes up a person, he becomes crazy, delusions, hallucinations, talks to
himself, doing things, this noise, that’s it, he is lost.
[Bakhtiiar, some methadone experience]

They [methadone clients] would not answer your questions. Sometimes they would
talk nonsense and gibberish. Their eyes are crazy. I heard someone say they would start
going through garbage, or even put their hands in the toilet bowls. In a nutshell, people
just become awful.
[Sultan, no methadone experience]

These accounts of the psychology of the methadone subject work to constitute him as Other,
residing on the margins of what is socially acceptable. No longer in tune with the “normal”
practices of daily prison life, the subject loses touch with reality. Defning this Other in terms
of an alternate reality, characterized by hallucinations and delusions, renders him unknow-
able. He occupies a diferent psychosocial space, and this space is grotesque.

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 How methadone becomes an intoxicant

But the efects of the methadone-Dimedrol object extend beyond the mind to afect the
body. To further explore how subjects are governed through methadone’s subjectifcation
efects, let us refect on how methadone with Dimedrol constitutes the body as a particular
kind of body (Bacchi and Goodwin, 2016: 69).

Te dehumanized methadone body

The extraordinary procedures of Dimedrol use and its psychological efects extend to its
bodily material manifestations, which participants’ accounts emphasize as equally “unnatu-
ral” and “inhuman.” The user’s body, having been “flled up” with methadone, undergoes
a transformation. Users of this substance complain of blisters; wounds; abscesses; bad teeth,
lungs, and livers; an addiction worse than heroin; and unprecedented drug withdrawals. As
Kalmurat notes, methadone users “degenerate right before your eyes.” He continues:

They disappear, the veins vanish. They’re aware. They know that their veins are burn-
ing. They know about their liver. Their hearts grow weaker. They know and con-
sciously do it. He gave up on himself. He just gets high. He needs nothing else.

Again, the substance of methadone-Dimedrol is experienced to be powerful enough to take

the will of the user hostage. The substance supersedes the body, leading to a loss of self and
a loss of body. And when it overtakes the body, methadone-Dimedrol degrades. The bodies
of these users are literally experienced to deteriorate and disappear:

I see them, those people who use 100 pills at a time. It’s scary even looking at this per-
son… Their legs are like my arm.
[Alim]

What person in his right mind, when he sees these zombies, excuse my language, all
these people with abscesses. What person in his right mind would support this program?
When doctors do autopsies on these methadone users, they say they are all meat-jelly
[kholodets] inside, they’re like monsters.
[Alibek]

These descriptions invoke the decay surrounding this methadone object—a new substance
incorporating Dimedrol—which works to infect and break apart the body. While prison
staf pointed to the negative efect that Dimedrol—not methadone—has on the body, within
the practices of prisoners’ daily lives, these two substances became interchangeable.
If methadone causes the body to deteriorate, the logical end is that the body turns to
nothing. Stepan commented, “there is nothing but bones left in me.” The methadone body
may end in “actual death,” which is sometimes presented as rationale for resisting the intro-
duction of methadone from the outside:

Nothing will change for the better if I start taking methadone. That is the same drug [as
heroin] but is killing people much faster than heroin.
[Bashir]

People die, right. Well, I already know many guys who used to take methadone, my ac-
quaintances, die. Their livers give up, lungs… As far as I understand, it’s from methadone.
[Barat]

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 Lyu Azbel and Frederick L. Altice

We clearly realize that this is the killing of drug addicts, the methadone program…
During [its] nine years, half of the population died. In nine years, half of them died…
It’s a slow death by methadone.
[Sergei]

The association of methadone with death, especially when aligned with Dimedrol, is so
strong that some of the participants even see it as a conspiracy to kill prisoners, who use
drugs. A point emphasized by Talgat who says it is “a legal way to kill people.” Salamat
explains further:

The goal is just to exterminate the druggies, the thieves, and the killers. Many countries
have said no to methadone. It’s just our Kyrgyzstan that continues it. We have a lot of
druggies. And I just see it, I see what’s happening with this program, they’re starting to
die. At frst, all’s OK, he’s blooming. And then one fne day, that’s it, and he’s a corpse…
My bones started breaking, the joints were giving in, and I said, “No, that’s it.” I’m still
young, I have a life ahead of me.

Accounts such as Salamat’s often present Kyrgyzstan as an exception to the rule of banning
methadone. There is a sense that while all “civilized” countries do not allow methadone,
Kyrgyzstan’s legislation of the methadone program is a function of the country’s backward-
ness. Participants even recounted rumors that Americans invented Dimedrol in order to
combine it with methadone to kill the drug using population.
The methadone body, especially in light of its incorporations with Dimedrol, is enacted
as a less-than-human body. The terms used to describe methadone users (“zombies,” “mon-
sters,” “animals”) render them inhuman. The ill health brought about by methadone is
evidenced in the visible physical degradation. This degradation is present in the personal
narratives of users. Maksim says, “I lost my teeth to methadone…I drank it and half an hour
later it all comes back out.” Leonid, who did not take methadone, observes, “They [the
methadone users] have sores and blisters… they have wounds.” In both cases, bodily ailments
are directly attributed to methadone, and the knowledge-making instances are those that are
witnessed frst-hand:

And so this methadone. Just look at what’s happening with those on methadone. You
can’t…just now a guy came in, it’s sad looking at him. It’s all because of your methadone.
He’s already shaking.
[Nikolai]

Well, I don’t know, just looking at them [methadone clients], how they’re killing them-
selves, I don’t feel like it, I still feel like living.
[Kamal’]

Well, you can tell that by just looking at the person. I tell you, it’s enough to take two
to three tablets and one can already see it in your eyes.
[Nurlan]

Methadone’s bodily incorporations are made real through witnessing. It is the instances
of seeing methadone user’s bodily transformations that makes methadone into a substance
that harms. Daniiar, who was enrolled in the methadone program, is a particularly striking

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case. During our interview, he pointed to his body, outlining the sores with his fnger,
and said: “these spots right here are ripping apart, the skin. I’m beginning to dry out from
these chemicals. I’ve lost my health. I’m already dying.” Health is something fnite and the
methadone-Dimedrol complex, agentic, eats away at it until it disappears. By bringing me
into seeing the inscriptions of methadone on the body, Daniiar was creating knowledge
about methadone. Seeing the devastating efects of the drug—whether on one’s own body or
the bodies of others—is a prime agent in creating methadone as toxic.

Conclusion
At the root of an intoxicant’s becoming are the knowledge-making practices of its use. That
is, substances, rather than possessing solid or stable efects, are made within social practices
(Dennis, 2016, Duf, 2013, Gomart, 2002). We have demonstrated that methadone’s material
manifestations, such as withdrawal symptoms, physical dependency, and drug embodiments,
produce evidence about the substance. Pushing aside health-enabling enactments of metha-
done, the methadone enacted in prisoners’ accounts is a toxic drug.
Locally enacted methadones, including this toxic methadone, are negotiated in rela-
tion to a drug assemblage. The relations between methadone and heroin, and methadone
and Dimedrol, are key to understanding methadone’s toxicity. Through its folding into
health-destroying Dimedrol and away from health-producing heroin, methadone becomes
a poison rather than a treatment. Methadone is intertwined with Dimedrol in complex
ways to produce a methadone-Dimedrol complex and afect a sickly “methadone-body.”
The efects aforded by methadone take on, and then become indistinguishable from, those
of Dimedrol, a substance constituted as particularly messy in the bodily damage it causes.
While global health narratives treat methadone as a discrete and stable object, participants’
accounts work to blur the boundaries of these substances, making it impossible to cleanly
tease them apart. Not as clearly visible but, existing within the margins, a health-producing
methadone also comes into view—a testament to the possibility of alternative enactments
within this actor-network. Showing how a harm-producing methadone is made provides
hope that, given a change in the set of implementation practices, a health-producing meth-
adone can also be made.
In this chapter, however, we have worked with the idea of the “methadone body” to
explore the material efects of methadone-Dimedrol at the level of the individual subject.
We saw that a rotting methadone-Dimedrol body is enacted through the material relations
of drugs with other drugs as well as drug use practices. This form of analysis illuminates the
shifting bodies produced through interactions with methadone, which, while remaining
unaccounted for by public health, are essential for a competent intervention implementation
in the Kyrgyz prison space and beyond.
The signifcant implication of this theoretical shift is that, unlike within much of the
public health literature, there was no methadone “out there” that could be uncovered by the
removal of “barriers” to its translation. Context is, rather, an active participant in the making
of local methadone and its efects. Given a diferent context, then, the methadone performed
would also be diferent. This has implications for how intervention implementers think
about substances and their intoxication efects. We call for a departure from the imagined
stable substances articulated by much public health writing to challenge the very notion that
a substance, translated to a diferent place, should, given ideal circumstances, produce the
same health outcomes. We urge public health practitioners to consider the way interventions
are made multiple times within their practices of use.

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 Lyu Azbel and Frederick L. Altice

Note
1 “Sampling” is not the most appropriate term, given that this study focused more on process rather
than attaining a specifed end result, including the number of participants.

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 14
TRADE-OFFS BETWEEN
INTOXICATION, SAFETY, AND
SOCIABILITY WITHIN A DRUG-
CONSUMPTION FACILITY
Esben Houborg and Siv Schjøll Berge

Introduction
In this chapter, we present a study of how people who use a drug consumption room (DCR)
in Copenhagen, Denmark think about using drugs in that setting compared with other set-
tings, and which trade-ofs they consider when deciding where to use drugs. Such consid-
erations could involve a trade-of between minimizing the risk of an overdose and the best
possible experience of getting intoxicated, or a trade-of between enjoying the company of
others when using drugs, or getting more ‘bang for the buck’ by using alone. As part of this
investigation, we are also interested in how diferent ‘modes of use’ – such as self-medication
of physical or mental problems, alleviating withdrawal symptoms, solitary experience of
particular forms of intoxication, drug use as a social activity, etc. – can be associated with
using drugs in diferent settings. In doing this study, we follow previous qualitative research
on how people experience using DCRs and how they consider using drugs in a DCR or
in other settings (Clua-García, 2020; Duncan, Duf, Sebar, & Lee, 2017a; Duncan, Sebar,
Lee, & Duf, 2019, 2020; Small, Moore, Shoveller, Wood, & Kerr, 2012; Small et al., 2011).
Our contribution to this literature is that we show how users negotiate drug use in diferent
settings, rather than mainly focusing on what happens inside the DCR. We also show the
variety of diferent considerations that can be involved, rather than mainly focusing on risk
and risk management. We emphasize the importance of considering how to regulate the
boundaries between the institutional space inside a DCR and the drug scene outside a DCR
when designing and managing a DCR.

Background
DCRs are intended to provide a safe and hygienic space to use drugs to prevent drug-re-
lated harm. It is a harm-reduction service that many studies have shown to be efective
in reducing fatal overdoses and infections from blood-borne infectious diseases (HIV and
Hepatitis B and C), increasing drug users’ access to social and health benefts, and improving
public order (Folch et al., 2018; Hedrich, Kerr, & Dubois-Arber, 2010; Potier, Laprévote,
Dubois-Arber, Cottencin, & Rolland, 2014).

DOI: 10.4324/9780429058141-18 221

 Esben Houborg and Siv Schjøll Berge

In 2012, the Danish Parliament made an amendment to the drug legislation that made
it possible for municipalities to establish DCRs. The municipality of Copenhagen, having
wanted to establish a DCR since the early 2000s, was quick to set up frst one and then an
additional facility. The second facility, which has been in use since 2016, is the object of our
study here. Before the public DCRs were established, a private organization had already
established a mobile injection facility, which the municipality took over when it became
legally possible.
Much of the literature on DCRs as ‘safer environment interventions’ (McNeil & Small,
2014) articulates a risk-oriented public health perspective, which means a focus on risk fac-
tors that increase the likelihood of drug-related harm. There is increasingly, however, a
literature that seeks to create a more varied understanding of how DCRs function by taking
their point of departure in users’ perspectives. This includes users’ conceptions of risk (Small
et al., 2012), how DCRs can change social relations among people who use drugs (McNeil &
Small, 2014), DCRs as a setting for care (Duncan et al., 2019, 2020; McNeil & Small, 2014;
Small et al., 2012) and for enjoying drugs (Duncan et al., 2017a), and how users negotiate
using drugs in DCRs and other settings (Clua-García, 2020; Small et al., 2012).
Qualitative research on users’ perspectives on DCRs has documented that reduction of
health risks is only part of the beneft that DCRs can provide for marginalized people who
use drugs. Apart from minimizing the risks of fatal overdoses and getting infected with,
for example, HIV or Hepatitis C, DCRs can also serve to minimize some of the everyday
risks, including violence, robbery, or losing drugs, that are associated with the life of a mar-
ginalized person who uses drugs (Clua-García, 2020; Fairbairn, Small, Shannon, Wood, &
Kerr, 2008; Small et al., 2012). To understand this dimension of DCRs it’s important to
have an understanding of the social, cultural, and structural contexts within which a DCR
is situated, including the characteristics of the drug scene, other available health and social
services, or drug legislation and its enforcement. It has also been shown that the design of
DCRs, and which alternative settings for drug use exist, can infuence the extent to which
DCRs are used, by whom they are used, and how they are used (Clua-García, 2020; Small
et al., 2011). Some research also includes other issues, particularly how DCRs can infuence
the social dynamics of drug use and experiences of using drugs, including how pleasurable
they are. For example, a study from Barcelona, Spain has studied reasons why people de-
cide to use drugs in DCRs, public spaces, and private settings, and while the main topic
concerns risk perceptions and risk management, the study also touches upon how diferent
settings afect the intoxicating experiences of using drugs, and how this informs decisions
about where to use drugs (Clua-García, 2020). While some people decide to use DCRs
because they reduce the risks or provide a good setting for enjoying drugs, other people de-
cide to use drugs in public spaces or private settings, because they are experienced as better
settings for enjoying drugs or because it is more convenient to use drugs in these settings.
This research provides insights into how users negotiate diferent settings to use drugs.
Negotiations can include considerations of diferent positive and negative aspects of using
drugs in a particular setting. This can, for example, involve the risk of drug-related harm,
getting your high ruined by noisy people, getting disturbed or hustled by people who want
a share of your drugs, or having to wait a while before you can consume your drugs. A
study of people who use a DCR in Vancouver make similar observations about reasons and
rationales for using or not using a DCR (Small et al., 2011, 2012). The Vancouver study also
mainly focuses on users’ perceptions and management of risks, but the study does touch a
little on how the DCR is, for some people or in some situations, not an attractive place to
use drugs. Studies like these show the complexities of DCRs as harm-reduction measures

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and places to use drugs but, as indicated, the primary and explicit focus is on risk and
risk-reduction. It is rarer that it is the drug-using experience, and particularly the issue of
intoxication, that is at the centre of research on DCRs. This is, however, the case in a study
of a DCR in Frankfurt, Germany conducted by Duncan et al. (2017a). In an article appro-
priately titled ‘Enjoying the Kick’ Duncan et al., (2017a), they provide a detailed analysis
of how the social, material, and atmospheric setting of the DCR infuences the pleasures
of using drugs. In this way, the authors highlight perhaps the most important reason why
people use drugs, to get an enjoyable experience of the intoxication that drugs can pro-
vide, and which should therefore be central to evaluating DCRs. However, the literature
on DCRs has only been concerned with this issue to a limited extent. It has refected a
more general trait in social drug research, although in recent years more attention has been
given to the issue of the pleasurable experiences of using drugs in general (Duf, 2008;
Dwyer, 2008; Holt & Treloar, 2008; Houborg, 2010; Hunt & Evans, 2008; Moore, 2008;
O’Malley & Valverde, 2004; Race, 2009). The Frankfurt study also focuses on the DCR
as a socio-material setting that infuences the atmosphere of the service and how it creates
opportunities for engagement between staf and clients that, among other things, involve
care (Duncan et al., 2019). The authors seek to show the importance of an accommodating
setting and atmosphere in order to provide harm reduction, which they call ‘atmospheric
harm reduction’ (Duncan et al., 2020). By broadening the dimensions of the functioning of
DCRs and how users experience such services, the research by Duncan and his colleagues
makes a valuable contribution to the harm-reduction literature in general and the litera-
ture on DCRs in particular. It can also be seen as part of a trend in social drug research
to pay more attention to the pleasures that can be involved in using drugs. One important
contribution to this research is acknowledging that people who are dependent on drugs
also enjoy them and that all use is not dependent use or self-medication. Rather, just like
others, people who are dependent on drugs can engage in diferent ‘modes of use’ (Gomart,
2002; Lowenstein, Gourarier, Coppel, Lebeau, & Hefez, 1995), including dependent use,
self-medication, and recreational use. DCRs and other places where drugs are used may
provide settings that facilitate diferent modes of use and diferent drug-use experiences,
and this may afect where and how drugs are used (Clua García, 2018, 2020). To neglect
the roles intoxication and pleasure play for drug users would, as mentioned, mean ignoring
much of what makes the things that drug users do meaningful to them.
This chapter should be seen as a contribution to the line of research presented above that
seeks to broaden the perspectives on how DCRs function, by taking user’s experiences as
the point of departure. More specifcally, we are interested in exploring the considerations
that are involved when users decide to use or not use a DCR. While this has been touched
upon in previous research, it has not to our knowledge been the centre of attention except
in the study by Clua-Garcia of Barcelona (Clua-García, 2018, 2020). We will use the term
‘trade-of’ to investigate how the users negotiate when and where to use drugs (Kloster et al.,
2021). We use this term to show how considerations of diferent dimensions of using drugs
in diferent settings can be involved when deciding where to consume drugs. While this
may involve cost-beneft calculations, we use the term in a wider meaning to show that it is
not always straightforward and obvious for people who use drugs to do so inside a DCR. In
this way, we seek to contribute to the literature that presents the varied users’ perspectives of
DCRs in the hope that such perspectives are taken into account when DCRs are designed
and managed. Of particular concern here is how diferent considerations concerning intox-
ication and the enjoyment of using drugs can be involved when users consider to use or not
to use a DCR.

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Drugs can have many functions, be used in diferent ways, and have diferent efects
dependent on context (Becker, 1953; Duf, 2007, 2017; Houborg, 2012; Zinberg, 1984). It
would be a mistake to let a defcit model (O’Malley & Mugford, 1991) govern our way of
thinking about drug use among people who, in one way or another, are dependent on drugs,
that is, to think that their physical or psychological dependency is the only thing that makes
them use drugs. Rather, in order to get a nuanced understanding of drug use, it would be
more useful to study how diferent people can have diferent ‘modes of use’ in diferent sit-
uations and diferent contexts (Gomart, 2004). In our study of users’ experiences with drugs
in diferent settings, we have therefore tried to identify how diferent settings can be asso-
ciated with diferent modes of use. This means that for some people, a DCR may be a good
setting for some modes of use, and not for others. An important question is therefore which
modes of use can the design and functioning of diferent DCRs accommodate? How much
variability in terms of modes of use do they allow?

Study context
The DCR that is the topic of this chapter is located in the neighbourhood of Vesterbro in Copen-
hagen, Denmark. Vesterbro is the location of the largest open drug scene in the Nordic countries
and has for decades been associated with a highly visible trade and use of heroin, cocaine, crack,
methadone, and prescription drugs. Until the turn of the century, the main drug was heroin, but
for the past 10–15 years, cocaine (including crack) has become the dominant drug. This does not
mean that heroin has disappeared, and many of the people who participate at the drug scene are
poly-drug users. The change from heroin to cocaine as the dominant drug has infuenced how
the drug scene manifests itself. It has become more unruly, hectic, and loud. It is estimated that
between 600 and 800 people participate in the drug scene on a daily basis (Mændenes Hjem, no
date). Since 2012, the municipality of Copenhagen has fnanced DCRs in the area (Houborg &
Frank, 2014). Today, two DCRs, Skyen and H17, exist in the area with a total capacity for 28
smokers and 17 injectors at one time. The DCRs complement each other in delivering a 24-hour
service, and together, H17 and Skyen have between 500 and 1,000 drug intakes per day (Mæn-
denes Hjem, no date). One can use the facilities anonymously, and people from the rest of Den-
mark, Sweden, Norway, and other countries use them. When establishing the DCRs, a zone was
created around them where the users are allowed to be in possession of illicit substances for per-
sonal consumption without criminal prosecution, and hence exempts the users from Denmark’s
zero-tolerance policy on possession of drugs. The decriminalized zone encompasses the whole
area of ‘Inner Vesterbro’ where the drug scene is situated (Houborg, Frank, & Bjerge, 2014). The
area of Vesterbro is a mixed residential and business area dominated by high- and middle-income
housing (Larsen & Hansen, 2008) and restaurants, bars, cafés, and hotels due to the proximity of
the main railway station. Several low-threshold and harm-reduction services exist in this gentri-
fed area in addition to the two DCRs. In this chapter, we focus on the DCR H17.
H17 is a 1,000 square metre converted slaughterhouse of yellow brick located a short
distance from Copenhagen’s central station, on the edge of Copenhagen’s historic red-light
district, next to the old Meatpacking District and just opposite the local police station. The
name H17 refers to the address, Halmtorvet 17. The staf consists of nurses and social work-
ers. Originally, H17 was meant to ofer a recreational place with a lounge and a café area for
the users, but this has not been fully implemented. H17 runs an almost 24-hour service and
only closes for a couple of hours a day for cleaning. However, keeping H17 open for business
has proved to be difcult because of staf shortages and closures due to fghts and violence
inside the facility.

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To access H17, one passes ‘the ramp’, which runs along most of the façade of H17. On the
ramp, benches are bolted to the ground, and trashcans and sharps containers are mounted on
the walls. As an expected consequence of the opening of H17, much of the drug trade has
become centred on and nearby the ramp. Weather conditions, time of the day, and day of
the month infuence how many people are on the ramp and the drug scene in general. The
ramp constitutes a complex place with several diferent functions: entrance area, waiting area
for those who want to get into H17 to consume their drugs, hang-out area, sleeping area,
drug-using area, and drug-trading area. The gathering of diferent groups of people and the
diverse functions sometimes cause a restless and unruly atmosphere. From the ramp, there
are three doors leading into H17 an additional entry beneath the ramp for the staf only.
Users are not let into the building until there is a vacant drug-using place, unless they need
to use some of the other facilities in H17, such as the toilets.
A polka-dotted automated sliding door leads to a tiny blue-painted hallway inside H17.
From there, one enters a reception area, also decorated in blue shades to create a calm at-
mosphere. The reception area is about 12 metres long with high ceilings and skylights. The
reception is a rectangular counter in the middle of the room, where the staf register the
guests (anonymously, e.g., nick-names) and the drugs they plan to consume. On the recep-
tion counter, there are jugs of free juice and stacks of disposable cups for guests. In front of
it, there is a trolley with injecting equipment, tin foil, and other material for those who will
smoke their drugs. Behind the counter, a long frosted-glass wall separates the reception from
the smoking area, and opposite doors lead to restrooms, a deposit, and the injection room.
The smoking area contains eight smoking cabins with two seats mounted in each, with
glass walls and doors to close, because of the ventilation system. A maximum of 20 users are
allowed in the area at the same time, and often they gather in the cabins where the drugs are;
that is, all 20 could easily gather in two booths or in the passageway in front of the rooms.
Because of health regulations, the staf are not allowed to enter the smoking rooms or the
passageway. The time slot for smokers is 30 minutes in the case of a queue developing. If
there is a queue to enter on the ramp and a big shift has to be made, people are asked to leave
through the chill-out area, passing the injection rooms to avoid a trafc jam at the main
entrance.
A door separates the reception area and the injection room that is located on the opposite
side of the reception to the smoking area. In the injection room, steel tables are placed in a row
along the wall. A frosted glass screen separates each of the eight seats available. Each table is
provided with a simple chair and a hole in the table top to get rid of spent equipment. Behind
the row of injection tables is a passage that is also a space for clients to walk back and forth in or
to hang out with friends in, besides being the route to the individual stalls. There is always staf
present in the injection room in case of an overdose. The staf can also guide the user through
sanitary injection practice and help to fnd veins that work. The time slot for the injection stalls
is 45 minutes if there is a queue. If there is no queue, one can stay longer.
H17 has fve basic rules: (1) users must register and agree (by signature) to abide by the
house rules, (2) minors are prohibited from entry, (3) violence and threats are not allowed, (4)
no drug dealing is allowed, and (5) one must follow the instructions of the staf and comply
with the time slot assigned for the intake of substances (Mændenes Hjem, no date).
Enforcement measures range from a temporary ban, usually for an hour or the rest of the
day, but a severe sanction can sometimes be for longer periods. The staf are not allowed to
intervene in conficts between users and are to call the police if conficts need to be handled.
The police have special units that patrol the area, ofcers who know the drug scene and
usually seek to resolve conficts without the use of force (Houborg, Frank, & Bjerge, 2014).

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Methods and data

The data for this chapter comes from two diferent studies. The frst was conducted in
2017 and involved feldwork in the area where the open drug scene is located and in-
volved interviews with drug users, social workers and police ofcers. The second and pri-
mary data source comes from an evaluation of H17 conducted in 2018. Forty-one users of
DCR answered a survey interviews with questions about their sociodemographic back-
ground, drug use, and the experience of using H17. They were also asked if they had any
ideas for changes or improvements to the facility. The survey interviews were recorded,
and the respondents were encouraged to elaborate answers when they found it relevant
to do so. The recordings of the interviews were transcribed and coded in Nvivo using
a codebook built around questions about drawbacks and benefts in relation to diferent
dimensions of using drugs in H17 and other places, including at home, in public space,
and the other DCR in the area. Of the participants, 68% (28) were male, and 32% (13)
were female. The mean age was 40.5 (38.6 for men and 44.5 for women), ranging from 24
to 60. Danish citizens accounted for 78%; of whom 32% said that they were currently in
drug treatment. Cocaine was the most frequently used drug among the respondents; 83%
said that they had used cocaine inside H17 during the past week; 58% had used heroin;
41% had used methadone. Sixty-one per cent of the respondents said that they used the
smoking rooms inside H17, and 64% said that they used the injection room; 27% said that
they used a booth smoking room and injection room. Fifty-one per cent said that they
had used H17 two times a day or more during the past week.
When we conducted a survey among users of H17 in 2018 (n = 41), we asked them why
they used the DCR, and we found that the DCR served diferent functions for the users,
not just as a safe place to use drugs, indicating how the DCRs have become part of the drug
scene. Thirty-nine per cent said that it provided a sense of security because the staf could
help in case of an overdose, while 66% said that the facility provided a hygienic setting for
using drugs. Fifty-six per cent said that they frequented H17 to socialize with other drug us-
ers, and 61% said that they came to trade drugs inside or in the vicinity of H17. The respon-
dents were also asked about their experiences of using the DCR. Of the ones who used the
injection room, 65% said that it was a good experience to use the room compared with using
drugs in other settings, and 52% of the respondents who used the smoking rooms said that
it was a good place to use drugs compared with other places (Houborg, Holt, & Bancroft,
2018). These answers indicate that even though many of the respondents were satisfed with
the DCR as a setting for using drugs, there were also many that seemed to have reservations.
We will consider some of these reservations in the sections below. Most of the respondents
(93%) agreed or partly agreed that the staf treated them well and 73% agreed or partly agreed
that the staf were able to uphold the rules and keep a calm and orderly atmosphere inside
the DCR. Sixty-one per cent said that they agreed or partly agreed that the staf were able to
provide care for the users. The most important reasons for not using the DCR were having
to wait too long (74%), preferring to use the other DCR (63%), too much noise inside the
DCR (54%), not a good experience to use drugs inside the DCR (53%), and that the DCR
was closed (53%).
In the following sections, we will look at some of the considerations that users mentioned,
when we talked with them about using drugs in the DCR and other settings. It is thus im-
portant to have in mind that our main focus is on those participants who considered trade-
ofs involved in using drugs in diferent settings.

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Te DCR as a safe and legitimate place to use drugs

Our research at the open drug scene in Copenhagen has shown that the two DCRs have
become an integrated part of the drug scene, and that particularly the large DCR H17 has
become a central hub for drug users in the area (Houborg & Holt, 2018).
In our study, we asked users about whether H17 had afected their sense of security, and
half of the respondents said that it had. One respondent said that it had him feel more safe in
the area by minimizing the everyday risks associated with the drug scene.

The scene is diferent today (…) there is a bit more control over the situation, there are
less knifngs, assaults – that is the crime has been reduced quite a bit, (…). People are
not nodding of in the streets. It has become much better, also after H17 has opened,
defnitely.
(Isam)

However, 76% said that they had felt a lack of security at the ramp outside the DCR.
When looking at responses about security inside H17, 56% said that it was a safe place for
women, 66% said that it was a safe place for men, and 54% said that it was a safe place for
transgender persons (Houborg, Bancroft, & Holdt, 2018). In the interviews, several of the
respondents expressed a sense of lack of security inside the DCR when it came to protection
against theft. For example, some respondents said that in the injection area, they were afraid
of getting their belongings stolen when they were sitting in the injection booths and/or were
intoxicated. While some of the respondents describe other users that steal drugs inside the
DCR, this user freely admits that he does the stealing himself.

Well, a lot of people get their coke taken over there because they are stoning or some-
thing like that, and their wallet and … Well I have to admit that I have done it myself.
When people have been nodding of that I have just walked past and taken his cup with
coke or something.
(Fred)

In a jurisdiction like Denmark where possession of illicit drugs is a criminal ofence, a DCR
creates a space where users will not be prosecuted for this ofence and hence it provides a le-
gal place to use drugs. Furthermore, a DCR makes it possible to avoid using drugs in public
or semi-public settings where it can be observed by other people who pass by. In this way, the
DCR provides a non-stigmatizing and legitimate place to use drugs (Duncan et al., 2017a;
Small et al., 2012, 2011). Many of the participants in our study reported that H17 provides a
setting for alleviation of shame, as drugs can be taken sheltered from public view, especially
that of children. Particularly the wish to shield children occurs across several studies (Clua-
García, 2020; Duncan et al., 2017a). About using H17, Kamas explained:

You hide. Before, we sat outside, which was unpleasant because children passing by and
such embarrassed you. Now there’s a sort of freedom.
(Kamas, 50)

The experience of shame and stigma can make public space a very stressful setting to use
drugs, and a DCR can relieve such stress and, in this way, prevent the harm this could cause.

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In the quote below, the user, Henrik, who injects drugs, explained how the stress of using
drugs in public space makes it difcult to inject.

I could never use drugs out here (in public). If someone comes around the corner and
you sit there. To see another person do that [inject drugs]. I don’t like that. It makes
me far too stressed and then I can’t do it. […] Because you get stressed, so you can’t hit
anything [a vein], so might as well not try to do it, you waste 30 needles and get pricked
all over, like a sieve. That is stupid. You only do that a couple of times.
(Henrik, 39)

It is thus not just the opportunity to use drugs in a safer environment that makes people
use a DCR, but also the fact that it provides a legitimate place to use illegal drugs. While
this is clearly an improvement for many marginalized people who use drugs, for whom
the alternative to using in a DCR is to use in public space, research from Vancouver has
found that when such a legitimate place to use drugs is constructed, some may see it as a
moral obligation to use drugs in such a setting. This may result in labelling people who
do not use the DCR as immoral, irresponsible, and/or irrational, hence developing a
new kind of stigmatization (Small et al., 2012). Instead of this, it is perhaps more mean-
ingful to ask why people do not use a DCR, because they may have good reasons and it
may not be irrational for them. It is precisely one of the reasons why it is important to
study how people negotiate the diferent aspects and trade-ofs involved in using drugs
in a DCR and other settings.

A new social setting for using drugs: H17

DCRs are constructed as a social and material space where an illegal activity is allowed in
order to minimize risk. They create a space for activities that previously would take place as
part of drug scenes outside DCRs. Thus, a DCR can be seen as a hybrid space where par-
ticular aspects of the drug scene are allowed in an institutional setting. One of the import-
ant dimensions in the design and management of DCRs is how to regulate the boundaries
between the institutional space inside the DCR and the drug scene outside the DCR. The
rules and regulations that govern DCRs play an important role in defning this hybrid space
and the boundaries between drug scene and institution. As such, they are also an import-
ant part of creating a new setting for drug use that infuences the social relations and social
interaction that are involved in drug-using activities (Duncan et al., 2017a, 2020; Small
et al., 2012). For example, rules that do not allow the sharing or splitting of drugs interfere
directly with an important practice among many marginalized drug users that can both help
to secure a supply of drugs and can contribute to the formation of social relations and moral
commitments (Bourgois, 1998).
The legislation on DCRs in Denmark prohibits drug dealing inside DCRs and this is also
specifed in the local agreement on DCRs in Copenhagen, between the Copenhagen police
department and the municipality of Copenhagen. This does not, however, mean that drug
sharing and drug dealing do not take place. A staf member explained how difcult it can be
to stop exchanges of drugs inside the DCR.

Drug use of course not legal, just as it isn’t anywhere else in the world or society. But
what we say is that you should not proft on other peoples’ misery. And this means that

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exchange of balls [small packages of drugs] and sharing and things like that. We know
that happens and we do not clamp down on it. We clamp down when we see more
organized drug dealing.
(Staf member at DCR

This means that a particular interpretation of the rules allows sharing and the exchanging
of drugs among users, opposite to the information described in the Vancouver study (Small
et al., 2011, 2012). This means that aspects of the social relations and the social interactions
that are related to drug use outside the facility also occur inside the facility in Copenhagen,
which highlights a further diference between the DCR in Copenhagen and the one in
Vancouver. In Copenhagen, a key issue is how to maintain the line between drug sharing
and more commercial drug dealing and related activities such as debt collection, punishment
for late payments. It can be difcult to stop such activities, particularly if the material design
and the functioning of the DCR makes it possible.
As described, the smoking area of H17 is separated from the rest of the DCR by a glass wall
and there is a corridor from which you can access fve smoking cabins designed for two users. Of-
ten, users will be gathered in the corridor or in two or three of the cabins. Because the staf does
not enter this area, because of the health regulations, it becomes a place inside the DCR where
activities, social relations, and social interactions that exist in the outside drug scene become pos-
sible inside the DCR, even though they are not allowed. This creates a social environment that,
from time to time, creates an atmosphere that afects how some users experience using drugs at
the DCR, which, in turn, infuences their decisions about whether or not to use the DCR.
Søren, for example, told us that he would have used drugs somewhere else on the day we
interviewed him, if he had known there would be a hectic atmosphere inside H17. He expressed
frustration that the staf do not enforce the rules, because it makes using drugs inside a bad expe-
rience, and he fears that too much drug dealing will threaten the existence of the DCR.

There are no consequences: They sit and trade inside the smoker [smoking room] with the
scales out, and customers just run in or stand with pliers (…) and say ‘I need so and so much’.
(…) And then I told one [from the staf ], ‘Listen, I don’t get why you don’t just call the cops
when you see so much of this [drug dealing] going on.’ Because otherwise the place [H17]
will be closed. And then we will be back to fxing on…[the streets]. If I had known there
had been so much tension in there today, I had never gone inside to fx. (…). Then I hadn’t
done it ever. I also make sure to put away all of my stuf [not to get robbed].
(Søren, 42)

It was not only drug dealing, or exchange and sharing of drugs that users mentioned as
activities that are common outside but also occurred inside, and which could disturb the
drug-using experience. Another disturbance was created by allowing people, who did not
bring their own drugs to consume to come inside the DCR. They would sometimes try to
buy or ‘hustle’ drugs inside, which could disturb other users. Nina, for example, explained
how other users disturb her by trying to hustle her.

You don’t have the time to … well, you could enjoy it, if you didn’t get all those dis-
turbances once in a while. People come and ask you, ‘Can I get your cotton?’, ‘Can you
spare a line?’ all that stuf you know?
(Nina, 51)

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For several of the users we interviewed, when they got disturbed by other users or there
was a noisy atmosphere, the DCR provided less than optimal conditions to ‘enjoy the kick’
(Duncan, Duf, Sebar, & Lee, 2017b). This could lead some of them to go somewhere else to
use drugs, as mentioned by Søren above. However, it is not just push factors like disturbances
from other users that can make users go somewhere else to use drugs; there can also be a
combination of push and pull factors. Flemming, for example, likes to enjoy his cocaine in
the sun, just like other people may like to enjoy a beer.

Otherwise I go outside. Just not when the weather is like it is today. But when the
weather is sunny I much more prefer sit outside and take a hit of coke and enjoy it in the
sun. Just be by myself instead of having people shouting all the time ‘hey ma’, and people
coming up ‘hey can I have your cotton?’ [cotton used to flter the drug] […] while you
are enjoying your trip, or something. Then you get angry, because then it ruins your
high. So that’s why I go out in the sun.
(Flemming)

Søren from above also explained how he sometimes prefers to fnd a quiet spot in one of the
narrow niches and allies in the old Meatpacking District outside the DCR to optimize the
efect of the drug.

I: And you don’t need health workers to be present?

S: No. It gives … somehow it would be best … but if I have to choose between that and all those troubles
[inside the DCR], then I would rather do without. Then I have to take the chance. (Søren, 42)

In both cases, there is a trade-of that involves the enjoyment of drugs and, prompted by
the question by the interviewer, we fnd out that for Søren, the enjoyment of drugs’ efects
balances out the risks associated with using drugs outside. In the research on drug use in
diferent settings in Barcelona by Clua-Garcia (2020), we see similar considerations about
which settings provide the best conditions for an intoxicating experience, and his research
also shows that a public setting may sometimes be preferred instead of a DCR. The research
by Small and colleagues also indicates similar considerations. They discovered that users
would prefer the DCR precisely because they were not disturbed and hustled by other users.
This was an efect of the rule that users were not allowed to share drugs.
Another trade-of relates to the fnancial aspects of using illicit drugs. Niels ofered the
reason that using drugs at H17 was too expensive for him, because he had to increase the
quantity of drugs he took to compensate for the noisy atmosphere.

I have started to do it at home instead because I get more out of it at home than I do in
here. In here, there is so much noise that I don’t get anything out of smoking cocaine.
When I want peace and quiet, then many times I just go in here to get the drugs and
then go home again… because a 200 kr. bag will last three to four hours at home and 20
minutes in here. So, it is logical that I come and go.
(Niels, 40)

But later in the interview he told us that sometimes he would choose to use drugs at the
DCR even though it was expensive, because for him drug use was not just about a particular
way of getting intoxicated; it was also a social activity.

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So, while the functioning of the DCR sometimes may make it difcult to engage in a
mode of use that involves solitary intoxication without disturbance, it did aford the oppor-
tunity for more social modes of using drugs.
For many people, drug use is a social activity and the DCR is a new context for this
activity. The literature on DCRs has touched upon this aspect more or less directly. Small
et al. (2012) discuss how a Vancouver DCR severs, or at least severely curtails, social relations
between users by prohibiting sharing and splitting of drugs. The same kind of individual-
ization of drug use can be inferred from descriptions of other DCRs (Duncan et al., 2017a;
Small et al., 2011) and by looking at their designs, particularly the construction of separated
booths for injecting drug use. While this makes sense from a clinical perspective, it may not
make sense for people for whom drug use (sometimes) is a social activity and not just a matter
of (the most hygienic) injection of drugs. As mentioned above, this was the case for Niels.
He describes how sometimes he would go home to consume his drugs, because the quieter
setting of his home would maximize the intoxicating experience of his drugs, but sometimes
he also wanted the company of others when he used drugs, and then he would stay at the
DCR. Niels continued:

But, sometimes, you are stupid enough to sit in here to have a good time and things like
that. But then it is just more expensive.
(Niels, 40)

For Niels and others like him, using H17 is not so much a negotiation or trade-of between
enjoying drugs and harm reduction as it is between diferent ways of enjoying drugs and
how this is afected by diferent drug-using settings. To maximize the drug efects, Niles
would either choose to go home to use drugs or to enjoy the company of others, he would
go to H17.
For some users, drugs are not even the primary reason why they visit the drug scene and
use the DCRs. For these users, it is just as important that the drug scene is a place – for some,
the only place – where they can interact with other people without experiencing stigma-
tization (Houborg & Holt, 2018). Drug-related activities, including drug use, is, of course,
central to the social interaction between people at the drug scene, and for this reason, the
fact that the DCR provides a place to meet around drug use outside the gaze of the public
is important. A user explained how the setting creates a particular kind of sociability that is
a rush for him.

It could be, for example, that I feel like talking to that woman over there. That can be
a rush for me. It is a kind of dependency, right. I can easily stay an hour and get some
emotions up running with her, right. Then I get tired of that, and then I try to fnd
somebody who also needs something [drugs], and I try to fnd somebody who has some-
thing I can be in on.
(Rami, 37)

One could say that the DCR and the drug scene around it can mediate practices that
allow marginalized drug users to be part of recreational activities equivalent to ‘party
users’ in clubs and bars (see Duf, 2007). The examples illustrate how this particular
mode of recreational use can facilitate pleasures, for these users, that would not occur
in other contexts.

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Negotiating time
The freedom to arrange the drug using situation the way you want to, without having to
adhere to various rules and regulations, has been mentioned in the research literature as a
reason for people not to use DCRs (Clua-García, 2020). While none of the users we inter-
viewed explicitly mentioned the freedom to use drugs the way they wanted to, some of the
reservations that users mentioned about using drugs in H17 can be interpreted as having to
do with lack of freedom. One aspect of this concerns time: the time users want to consume
and enjoy drugs and the period of time they are allowed to take up a seat inside the DCR.
Managing a DCR can involve this balance between ‘drug time’ and ‘bureaucratic time’.
On the one hand, the DCR has to manage the demand for using the service, which is done
by giving users time slots during which they can consume their drugs. On the other hand,
these time slots may not be enough or may be cut short for various reasons. Furthermore, us-
ers may have to queue, which sometimes can be difcult if they are experiencing withdrawal
symptoms. If there is too much of a discrepancy, users may choose to use drugs outside the
DCR (Small et al., 2012). Regulating time is one of the important tasks of the staf, and
keeping time and getting time is one of the issues that can cause controversy in everyday life
in the facility.
Nichole, who always uses drugs with her boyfriend, Chris, told us how the staf some-
times interrupt their drug-use session before their time slot is over and how, for her, this
spoils the pleasant experience of using cocaine. She commented that she and her boyfriend
spend a signifcant amount of money to buy the drugs and indicated that the money is lost
if they are interrupted. We asked her if the time she is allotted inside H17 is enough, and
she said that mostly it is, but that when many people are queuing up, the staf may cut their
time short.

Yes, in most cases, but sometimes when the pressure is high [many users wanting to use
the facility], even though they say 45 minutes right, then they come in before time. You
have just had time to inject. And that’s not cool, when you have been sitting for like 5,
10 minutes and then they enter and slap that in your face.

She continues to explain that she and her boyfriend have a particular way of arranging them-
selves to enjoy cocaine for a short time and how the staf accommodates them.

Like I said, we may have used like 800 kr. on coke. Because coke does not last for long,
we’ve found out that we can chill out for maybe half an hour in here. They know that
we always lie down to enjoy it afterwards. And then we signal to them that we are all
right. We’ve been coming here for many years, so they know us. So that is…that is really
nice, yes.
(Nichole, 42)

Nicole explained how she and her boyfriend have a mode of use that involves particular ex-
pectations and rituals when they use cocaine and that H17, for the most part, is a setting that
allows them to have this mode of use. However, she also told us that this precarious setup
can be disturbed, for example, when the staf cut their ‘time’ short to increase the fow of
users through the facility.
Other users explained in a similar way how they do not get the efect of the drugs they
want if they are interrupted by the staf shortly after injecting. Nina, for example, explained

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how inside H17, ‘there is time on everything, right, and that is so stressful’. Her friend, Nina O,
emphasized this when she said, ‘Yeah, when we sit and smoke, then many times we only get to make
it [the rock] ready, and then we have to leave, and that’s why we like better to take it home, where it is
much snugglier’. At home, she can arrange the drug using setting the way she wants, and do
things at her own pace and avoid the distress of being on a schedule.
Many users waiting to get in, particularly during the cold season and when the weather
is bad, can put pressure on the staf to increase the fow of users through the facility, both to
avoid too much unruliness and to allow as many as possible to beneft from the DCR. This
means that the staf need to consider trade-ofs between harm reduction and recreational
time. The dilemma is that a reduction of recreational time can also increase harm because
some users will choose to go somewhere else where they have more time to enjoy the drugs,
or will need drugs again within a short period. However, too long a waiting time can also
make users go somewhere else to use drugs (Clua-García, 2020; Small et al., 2012, 2011).
But for some users, an interaction can occur between time, the ways they ingest drugs, and
the weather and this interaction can sometimes be very stressful and painful. For example,
for Halim, who smokes heroin, it is important to get inside H17 to use his drugs because
the wind and the weather can infuence how much efect he gets from the drugs. This can,
however, involve a long and painful waiting time because he gets withdrawal symptoms:
‘Because it was windy and raining, and I didn’t have much money, so I had to wait and wait and wait,
and I got pain all over my body’ (Halim, 58). For a user like Halim, the DCR is an attractive
place to smoke his drugs, because it provides shelter. For him, the trade-of is between ex-
periencing withdrawal symptoms and losing the efects of the drugs because of the weather.
This dilemma is, of course, even more pertinent for people who do not have alternatives to
public space and a DCR. A fnal dimension of time that we want to mention involves users
who need more time than the rules allow, because they have difculties fnding useable veins
and hence get less (too little) time to enjoy the drugs when they have consumed them. When
there is no queue, users are allowed to stay longer inside the DCR.

Framing modes of use

The design of H17 – and other DCRs described in the literature – creates conditions for
particular modes of use, often as a consequence of safety considerations (Duncan et al., 2020;
Small et al., 2011). It is thus clear that a diference is constructed between smokers and in-
jectors and their modes of use. In the injection area of H17, there is only one room where
two injectors sit behind a closed door and consume drugs. In the rest of the injection area,
the users sit one by one in separate stalls with no door to close behind them. This means that
injection use is mainly framed as an individual activity, not a social activity, and framed in a
way that leaves little room for privacy. The rationale for this design is to make injection drug
use safer. However, smoking occurs in booths where you can be in the company of others
and with the possibility to close a door behind you. Smoking thus seems to be framed as a
more sociable and private activity than injection. The material design and the types of social
interactions and social relations it allows makes some modes of use possible, while other
modes of use are made more difcult to achieve.
Several of the injection users mentioned that they would like separate rooms where they
could close the door, just like the smokers. For this reason, some injection users said that they
prefer to use drugs somewhere else, because they like privacy and/or enjoy the company of
others when they use drugs. The user below suggested that injecting drug use is, for him,
sometimes a social activity which the physical setting only allows to a limited extent. He

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added that a separate room would also provide better isolation from the noises coming from
the smoking area of the facility

I: Is the layout of the injection rooms alright?

U: No.
I: What’s the problem?
U: I thought they would make booths for all.
I: Private booths?
U: Yes, with glass doors, and then make them two-and-two.
I: Oh, so you could sit two persons together?
S: Yes, [now] they have one room with two chairs and two tables, which is closed by a door. It should also
be like that with the rest. Because then you can avoid all that noise and shouting and those people
at the other end [the smokers]. That was what I told them when they built it. […] And then what
happens? The smokers get it. […]. One person from the staf said to me it has to do with ODs—
ODs, man! Shut up—put in some glass doors, so you can see when people slide down. (Søren, 52)

For some users, injecting cocaine evokes a sense of togetherness, which calls for a setting
with the possibility for intimacy. Nina and her friend, mentioned above, told us that when
they use drugs together, they sometimes like to lie next to each other, but the design of
the injection room does not include the possibility of lying down comfortably. So for them
the physical setting does not always provide a satisfactory setting for some modes of use.
Instead, they go home and arrange themselves a ‘snuggly’ setting for using drugs, as men-
tioned earlier. This experience could be interpreted as an experience of lack of freedom to
engage in your own practices and rituals when using drugs and the possibility to arrange the
drug-using setting in accordance with your own preferences. In his research, Clua-Gardia
(2020) found that some users would prefer to use drugs at home or in public spaces, because
it allows them more freedom. One thing that users in Clua-Garcia’s study mentioned, that
was not mentioned by users in our research, was that they did not like to be observed when
using drugs. But perhaps the request for more privacy from some users could be interpreted
as involving this dimension.

Diferent settings and diferent modes of use

In some of the interviews, respondents talked about how they had diferent modes of use
that were associated with diferent situations and diferent settings, as well as diferent feel-
ings, attitudes, and identities. This was indicated by Niels above, who used drugs at home
to get the best intoxicating experience and used drugs at the DCR to get a recreational
experience. However, he also mentioned that sometimes he engaged in another more social
mode of use that involved the company of others inside the DCR. This implies that Niels
has diferent modes of use depending on what he expects from using the drugs in a specifc
situation and this, in turn, infuences his decisions about whether to use the DCR or not. Ali
also has diferent modes of use that he associated with diferent settings. He mainly smokes
heroin but also uses cocaine, and, in addition, takes prescribed methadone. Depending on
his fnances, he consumes drugs 5–15 times a day. When we talked with Ali, he told us that
one of his biggest concerns was not being able to fulfl his role as a parent, son, brother, and
friend. During the interview, Ali expressed guilt, shame, a bad conscience, embarrassment,
and loneliness associated with distancing himself from his family and non-using friends. His
drug use is thus connected with negative and demoralized feelings, which make it difcult

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for him to fnd a setting where he can enjoy drugs. The DCR was a legitimate place for him
to use drugs.

I: Yes. It is because you want to take the drugs inside the rooms [DCR]?
A: Exactly!
I: Because you don’t want to take it alone?
A: Well, I do want to take it alone. It’s just that there are no places where you can take it…well, I can
go home to my own place. But I don’t want…my boys also come to visit…I don’t want it to smell
and stuf like that, right. So that’s it. Sometimes I smoke at home, but that is very rare. (Ali, 52)

Ali’s main concern is not minimizing drug-related risks, but having a place to use drugs
that is less emotionally and mentally stressful and stigmatizing. But sometimes Ali would
use drugs at home. Not in order to enjoy the intoxicating experience of the drugs, but to
relieve withdrawal symptoms. In this way, drug use at home was associated with a medical
mode of use.

But then, of course, sometimes I smoke at home. For example, in the mornings, if I have
something left from the day before and if I am sick [withdrawals], then when I get up,
I smoke it, of course.
(Ali, 52)

In other words, Ali has diferent modes of use in diferent settings where drug use has diferent
functions and meanings and involves diferent practices. Other users also talked about what
we call diferent modes of use. Most often, this involved a distinction between ‘medical’ and
‘recreational’ use, that is, using to relieve withdrawal symptoms and using to ‘get high’. One
participant, who has 15 years of drug-use experience, said, ‘I’ve only used H17 to sleep in or if I
had to take the methadone tablet, but that is just medicine, so…’ (Inuk). Inuk does not get prescribed
methadone, but buys it on the illegal market, but still perceives it as medicine and not a recre-
ational drug. One could say that to Inuk that H17 has a very diferent, almost opposite, conno-
tation than it has to Ali. H17 does not provide a recreational setting for Inuk as ‘there is always so
much noise and disturbance, and when I want to enjoy my drug, then it should rather be peaceful’ (Inuk).
The recreational mode of use happens outside the DCR and Inuk did not have an issue with
using drugs in public or semi-public spaces like underground parking lots.

Conclusion
DCRs are harm-reduction services that can minimize drug-related harm like fatal overdoses,
and the transfer of blood-borne diseases such as HIV and HCV. These risk-minimizing
functions are an important reason why people use DCRs. It would, however, be a mistake
to think that people use DCRs just to minimize the risks of drug use. Our own, as well as
other research, has shown that there can be other reasons to use DCRs, including reduction
of everyday risks associated with life as a marginalized person who uses drugs (McNeil &
Small, 2014; Rhodes et al., 2006; Small et al., 2012). But risk should not be the only term by
which to understand the function of DCRs for people who use drugs. A DCR can function
as a setting for enjoying drugs (Duncan et al., 2017a) and receiving care (Duncan et al., 2019)
and to socialize with other people who use drugs.
Our study has contributed to the literature on DCRs that try to provide a broader un-
derstanding of DCRs than just being harm-reduction services, by building on previous

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 Esben Houborg and Siv Schjøll Berge

research and adding new perspectives. Like Clua-Garcia (Clua-García, 2020), we have been
interested in understanding how a DCR can be one of several settings where people can use
drugs and, like Clua-Garcia and the research from Vancouver by Small et al. (2011, 2012),
we have also been interested in things that can both make DCRs attractive or less attractive
as places to use drugs. Although the previous research has touched upon diferent dimen-
sions that make DCRs attractive or unattractive, like the role that rules and regulations,
noise, and other things play, the main focus of this research is on risk, particularly the way
users themselves perceive risks and manage risks. We have wanted to extend the focus from
primarily being concerned with risk. In order to contribute to the understanding of how
people consider using drugs in diferent settings, we introduced the two heuristic ideas of
‘trade-ofs’ and ‘modes of use’. The former provides a concept for considerations expressed
by users when they considered things that were attractive and less attractive when deciding
to use drugs in diferent settings. The latter was inspired by research done by Gomart (2004)
to provide a concept for diferent ways of using drugs that can have diferent functions and
be associated with diferent expectations and rituals by the users. By using these tools, we
sought to grasp the variability that can be involved when using drugs and how this variability
is related to diferent settings. We found that for some users, the DCR provided a suitable
setting for particular modes of use, for example, for a mode of use where drug use was a so-
cial activity that involved the company of other drug users. However, some users did not see
the DCR as an appropriate setting for a solitary mode of use where the main objective was
to have a particular intoxicating experience. We found that the design and the management
of the DCR seem to be more accommodating for some modes of use than others. Private
injection use in the company of another person was difcult, because only one separate room
was available for injection users, while others would have to use open stalls. We also found
that some users found it difcult to make the room accommodate their particular rituals and
practices when using drugs (lying together on the foor).
We have been interested in the negotiations that are involved in using and not using the
DCR and the diferent trade-ofs involved. On this basis, we were able to see how diferent
people use the DCR in diferent ways and have diferent considerations about whether and
how to use it. We identifed several trade-ofs, including negotiations between harm reduc-
tion and pleasure, between drug efects and sociability. However, most of the trade-ofs in-
volved diferent aspects of pleasure and enjoyment in relation to drug use, including enjoying
drug use as a social activity with other people and how this is infuenced by the drug, and the
setting of the users. While using drugs is a recreational social activity that many of the users
enjoy doing with other people, it is clear from our fndings that one of the main challenges
for H17, and we suspect for DCRs in general, is to accommodate various modes of use. For
example, our fndings show that it can be a major challenge to have crack and opioid users
in the same setting if they are not properly separated. Similarly, our fndings show that it
is important to pay close attention to which aspects of the drug scene outside of the DCR
should be allowed inside it. If too many or the ‘wrong’ aspects of the drug scene are allowed
inside, it can reduce the number of diferent modes of use that are possible in the facility,
and some people will choose to use drugs in other places because using the DCR does not
involve a positive trade-of.
Our research indicates that when designing and managing DCRs, attention should be
paid to how they can accommodate diferent modes of use. But sometimes it may be just too
difcult to make a DCR compete with other settings for particular modes of use, such as a
recreationally relaxed mode of use on a nice sunny day.

236
 Trades-offs

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 15
INTOXICANTS IN WARFARE
Łukasz Kamieński

The confation of “drugs” and “war” is usually associated with the “war on drugs”. This,
however, is not only the most recent appearance of the age-old synergy between intoxicants
and warfare, but is also somewhat paradoxical, because historically force has been employed
for the very opposite reason: not to suppress illicit substances but to secure drug markets.
Armed conficts were thus at times waged “for drugs”, of which the mid-nineteenth-century
Opium Wars are the primary example. Over the centuries, with mind-altering substances
gaining in potency and with warfare becoming increasingly “drugged”, the intoxicants-war
relationship has expanded and become intertwined, from the medicinal use of psychoactive
substances to their supervised administration for the enhancement of combat performance,
the funding of war-making with tax revenues and illicit drug production and trafcking to
the attempted weaponization of intoxicants, and from soldiers’ unauthorized recreational
drug-taking to veterans’ struggles with addictions and the changing patterns of post-bellum
substance manufacture, consumption, and regulation. This chapter aims to crack the code
of two of these types: the use of drugs by soldiers (both self-prescribed and authorized by
the military) and the employment of psychotoxic substances as chemical non-lethal weapons
(NLWs). To this end, it seeks to briefy outline some aspects of the multifaceted psychophar-
macological landscape of warfare across compounds, use patterns, continents, and time, with
the main focus on the twentieth and twenty-frst centuries.
Two recent examples prove that intoxicants continue to play a role in military afairs.
First, in February 2019, Major Emre Albayrak, a US Marine Corps ofcer, put forward a
bold proposition. He argued for the microdosing personnel with psychedelics to enhance
intelligence operations, and perhaps also combat performance. Microdosing 10–20 micro-
grams of lysergic acid diethylamide (LSD) is sub-perceptual, i.e., insufcient to produce any
hallucinogenic or harmful efects, but sufcient to provide noticeable cognitive augmenta-
tion. Albayrak’s advice, given this, was that supplying soldiers with minute quantities of LSD
should be considered (Albayrak 2019).
The second case is this: in March 2017, the US Patent and Trademark Ofce granted the
Californian company Saint Brand Cannabis a patent for a “Cannabinoid formulation for the
incapacitation of a human or animal” designed for “rendering a subject intoxicated, incapac-
itated, and/or immobilized” (Cannabinoid 2017, 1). The inventor touted a marijuana-based
NLW as perfect for riot control and urban warfare, notwithstanding the fact that the use

DOI: 10.4324/9780429058141-19 239

 Łukasz Kamieński

of incapacitating agents in armed confict is outlawed under the 1993 Chemical Weapons
Convention (CWC 1993, article II.2).
Stories about intoxicants in military contexts are usually perceived as sensational, but
the fact is that combatants have self-medicated with a variety of drugs throughout most of
history. The practice, even if ofcially not permitted, was usually overlooked insofar as it did
not undermine combat efectiveness and troop morale. Equally unexceptional was the ap-
proved employment of drugs either to improve the performance of an army’s own units or to
impair the fghting capacity of the enemy. Therefore, neither military pharmacological en-
hancement nor the concept of psychochemical armaments are new phenomena. If examples
like the two aforementioned propositions – for personnel augmentation with microdoses of
LSD and a cannabinoid weapon – generate public astonishment, it is because such practices,
although well-established, have not hitherto been widely known.

Te taboo: intoxicants, war, and historiography

While the “war on drugs” has been studied extensively (for a recent take on the subject,
see, i.e., Crandall 2020), the use of mind-altering substances in contexts of armed confict
has been generally neglected in scholarship. Until recently, intoxication was not seen as
an appealing subject for the discourse on war, and the topic was given greater attention by
the historians of drug use and control policies (Courtwright 2001; Davenport-Hines 2004;
Rasmussen 2008), yet with little infuence on military historians. Five reasons as to why the
relationship between intoxication and war was for so long an untold story can be identifed
(Kamień ski 2016a, 293, 2016b).
First, because until the mid-twentieth century the therapeutic use of drugs (such as alcohol,
opium, morphine, heroin, cocaine, and amphetamine) was commonplace, it was generally not
at issue. Substances that today are controlled for being harmful were formerly legal and vital
medicines. As a consequence, there was also little debate about dependence among soldiers and
returned veterans, who developed their addictions through treatment or self-medication. The
military use of psychopharmaceuticals as such also received scant attention, often leading to a
situation in which the line between therapy and enhancement was blurred.
Second, the employment of intoxicants by armed forces was, overall, kept covert. Secrecy
was crucial when the goal was to improve combat efciency and thereby gain or main-
tain tactical edge. Clandestineness was even more important when psychoactive compounds
were used, or being attempted to be used, as a weapon, either to subvert the enemy or its
civilian population (by supplying drugs to undermine their fghting power and resilience) or
to incapacitate them (through militarized psychochemical agents).
Third, since the early twentieth century, secrecy has been further fostered by the ambigu-
ity of the practice of drugging the ranks. The development of proscriptive and prohibitionist
policies, beginning in the 1910s with the Hague International Opium Convention of 1912
and the US Harrison Act of 1914, made the approved use of intoxicants among militaries
increasingly taboo (Kamień ski 2016a, 293). A government that penalizes mind-altering sub-
stances would want to keep covert their authorized distribution to servicemen. This double
standard has been obscured by a veil of secrecy, which has also encompassed the feld of
scholarship.
Fourth, the research on combat motivation overlooks the pharmacological factor because
it is unsettling for the authorities to acknowledge that such powerful forces as patriotism or
nationalism may not sufce to commit citizens to battle. British military historian John Kee-
gan gave a concise answer to the question of “why soldiers fght”: it is because of inducement,

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coercion, and narcosis (Keegan 1997). The frst incentive, a positive motivation, is achieved
through socialization into military life, bonding, ideology, good leadership, and rewards.
The second reason, a negative motivation, comprises training, discipline, obedience, and
sanctions. However to inspire courage and help them endure the hardships of the battlefeld,
soldiers would often need a psychoactive stimulus.
Finally, many scholars have simply seen intoxicants and intoxication as irrelevant in ex-
plaining war. This view located drugs outside mainstream military history, next to such
niche topics as contagious disease, climate, or sex. But as the feld of military history has ex-
panded beyond its formerly narrow boundaries, what was previously neglected is now con-
sidered a proper subject of study, be it epidemiology, environment, or sexuality. Similarly,
the growing body of literature on the war-related functions of intoxicants is a harbinger of
a long overdue “pharmacological turn” in war studies (Andreas 2020; Bergen-Cico 2012;
Kamień ski 2016a; Kan 2009; Ohler 2017; Pugh 2018).
Calling for a cultural history of alcohol in France, Thomas Brennan argued that “we
can learn a great deal about society through the prism of a wine glass” (Brennan 1989, 85).
Likewise, it has eventually become acknowledged that a great deal can be learned about war
and the military through the prism of intoxicants. The recognition of the roles that psycho-
pharmacology has played in armed conficts provides an alternative and complementary per-
spective. It ofers to shed new light on the three levels of analysis which Paul Kennedy calls
“war from below” (the individual experience of fghting), “war from the middle” (how things
got done and who did them at the tactical and operational levels), and “war from above” (the
strategic and diplomatic conduct of a confict) (Kennedy 2010, 38). The main focus of this
chapter is the second one; it will also consider, to a lesser extent, the frst level.

An overview of drug use by combatants

Men have fought while intoxicated on plentiful occasions for much of history. It is, therefore,
imperative to identify the main motivating factors for and patterning of the use of intoxi-
cants in military settings. Medical treatment apart, these can be grouped into fve central
categories discussed in this section: (1) soothing nerves and raising fghting spirits, (2) im-
proving stamina, endurance, and performance, (3) limiting or mitigating the mental cost of
combat, (4) fostering group cohesion and boosting morale, and (5) killing the monotony and
banality of daily soldierly life. These are examined in detail through the historical examples
of particular wars, military operations, and their efects on warfghters; more detailed con-
textual information is provided by the literature referred to throughout the chapter.

Inspiring courage
In The Anatomy of Courage, Lord Moran, Prime Minister Winston Churchill’s physician,
argues that every soldier has a certain supply of courage: it is “his capital and he is always
spending” (2007, XXII). While no one has unlimited reserves, it is possible to recharge
them. Invoking Moran’s metaphor, intoxicants, like alcohol and opium (which, although
they are typical depressants, both can work as mild stimulants when taken in small doses),
cocaine, and amphetamines, may serve as replenishers of courage. The problem, however, is
that these supplementary chemical supplies cannot be saved for later use, and the repeatabil-
ity of dosing-for-recharging involves the risk of habit-formation. Thus, the double-edge: in-
toxicants have lifted soldiers’ morale and bravery but also quite often impaired their combat
capability and created the problem of addiction.

241
 Łukasz Kamieński

The most favorite pharmacological motivator is alcohol, the provider of the proverbial
“Dutch courage”. This expression, common in English since the seventeenth century, de-
rives from the insult used by the English soldiers deployed in the Netherlands during the
English-Dutch wars toward their Dutch counterparts, who they saw as unable to fght un-
less drunk, usually with gin (Purdy 2015). Liquid courage, however, dates back longer, to
pre-modern times. Victor Davis Hanson, a prominent scholar of the Greek way of war, con-
tends that a Greek hoplite marched into battle drunk and probably fought slightly inebriated.
Wine could “stanch his fear, dull his sensitivity to physical injury and mental anguish, and
make the awful task of facing an enemy phalanx that much easier” (2000, 121). Over the
centuries, nations developed and adapted their specifc drinks of choice. The Romans, just
like later their Italian descendants, preferred wine. So did the modern French, though a stan-
dard wine provision replaced a small daily ration of distilled alcohol only early in the twenti-
eth century. The Germans commonly issued beer, but also schnapps and wine. The Russians
relied on a vodka allowance known as charka (125 milliliters), which was institutionalized in
the eighteenth century. For their part, the Americans initially doled out rum, but switched
to whiskey after the Civil War of 1861–1865 (Andreas 2020, 24–36; Dunbar-Miller 1984;
Herlihy 2002, 56; Kamień ski 2016a, 5–14, 19–21).
Perhaps best-known in the modern experience of war are the British rum rations during
WWI. In the eighteenth century, rum replaced the earlier customary provisions of wine,
beer, and brandy, but the practice was discontinued in the 1890s. However, when in Sep-
tember 1914 the British forces arrived at the Western Front, the regular allowance was re-
introduced, justifed exclusively on medical grounds as a remedy for fatigue, stress, and the
hardships of arduous campaigning. The standard ration of thick, 80% proof “fatigue rum”
was 2.5 ounces (about 70 milliliters), issued daily in the trenches. To give heart to men before
they went over the top, a double portion was dispensed (Dunbar-Miller 1984; Holmes 2004,
329; Kamień ski 2016a, 18–19, 2019).
Overall, wars have rarely been fought sober. For most of history, it was beyond question
that soldiers must be routinely provided with “liquid courage”. In 1777, at the height of the
revolutionary struggle against Britain, general George Washington captured this common
belief well: “the benefts arising from the moderate use of strong liquor have been experi-
enced in all Armies and are not to be disputed” (in Gately 2008, 196). But soon they were
challenged, for while moderately consumed alcohol can provide courage, when abused it
might threaten to seriously ruin discipline and fghting power, as soldiers come to be “more
interested in bottle than in battle” (Andreas 2020, 41). In fact, alcohol has caused problems
to the military since antiquity and at times inopportune drinking led to defeats (Chafetz
1965, 20–23, 159). In modern times, armies increasingly struggled with drunkenness among
the ranks, which already in the eighteenth century became a serious issue, for example, in
the British armed forces. It was, however, in Russia that the consequences of heavy drink-
ing were particularly devastating; following the 1917 revolution, the Bolsheviks launched
an anti-alcohol crusade, deeming drunkenness counter-revolutionary. Yet, this temperance
campaign was not a great success, and in late 1941 daily vodka allowances were reintroduced
to hearten the Soviet troops to face the Wehrmacht (Kamień ski 2016a, 15–16, 23).
WWII marked the beginning of the end of standard provisions of alcohol in soldiers’
rations, though the US units deployed to fght in both Korea and Vietnam continued to
receive their everyday allowance of beer (Andreas 2020, 63). Although modern militaries
have sobered up, and although contemporary institutional military culture prohibits drink-
ing, alcohol remains a popular, albeit no longer authorized, means of relieving the fear and
stress of combat. Drinking for courage has been largely taken over by drinking to become

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desensitized to the realities of combat, a pattern of motivation which involves a higher risk
of abuse. For instance, it was misuse and abuse of alcohol that posed a greater challenge to
discipline in the US ranks deployed to Vietnam than the widely publicized heroin or mari-
juana taking (Kuzmarov 2009, 35).
Moving on to non-alcoholic examples of lubricants of courage, the African Zulus owed
their reputation as fearless warriors not only to their inborn belligerence. When conquering
the Zululand in 1879, the British Army encountered an enemy who supported themselves
with a wide spectrum of psychoactive alkaloids. These energized the warriors’ bodies but
also afected their minds, rendering the Zulus amazingly brave. Shamans provided them
with herbs, such as intelezi (a traditional plant taken in purifying rites to boost group morale),
medicated beer, dagga (the South African variety of cannabis which, initially after being
taken, has a stimulating rather than sedative efect), and probably also the toadstool known as
Amanita muscaria or “fy agaric” (Bryant 1949, 222; Kamień ski 2016a, 84–88; Kan 2009, 47).
The mushroom was certainly for a long time in circulation among the warriors of the
Siberian tribes of Chukchi, Kamchadals, Koryaks, Yakuts, and Yukaghirs. A raw Amanita
muscaria has mild psychoactive efects, but when dried it develops potent neurotoxic prop-
erties (during the decarboxylation process one of its compounds, ibotenic acid, is converted
into the muscimol alkaloid, which is a sedative-hypnotic agonist of the GABAA receptors
in the brain’s award system). The efects are both hallucinogenic and stimulating: the fungus
boosts the brain, triggers the thirst for action (in particular provoking motor hyperactivity),
and alters perception by generating the feeling of omnipotence (due to the efect known as
micropsy, which makes the surroundings appear as diminished). Because the urine of the
Amanita eater retains strong psychoactive properties, having had harmful toxins fltered out
of it, urine drinking was very popular among the Siberian tribes and their warriors (Mann
2000, 221). Narratives say that the mycophilic tribes of muscaria lovers produced ferce,
muscimol-triggered warriors. Similar efects were also documented in modern accounts.
During the war between Sweden and Norway in 1814, some Swedish soldiers got high on
Amanita and fought in “a raging madness, foaming at the mouth” (Wasson and Wasson 1957,
192). In 1945, a group of Soviet soldiers, presumably from Siberia, was reported as perform-
ing fearlessly while under the infuence of “fy agaric” at the battle of Székesfehérvár in
Hungary (Kamień ski 2016a, 38–40; Rudgley 1993, 40–41).
If prior-to-battle pharmacopoeia has assisted in preparing soldiers for combat by relieving
fear and fostering a fghting mood, it has also helped in empowering them and keeping them
in line when the actual fghting starts.

Enhancing performance
The less prone to fatigue and collapse troops are, the greater their edge vis-à-vis the adver-
sary. In pursuit of superior strength, fghting endurance, vigilance, and resilience, combat-
ants have every now and then been reinforced with stimulants which reduce tiredness and
the need to sleep, promote alertness, build up stamina and self-confdence, and suppress
hunger. Uppers can not only maintain but also expand fghting efectiveness. Diverse sub-
stances have been used in this way to make for more efcient warriors, such as alcohol (in
small amounts), cafeine, tobacco, coca and cocaine, cola nuts, khat, amphetamines and
amphetamine-like stimulants (ATS) and nootropics.
In the nineteenth century, European militaries began to embrace what traditionally had
been practiced by the Andean peoples and armies: chewing coca leaves for improved endur-
ance. Then, in 1883, a Bavarian army physician, Theodore Aschenbrandt, carried out the

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frst experiments on soldiers with cocaine. He speculated that its appetite-inhibiting proper-
ties could help cut army food supplies by as much as 20% (Streatfeild 2002, 67). In the early
twentieth century, mass-produced and in widespread use, cocaine found its way to the bat-
tlefeld. It was not, however, its already common therapeutic application as a local anesthetic
that proved most benefcial during WWI. Cocaine was both issued and taken unsupervised
for enhancement, although the scale of this consumption remains impossible to estimate
due to the lack of ofcial records. Limited and often circumstantial evidence suggests that,
blended with food rations, a powdery compound was dispensed by some of the belligerent
armies to keep their units soldiering by improving their spirits and helping them stay awake
and focused (Kamień ski 2019).
Cocaine “fortifed” early German and French pilots, who took it on long-distance sorties
(Woods 1931, 42). The British Army made use of “Forced March”, a mix of cocaine and cola
nut extract. The medicine, part of the Tabloid brand products by Burroughs Wellcome &
Co., was advertised to “allay hunger and prolong the power of endurance”. One tablet “ev-
ery hour when undergoing continued mental strain or physical exertion” was recommended
(in Kamień ski 2016a, 97). Having known that at the beginning of the twentieth century,
“Forced March” had proven benefcial during polar expeditions, assisting Roald Amundsen
and other explorers of Antarctica, the Army’s command decided to made use of the product
too. Thus, the British troops “imbibed these convenient pills, perhaps helping them endure
the rigors of trench warfare” (Bourke 2010, 1817).
Early in WWI, the German Army Command intended to issue every soldier daily rations
of cocaine to suppress their appetite and increase resilience, but the project was abandoned due
to a limited stock of the drug (Hobhouse 2003, 230). However, when at the outset of WWII, a
similar idea was devised, the military was well-equipped with a much more potent stimulant:
methylamphetamine. Manufactured as Pervitin by the Berlin-based Temmler-Werke company
and available in the market from 1938, it became a very popular supplement in German society.
This early version of meth, which produced high- and long-lasting alertness, found its way
also to the military (Ohler 2017, 34–48). Between April and December 1939, Temmler sup-
plied the Wehrmacht with 29 million 3 mg Pervitin “assault” pills (Kemper 2002, 128). Large
amounts were distributed to medical ofcers during the invasion of Poland in September 1939
to be tested to combat fatigue (Steinkamp 2007, 63). The Polish campaign turned out to be
not only a dry run for the lightening ofensive maneuver war of Blitzkrieg but also a battlefeld
experiment in the use of stimulants. The results were encouraging: Pervitin proved useful in
keeping men alert and profcient (Beevor 2017; Ohler 2017, 62–66; Snelders and Pieters, 2011).
Consequently, during the conquest of the Netherlands, Belgium, Luxemburg, and France in
the spring of 1940, German troops were issued some 35 million tablets (Rasmussen 2008, 54).
With its great speed and scope, the Blitzkrieg was “powered by amphetamines as much as it was
powered by machine”, with some soldiers taking up to four Pervitin pills a day for weeks on
end (Rasmussen 2008, 54). Soon, however, meth’s side-efects – such as hangover, nervousness
and aggressiveness, addictiveness, and higher accident and suicide rates – were discovered. Its
use was therefore limited and in December 1940, consumption dropped tenfold to 1.2 million
pills a month (Nöldecke 2002; Ohler 2017, 143–148). Yet, the harsh winter conditions of the
war against Russia in 1941 again brought increasing demands for the stimulant. Overall, based
on the available data on average monthly supplies and use, it can be estimated that during the
war the German military consumed some 200 million stimulant pills.
As in Nazi Germany, methamphetamine was the drug of choice in Japan, the country in
which the compound was frst synthesized in 1919. The most popular brand was Philopon
(hiropon), produced by the Dai-Nippon Seiyaku Corporation. Coined from the Greek words

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philo (“love”) and ponos (“work”), it was trademarked in 1941 for its ability to arouse the urge
to work. In fact, stimulants were issued not only to soldiers but also to civilians employed
in war-related felds. The Emperor’s Army distributed senryoku zōkyōzai, tablets which in-
creased the fghting spirits and helped people stay awake. Believed to improve night-vision,
they were known as nekomejo or “cat-eye pills”. Kamikaze pilots received special “storming
tablets” named tokkojo, which consisted of meth blended with green tea powder and stamped
with the emperor’s crest (Edström 2015, 522; Kan 2016, 156; Satō 2008, 720; Vaughn,
Huang, and Ramirez 1995).
Britain and the United States also followed suit, employing amphetamine (speed): 5 mg Ben-
zedrine tablets manufactured by the US Company Smith, Kline & French (SKF). In September
1941, the Royal Navy authorized its use, followed in November 1942 by the Royal Air Force
and later also by the Army (Pugh 2017). The main consumers of Benzedrine were pilots, who
took it to prevent performance degradation and ward of fatigue and drowsiness, especially
during long nocturnal operations (thus the popular nickname: wakey-wakey pills). The British
military used, in total, some 72 million speed tablets (Pugh 2018, 756; Rasmussen 2008, 71).
By 1942, Benzedrine (known in the United States as benny) was placed in emergency kits for
American bomber crews, and in 1943 also for the infantry. Although doctors could not conclu-
sively prove that amphetamine enhanced combat performance, servicemen found it benefcial
in prolonging alertness, boosting confdence, and improving a sense of well-being. Rasmussen
explains that “The drug was simply too useful for the military to do without, regardless of
what science had to say” (Rasmussen 2008, 71). About 15% of US soldiers took bennies regu-
larly. Research carried out at the end of the war in an American military hospital revealed that
25% of the patients abused amphetamine and 89% had taken it on a regular basis during their
tour of duty (Bayer 1973). In the course of the war, American armed forces used between 250
and 500 million Benzedrine sulfate tablets. Estimating the precise number would depend on
the government procurement price, which is unknown (Rasmussen 2008, 84).
WWII marked the beginning of the large-scale use of synthetic stimulants. As the Amer-
ican military continued to use speed, during the Korean War (1950–1953), the regular
prescription of dextroamphetamine (Dexedrine) for combat was introduced and its adminis-
tration became almost commonplace (Rasmussen 2008, 193). The scale of the military em-
ployment of amphetamine in the 1950s was astonishing, but it should be seen in the general
context of the pervasive consumption of speed across American society, which caused Charles
Jackson to call the United States the “amphetamine democracy” (1975). Speed-popping
within the ranks persisted as the norm in the Vietnam War (1965–1973), when pep pills were
distributed not only to men leaving for long-range reconnaissance missions and ambushes
but more or less routinely in general. The extent of the state-sanctioned use of amphetamines
was massive. In 1971, a report by the House Selected Committee on Crime revealed that in
1966–1969 the US forces in Vietnam used 225 million 5 mg Dexedrine pills (or statistically
30–40 tablets per fghting man per year) (Iversen 2008, 72; Kuzmarov 2009, 17; Rasmussen
2008, 190–191).
The practice of enhancing performance with amphetamines persisted, and during Op-
eration Desert Storm in the Gulf War (1990–1991), 58% of American pilots enjoyed dex-
troamphetamine support, while 17% few regularly on go pills, as the crews nicknamed their
legal uppers (Kamień ski 2016a, 269). Amphetamines continued to be employed among the
US pilots for “fatigue management”. Under a strict control regimen and specifc procedures,
Dexedrine was allowed for crews to keep them alert on lengthy missions. Jet and bomber pi-
lots embarking on sorties longer than 8 hours (for single-pilot fights) or exceeding 12 hours
(for two-person crews) could be prescribed 10 mg Dexedrine pills each time (Performance

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2000). The use of the stimulant was voluntary; those crewmembers who opted for it were
upon their return to base entitled to receive sedative, sleep-inducing no-go pills (e.g., Ambien
or Restoril). In 2003, amphetamines began to be supplemented and then in 2017 replaced
by modafnil (Provigil), the eugoric psychostimulant and a common lifestyle smart drug
discovered in the late 1970s in France. It promotes a natural-seeming sense of wakefulness
and mental acuity by selectively arousing the central nervous system and comes with the
relatively small risks typically associated with amphetamines. The maximum allowed daily
dose for the US pilots is 400 milligrams of modafnil (Baranski et al. 1998; Caldwell et al.
2004; Caldwell, Caldwell, and Schmidt 2008; Kamień ski 2016a, 276–280; Pigeau et al.
1995). The US military today is, it seems, the only one that ofcially authorizes psychostim-
ulants for fatigue management. However, in 2011 the Chinese military unveiled its own
novel anti-sleep drug called “Night Eagle”, reportedly enabling men to stay awake for up to
72 hours (Moreno 2012; Ye-seul 2011).
While regular armies have mostly abandoned prescribing intoxicants to build up combat
performance, the irregulars have increasingly relied on them. Following Operation Iraqi
Freedom in 2003, in which the US-led coalition forces overthrew Saddam Hussein’s regime,
some insurgents fghting the US forces were reported to be doped up on amphetamines
and cocaine (Perry 2005). The terrorists of Lashar-e-Taiba, the anti-Indian jihadist militant
group based in Pakistan, who perpetrated the November 2008 attacks in Mumbai, enhanced
their efectiveness with cocaine and steroids, which enabled them to withstand the Indian
special forces for nearly 60 hours (McElroy 2008). For their part, the Islamic State’s fghters
and terrorist suicide bombers have also been reported to boost themselves with drugs. The
ISIS fghters in Syria took cocaine, meth, heroin, hashish, and opioid painkillers. Yet, the
main battlefeld catalyst for them was Captagon (fenethylline), a synthetic ATS invented in
1961 which is metabolized in the body to form two compounds: amphetamine and the-
ophylline (El Khoury 2020; Kamień ski 2016a, 233–238, 241; Kan 2016; Keefe 2016). The
jihadists also drugged children to turn them into hardened and loyal fghters. This was not,
however, a unique practice as intoxication is almost intrinsic to the child-soldiering phe-
nomenon. Since the 1990s, from Sierra Leone to Afghanistan, Somalia to Iraq, and Liberia
to Mexico, young soldiers have been given drugs (especially amphetamine, cocaine, and
heroin) for various purposes, including to increase their risk-taking behavior and improve
performance (Kamień ski 2016a, 243–262).
Recently, advances in brain science and neurotechnologies ofer new prospects that could
supplement or even replace psychostimulants in combat. For example, magnetic, electrical,
or focused ultrasound transcranial brain stimulation allow for various forms of enhancement,
including greater alertness, concentration, and learning skills. Already in 2016, the US Navy
Special Warfare Development Group (Seal Team 6) began testing a brain-stimulating head-
set device developed for athletes by the Halo Neuroscience Company. The trials proved
promising, as personnel could train faster with the same results, or at the same pace but for
much better outcomes, be it operating weapons, movement-based combat skills, or decision
making (Brown 2017; Seck 2017; Halo Neuroscience).
To sum up, throughout history, stimulants have served as a means for expanding fghters’
physiological and cognitive abilities and thwarting fatigue.

Mitigating the mental burden of combat

The long-term efects of battle experience can have severe efects on the mental health of
service members, including post-traumatic stress disorder (PTSD). Traditional methods for

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avoiding reactions to combat anxiety and preventing mental breakdowns, such as the psy-
chological screening of candidates, tough training, psychiatric services on the frontline, and
deployment rotation, have been supplemented with drugs. Depressants have been particu-
larly popular in helping combatants cope with the psychological burden of soldiering. To
this end, in the aftermath of battle, alcohol was often issued and troops additionally rewarded
themselves with the stocks they had looted. Soldiers and veterans sufering from psychiatric
disturbances have often self-medicated. Intoxication to relieve the pain of combat has a very
long history. In the Odyssey, Homer describes how the grief and sorrow felt for companions
who died in the Trojan War were drowned in nepenthe, most likely the tincture of opium
and wine (Gahlinger 2004, 19; Homer 2002, 4.219–227, 12). In the nineteenth century,
and especially during the American Civil War and the Franco-Prussian War (1870–1871),
opium and morphine were dispensed liberally for their soothing efects not only on the body
(as palliatives) but also on the psyche (as depressants). The psychological costs of fghting
expanded with the growing scale, intensity, and mechanization of the modern battlefeld.
During the Vietnam War, the routine prescription of potent antipsychotic drugs (sedatives
and neuroleptics, including an antipsychotic chlorpromazine) was supplemented by wide-
spread self-intoxication by the servicemen, most commonly with alcohol, marijuana, and
smokable heroin. As many as 37% of US soldiers in Vietnam who took drugs reported doing
so to forget the killing and relieve the mental strain (Kuzmarov 2009, 22). Alcohol apart, the
most popular self-prescribed drugs were marijuana, heroin, opium, sedatives, hallucinogens
(mainly LSD), and (meth)amphetamine. Heroin, in particular, became a severe and wide-
spread problem: in 1971, it was estimated that as many as 15% of the troops were addicted to
this narcotic (Booth 1998, 272; Kamień ski 2016a, 195).
In the early twenty-frst century, the asymmetrical character of the wars in Afghanistan
and Iraq burdened soldiers with severe stress. Insurgency and urban warfare, as well as the
traumatic experience of death and injuries caused by irregular forces resulted in a signifcant
increase in the number of US servicemen sufering from serious mental disorders (on average
11% of those returning from Afghanistan and 17% of those serving in Iraq) (Hoge et al. 2004,
13). In April 2008, there were approximately 303,000 Afghanistan and Iraq veterans diagnosed
with PTSD or other severe disorders (Tanielian and Jaycox 2008, XXI). Soldiers with psychic
problems on the frontline were routinely administered psychotropic drugs to quickly restore
them to combat readiness. The increase in prescription medications issued to personnel was ex-
tensive. Steve Robinson, an intelligence analyst at the Department of Defense under President
Bill Clinton’s administration, reported that soldiers he talked to “were receiving bags of anti-
depressants and sleeping meds in Iraq, but not the trauma care they needed” (in Allen 2006).
In 2009, some 106,000 ground force servicemen were prescribed psychotropic antidepressants
or analgesics (McKinley 2010). A black market for prescription medications also emerged with
Valium (diazepam) being particularly popular among troops in Iraq (Allen 2006).
The psychological costs of these conficts also triggered new research on pharmaceuticals
that could alleviate or even prevent combat-induced anxieties and PTSD. Propranolol, a
popular beta-blocker used for heart and circulatory conditions, has been intensively investi-
gated for this purpose. Results have been promising, as blocking beta-adrenergic receptors in
the brain can suppress the creation of bad emotional memories and subsequently avert anx-
iety disorders (Kamień ski 2013). So far, however, these drugs have not been recommended
for the pharmaco-prevention of combat stress and anxiety disorders.
To conclude, both prescribed and self-administered psychoactive substances have assisted
combatants in coping with the stress of battle and lessening the psychological experience of
fghting, killing, and the presence of death.

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Facilitating camaraderie and relieving boredom

The major motivational factor in terms of understanding why soldiers fght is not grand ideas
or sentiments like patriotism or nationalism, but their companions (McClure and Brough-
ton 2000, 482–483; Wong et al. 2003). Thus, primary group bonds, close relations within
a small military unit, usually at the platoon level, are crucial for morale and fghting spirit.
One of the activities that can foster social bonds is the collective taking of drugs. A shared
experience of intoxication might be meaningful, and enhance group cohesion. Alcohol is the
most common ice breaker. By increasing forthrightness between soldiers, it can facilitate ca-
maraderie. One observer commented on the American War of Independence of 1775–1783
that “without New England rum, a New England army could not be kept together” (in
Gately 2008, 195). Group drinking strengthens ties and builds trust, which is vital for the
operation of a unit. This socialization function has also been performed by other intoxicants.
For instance, before going into battle, the Zulus performed preparation rituals intended to
fortify them. Shamans gave warriors psychoactive plants, one of which induced communal
vomiting expected not only to purify men but also to bring them together “as a strong fght-
ing force” (Kamień ski 2016a, 85). Another example is the newcomer American GIs in Viet-
nam, for whom drug-taking was often a mandatory part of their initiation and socialization,
so that smoking marijuana and heroin frequently took on the form of a ritual, being more of
a group than a private experience (Kamień ski 2016a, 201).
While fostering social bonding through shared intoxication can ultimately promote bet-
ter combat performance, it also helps pass the time in periods of military inactivity. For
over 300 years, one of the most popular antidotes to boredom has been tobacco, which is
also very useful for both relaxing and stimulating the smoker (Andreas 2020, 68–100). The
consequences of acute boredom, inherent in the very experience of war, can be debilitating
(Mæland and Brunstad 2009) and were particularly vivid in Vietnam. In his memoir of this
war, A Rumor of War, Philip Caputo recalls: “nine-tenths of war is waiting around for the
remaining one-tenth to happen” (1996, 43). During the Soviet Afghan War (1979–1989), the
Red Army soldiers also extensively reached out for intoxicants to relieve boredom. Alcohol
was expensive and difcult to obtain, so hashish (locally known as plant), marihuana (anasha),
and opium (khan/chars) were popular. Heroin and cocaine were also taken. Additionally, sol-
diers sampled local brands, including partly refned opium (used to produce heroin), koknar (a
brew of boiled poppy heads), and chefr (very strong tea) (Kamień ski 2016a, 220–227; Reese
2000, 173). Overall, being a remedy for utter monotony, the recreational use of drugs has
helped combatants remain sane.

Te search for psychoactive weapons

Mind-altering substances have been employed to make soldiers stronger, faster, more resil-
ient, and desensitized. If drugs can make humans more machine-like, then maybe intoxicants
themselves can be weaponized into chemical tools of war. Disorientation, indecisiveness,
hallucinations, sluggishness, seizures, and other similar intoxication-induced efects ofer,
potentially, highly desirable military capacity. Thus since pre-modern times, there have
been attempts to use toxic plants and psychoactive ingredients (such as atropine, opium,
and cannabis) as weapons, albeit non-lethal ones – that is, aimed not to kill but to confuse,
disrupt, and immobilize an enemy, or overpower the populations in which they are nested.
It is important to realize that weaponization entails more than technical capability, as it is
closely entwined with the assignment of a coercive intentionality to an object (a psychoactive

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substance). Conceptually and practically, the making of a psychotropic NLW demands a

twofold reconfguration of both chemical weapons (their de-lethalization) and non-lethality
(expanding the realm of mind control). Thus, militarization provides a new, violent decon-
struction by instilling a diferent logic of functionality which, in the case of intoxicating
compounds, encompasses their utility and efects as well as perception and meaning.

From cannabis to atropine to opium

2,500 years ago, the Chaldeans would set heaps of Indian cannabis on fre, thereby trying to
strip their opponent of fghting power with incapacitating smoke. This method, however,
was sometimes counterproductive; when the wind boomeranged, the smoke impaired the
functioning of the Chaldeans themselves (Kamień ski 2016a, 169). Atropine contained in
Solanaceae plants was another substance employed to subdue the enemy without fghting.
Its intoxication induces mental and behavioral impairment, including sensory inebriation,
disorientation, confusion, loss of time-space relationships, illusions, and hallucinations. In
1962, Ephraim Goodman, a US Army Chemical Corps employee, penned a review of both
the accidental and deliberate use of atropine and its derivates for military purposes (2010).
Based on extensive library research, his manuscript was to substantiate the Corps’ Cold War
search for psychochemical weapons. Goodman provided a handful of examples. Around
200 BC, the Carthaginian commander Maharbal, knowing of a rebellious African tribe’s
fondness for wine, authorized the mixing of it with mandrake (a perennial containing at-
ropine) and had it left in a deserted camp. When the Africans returned and drank the toxic
beverage, they became disabled by atropine-induced psychedelic psychosis and were defeated
by Maharbal’s lurking men (Goodman 2010, 53–54; Ketchum 2006, 14). Similarly, “a stan-
dard Roman military stratagem” was to inebriate barbaric foes before ruthlessly defeating
them (Andreas 2020, 18–19; Gately 2008, 38). Very few documented instances of the use
of atropine for military purposes can be found in the Middle Ages. A huge historical gap in
evidence follows until the seventeenth century. In 1667, during the Bacon Rebellion of Vir-
ginia settlers against the colonial governor, the British soldiers sent to crush the uprising in
Williamsburg unwittingly poisoned themselves with the local plant known as James-Town
Weed or jimsonweed (Datura stramonium). They were rendered inefective, spending 11 days
in altered states of mind (Beverley 1705, 24). An early attempt to disseminate aerosolized
belladonna dates back to July 1672 and the assault on the city of Gröningen by the troops of
the Bishop of Münster, Bernhard von Galen, who used crude grenades flled with the inca-
pacitating alkaloid. The technique proved inefective as “the heat of combustion probably
destroyed active principles of vegetable poisons employed in shells” (Goodman 2010, 59). As
for more modern examples, in 1881 a French unit traveling through the desert from Sudan to
Algeria was poisoned with atropine by the Touareg warriors, so that the troops were debili-
tated by hallucinogenic delirium (Goodman 2010, 55–57). Then in 1908, 200 French troops
were poisoned in Hanoi in French Indo-China by plotting Chinese reformers: “One of the
intoxicated soldiers saw ants on his bed, a second fed to a tree to escape from an hallucinated
tiger, and a third took aim at birds in the sky” (Goodman 2010, 57).
Moving on to WWI, and from atropine to opium, prior to an attack in the third battle
of Gaza, in October–November 1917, the British General Edmund Allenby authorized the
airdrop of cigarettes laced with opium on Turkish positions in Palestine. This subversive
ploy was reported to “render the Turkish troops immobile” (Meinertzhagen 1960, 223–224).
They probably resembled the Chinese soldiers of the mid-nineteenth century who were
made unft for duty by their pervasive opium-smoking. Many infantrymen fghting in the

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Opium Wars (1839–1842 and 1856–1860) to defend the country against the food of the
smuggled drug supplied by the British East India Company were themselves heavy addicts.
In fact, one explanation for the success of the Taiping Rebellion, which took power in south-
ern China in 1851, is the epidemic addiction rates of up to 90% that aficted the ranks of the
Emperor’s Army. The rampant use of opium caused general weakness, apathy, and broken
discipline (Hanes and Sanello 2002, 171; Zheng 2005, 88–96). The question that intrigued
some militaries in the second half of the twentieth century was whether similar efects could
be achieved by the deliberate use of militarized intoxicants.

Te Cold War quest for psychotoxic arsenals

After WWII, the US intelligence warned that the communists were investigating the util-
ity of intoxicants, allegedly in preparation for psychochemical warfare. In 1951, it stated
that the Soviets were experimenting with an unidentifed psychotropic drug referred to as
“ketjubung” (Ketchum 2006, 245–246). They were reportedly also collecting large stocks
of ergot (Claviceps purpurea), the fungus which is parasitic in grains (mostly rye) and can be
synthesized into LSD (Albarelli 2011, 375). However, these concerns over the communist
military’s psychoactive capabilities proved as unsubstantiated as the parallel alarmist intel
that they had mastered narcotic-induced brainwashing methods, and already used them on
American prisoners of the Korean War. Although imaginary, the problem triggered the
United States to embark on a psychopharmacological arms race and research on weaponizing
intoxicating compounds (Carruthers 2009, 174–216; Streatfeild 2007, 1–28). Other nations,
including the British, Soviets, and Czechoslovakians, also joined in and experimented with
hallucinogens for military applications.
In 1949, in a document entitled Psychochemical Warfare: A New Concept of War, Luther
Wilson Greene, the technical director of the laboratories at Edgewood Arsenal, the US
Army Chemical Corps’ facility in Maryland, called for a doctrine of “bloodless warfare”.
Exposing the enemy to the efects of incapacitating agents, Greene argued, would knock
them back with attacks of delusion, panic, or hysteria and thereby weaken their will to re-
sist (Khatchadourian 2012). This prospect was taken further in the mid-1950s by the head
of the Corps, Major General William Creasy. Overwhelmed by the idea of hallucinogenic
weapons, he advanced the concept of “war without casualties”, in which an impairing cloud
dispersed over the enemy paralyzes but does not kill even the most elite units (1959, 74 f ).
Although in the 1950s no efective ofensive neurochemical capability existed, the idea
of psychotoxic munition was not utterly fantastic because history had shown that intox-
ication could impede combat performance. For example, during the Egyptian campaign
(1798–1801), Napoleon Bonaparte’s forces developed a habit of using hashish, locally a highly
popular extract from the resin of the cannabis plant. The efects of hashish-eating for the
fghting efciency of the French soldiers were so devastating, with men wasted by laziness
and sluggishness, that the French authorities decided to introduce a total ban on the drug in
Egypt (Kamień ski 2016a, 53–54; Guba 2020, 49–82).
On other occasions, however, claims that a narcotic problem had destroyed combat read-
iness were mere allegations. During WWI, cocaine use was prevalent in both France and
Britain; yet, they both blamed Germany of smuggling it into their cities and trenches to
subvert their war efort. In 1916, a French deputy fulminated: “It seems that the Germans
can’t beat us with their fre or their asphyxiating gas, so now (…) they’re using cocaine and
morphine to wear us down” (in Padwa 2005, 340). It was, however, in Britain that this Ger-
manophobic psychosis erupted into a nationwide drug scare. The overblown problem was

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presented as a deadly threat to the Empire. Allegedly, the drug-crazed soldiers on the front
had become unpredictable and insubordinate. Turned into a cliché as part of a wartime con-
spiracy theory, cocaine became associated with hostile subversion, fostering the false myth
of German drug sabotage (Berridge 1984; Kamień ski 2019; Kohn 1999). Still, the deliberate
circulation of drugs among an opponent’s forces and population could weaken their capabili-
ties and morale, which, in fact, made for an actual US tactic in the 1980s, when a network of
dealers distributed narcotics, confscated in the United States by law enforcement agencies,
among the Soviet soldiers deployed in Afghanistan. Turning them into addicts was supposed
to erode their operational capacity (Cooley 2000, 128–129). Another telling example of a
narcotic myth is the Vietnam War. Because marijuana was the most common non-alcoholic
drug ordinarily self-prescribed by the US soldiers, the media blamed it for the failure to win
the war. Cannabis was described as a plague tormenting American troops, but the story was
made up as no compelling evidence existed that marijuana smoking presented a serious ob-
stacle to efective combat (Kuzmarov 2009).
If substance use and abuse was, sometimes falsely, believed to deteriorate military perfor-
mance, an intentional deployment of hallucinogenic intoxicants could perhaps ofer an im-
mense ofensive capability. The US Chemical Corps could have reasonably assumed, then,
that the weaponization of psychoactive agents might prove an efective means for impairing
the faculties of an adversary. Thus began the search for compounds that could feasibly enable
combat through mind control, a quest for ingredients which could be dispersed over hostile
forces, added to their food, or dissolved in water to deprive them of elementary fghting
abilities. In its attempt to unlock the military potentials of psychotoxins, from 1955 to 1975,
the Corps conducted experiments on humans. They were mainly carried out in Edgewood
but also at other army bases and in army-commissioned hospitals, penitentiaries, and uni-
versities, including Baylor University, the University of Pennsylvania, Tulane University,
Johns Hopkins University, and universities in Indiana, Utah, and Washington (Hornblum
1998, 131). The staf at Edgewood had no problems with recruiting volunteers, the majority
of whom were drawn from among the soldiery. Many enrolled several times, encouraged by
incentives such as extra pay, free three-day weekends, or relocation closer to home (Ketchum
2006, 51, 253).
The participants underwent medical screening and completed the Minnesota Multiphase
Personality Inventory psychological test to reveal any mental problems. Before signing a
mandatory informed consent form, each participant was required to be notifed of the char-
acter and aims of the experiment (Ketchum 2006, 25, 32–33, 58). However, the staf were
often not fully aware of efects of the substances to be tested, particularly when these were
samples of “rejects” from the pharmaceutical industry, i.e., the compounds deemed unft
for medical commercialization. This was the case, for example, with benzilate: created in
1951 by Hofmann-La Roche during its search for the treatment for ulcers, the compound
was rejected as unsuitable due to its strongly hallucinogenic efects (Kamień ski 2016a, 178).
Furthermore, most of the psychoactive agents that underwent trials on humans had no name
and the pharmacological terms or codenames associated with the rest meant nothing to the
subjects. Hence, it was often assumed that providing participants with specifc information
was redundant. Dr. Gerald Klee, one of the psychiatrists involved in the program, explained
that most of the volunteers “were not highly educated, and even if they had been told exactly
what they were to be given, they wouldn’t have understood it” (in Bowart 1978, 91). These
circumstances raised concerns regarding the subjects’ awareness of what they were exposed
to and provoked questions as to whether they were not, to some extent, “guinea pigs”. The
huge battery of substances that was tested on humans under the Corp’s scheme included

251
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amphetamines, atropine, 3-quinuclidinyl benzilate (BZ), LSD, mescaline, morphine, and

psilocybin (Moreno 2001, 251). Marijuana, LSD, and BZ seemed particularly promising.
Experiments with liquid concentrate cannabis had already been conducted in 1943 on
Manhattan Project ofcials (Moreno 2001, 191). Then in the late 1950s, the Corps ran hu-
man trials with a super-concentrated hash “red oil”, a substance codenamed EA1476. Studies
demonstrated that it could induce strong intoxication and deprive smirking soldiers of their
combat skills. In 1961, a series of studies with a synthetic, pure, and undiluted analog of tet-
rahydrocannabinol (THC), the principal psychoactive constituent of cannabis, were carried
out. Codenamed EA2233, this new cannabinoid compound was a mixture of eight stereo-
isomers (diferent spatial orientations of atoms of the same molecule) of THC. Compared
with “red oil”, its intoxicating efect was much stronger and longer-lasting. When in 1965
individual isomers of EA2233 became available, another series of trials was conducted with
the improved version of the THC analog. The knockdown efect left subjects almost unable
to move. Further experiments were thus suspended due to the health hazards. So, as the
full potential of cannabinoid isomers was never investigated, a window of opportunity may
still be open. As James Ketchum, the frst and leading psychiatrist in the research program
at Edgewood, later recalled: “This hypotensive (blood-pressure-reducing) property, in an
otherwise non-lethal compound, might be an ideal way to produce a temporary inability to
fght, or do much else, without toxicological danger to life” (in Lee 2008).
Another candidate for weaponization to be exploited was LSD, codenamed EA1729. The
Army program of testing it on human subjects commenced in 1955 and was conducted on
military and civilian personnel recruited from Army areas, mostly Edgewood (Ablard 1975).
The research involved administering the drug to the servicemen orally, diluted in a liquid,
prior to routine training. The general psychoactive efect on the subjects was that of being
so overpowered by uncontrollable giggling and cackling that they ceased to be able to carry
out even the most basic tasks (Bowart, 1978; Ketchum 2006, 99). Should this happen to an
enemy, it could literally be defeated by laughter. Hence, the Army was interested in mas-
tering efective dispersal methods that would allow it to throw “acid rain” down on enemy
units and civilian populations. But the search for weaponized LSD was seriously hampered
by the technical obstacles in the way of fnding a suitable form, the proper dosage (in a gas-
eous form, LSD is three times weaker than when administered orally), and accurate means
of delivery. Beginning in 1963, experiments with LSD in gaseous form aimed at designing
efective methods for its aerosol dispersal were carried out. Edgewood’s personnel conducted
feld trials at locations such as Fort Bragg (North Carolina, 1958), Fort Benning (Georgia,
1960), Fort McClellan (Alabama, 1959–1960), and Aberdeen Proving Ground (Utah 1959)
(Ablard 1975, 12). Overall, about 90% of the LSD trials were conducted before 1961.
Later, around 1966, the Corps became more interested in BZ (or “Agent Buzz”, code-
named EA2277) (Ketchum 2006, 244, 327). While the incapacitating efect of LSD lasts for
up to 12 hours, for BZ it can be up to 80 hours (Ketchum 2006, 24, 43–47, 52). The com-
pound induces delirium that can knock a person down, so it was an ideal candidate for wea-
ponization. Between 1959 and 1975, BZ was tested in clinical trials on 2,800 soldiers both
at Edgewood and in feld experiments. In 1964, one such trial was conducted on a desert
range in Utah, which entailed the spraying of Agent Buzz from a distance of 500 and 1,000
yards from the volunteer soldiers (Lee and Shlain 1992, 41). One of the aims of the whole
research project at Edgewood was to fnd antidotes for the incapacitating agents and build
defensive measures against hostile psychopharmacological attacks. Surprisingly, it was dis-
covered that when in the correct dose, atropine, which throughout the centuries was used in
military settings as an ofensive debilitating substance, can be an efective antidote to Agent

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BZ (Ketchum 2006, 109–116). In 1961–1962, benzilate was standardized as an incapacitating

chemical weapon into an assortment of clustered munitions for aerosol delivery via grenades,
mortars, cluster bombs, and rocket warheads, and adopted by the US Army. Never used in
combat, in 1977, it was declared obsolete (Kirby 2006, 2007, 43).
On the whole, the pursuit of mind-breaking, intoxicating ammunition has failed. The
plans for spraying an enemy with “deranging gas” or polluting their supplies with “psy-
chotoxic water” remained largely confned to the realm of visions. Still, the notion of soft
psychoactive violence continues to inspire research, as revealed by the idea for the non-lethal
cannabinoid formula patented in 2017.

Conclusion
Throughout history, and particularly in the twentieth century, the matrix of psychoactive
pharmacopeia and warfare was shaped by two overarching themes. The frst is the disobedi-
ence as regards social norms revealed by illegitimate self-medication. The second is, by con-
trast, the compliance with the institutional rules and/or informal sanctions epitomized in the
purposeful administration of intoxicants. These state-approved and reinforced military drug
practices have been an exceptional thread in the general history of intoxicants and intoxica-
tion. Substance use, when synchronized with military/state goals, has been constructed not
in terms of deviant behaviors but in a context of permissiveness. Hence, from a sociological
perspective, the relationship between the individual (combatant), social group (the military),
and behavior (the use of drugs) has been structured along the lines of normality. Above all,
the social construction of intoxicants/intoxication and war has been shaped by the power
interests of state institutions. By dispensing psychoactive substances to combatants, the au-
thorities have managed their bodies (so as to optimize and increase performative and pro-
ductive capacities) and exploited them (by conducting experiments on humans to weaponize
psychochemicals). Thus, drugs in warfare might be seen as a specifc politico-military an-
tropotechnology, or “technology of the body”. Likewise, anti-drug policies, control mecha-
nisms, and penalization can be analyzed in terms of “technologies for disciplining the body”.
Therefore, it is instrumentality, the logic of the means-end relationship, that has marked the
predominant socio-contextual meaning of intoxicants in military afairs.

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 PART IV

Intoxication Practices
 16
ENGAGING WITH DRUG, SET,
AND SETTING TO UNDERSTAND
NICOTINE USE EXPERIENCES
AND PRACTICES
Julia McQuoid

Introduction
Zinberg’s drug, set, and setting analytic framework (Zinberg 1984) has contributed to un-
derstanding a variety of drug use experiences and efects (Duf 2012, Moore 1993). This
includes work on MDMA (Shewan, Dalgarno and Reith 2000), prescription drug misuse
(Mui, Sales and Murphy 2014), cocaine (Decorte 2001), heroin (Fitzgerald et al. 2004),
psychedelic drugs (Carhart-Harris et al. 2018), cannabis (Hammersley and Leon 2006), and
alcohol (Shafer and Hall 2002). The framework proposes that understanding drug use initi-
ation, how it manifests as a recurring practice, and the efects of the drug on the individual
requires an integrated analysis of three elements: ‘drug (the pharmacologic action of the
substance itself ), set (the attitude of the person at the time of use, including his [sic] person-
ality structure), and setting (the infuence of the physical and social setting within which the
use occurs)’ (Zinberg 1984, 5). Largely absent from scholarship that explicitly draws on this
analytic framework are nicotine use practices. A notable exception is Kolte and Schmidt-
Semisch’s (2002) application of the framework to consider how diferent patterns of intensity
and frequency of smoking are maintained by diferent individuals (i.e., ‘tobacco chippers’
versus ‘heavy smokers’). They emphasize the importance of social context in understanding
smoking practices and the nature of addiction, a factor which has only recently and very
gradually become recognized as a relevant area of scholarship in tobacco research (Poland
et al. 2006).
Zinberg’s approach to understanding drug use might now be viewed as rather static and
simplistic alongside more contemporary drug use theories (e.g., materialist, assemblage, and
post-human), given his conception of drug use as a product of preexisting, separate com-
ponents (see, for example, Duf 2007). Nevertheless, I suggest that thinking broadly across
‘drug, set, and setting’ can serve as a useful framing device for taking stock of scholarly
advances and blind spots in researching nicotine use, and may yield richer understandings of
nicotine use practices and experiences. While the empirical focus of Zinberg’s work was on
highly intoxicating drugs, like heroin, one could argue that it is precisely the subtle psycho-
active efects of nicotine and its capacity to integrate into the contexts, functions, and ex-
periences of everyday life (Keane 2002) that should compel researchers to attend to all three
elements of Zinberg’s framework when examining nicotine use practices and experiences.

DOI: 10.4324/9780429058141-21 261

 Julia McQuoid

The relevance of the ‘drug’ element to current tobacco scholarship in contexts like the
United States is clear considering how the material, aesthetic, and pharmacological proper-
ties of nicotine-containing products have rapidly evolved with the introduction and mar-
keting of ‘novel’ products like diverse electronic nicotine delivery systems (ENDS) (e.g.,
‘pod vapes’), favored cigarillos, snus, dissolvable tobacco products, and ‘heat-not-burn’ de-
vices (Agaku et al. 2013, Auer et al. 2017, Osibogun et al. 2018). Research focusing on the
mammal pharmacology of nicotine and nicotine-containing products abounds within the
biomedical literature (Benowitz 2010). This body of inquiry into the material properties
and efects of nicotine and nicotine-containing products does not often take into account
the social contexts (setting) or the uniqueness of diferent individuals’ motivations and ex-
pectations of use (set). Conversely, most social science research on drug use practices and
experiences, including nicotine use, seems reluctant to engage with the chemical capacities
of drugs to act on, with, and through human bodies (Marković 2019a).
Research focusing solely on the properties of tobacco products and the industry and regulatory
forces that shape access to them provides an incomplete picture of the diversity of infuences that
shape use practices and experiences. As Zinberg noted: ‘Availability is always intertwined with
the social and psychological factors that create demand for an intoxicant’ (1984, 13). Indeed, the
diversity of ‘sets’, or psychosocial attributes and expectations of individuals engaging in nicotine
use practices must also be accounted for. For example, while decades of aggressive anti-tobacco
public health campaigns in places like California have vastly reduced cigarette smoking among
the middle and upper classes and non-minority groups, cigarette smoking has become increas-
ingly concentrated among groups who are more likely to lack resources, have social minority
identities, experience mental health disorders, and live in socio-economically disadvantaged
places (Barnett et al. 2017, Pearce, Barnett and Moon 2012, Poland 1998, Poland et al. 2006,
Thompson, Pearce and Barnett 2007). Each of these groups (e.g., racial, ethnic, sexual, and/ or
gender minorities) have their own collective histories and structural conditions that may infu-
ence their motivations and experiences of nicotine use (e.g., trauma-informed coping strategies).
A large body of literature has documented individual characteristics and ‘risk factors’ for nicotine
use in isolation from the pharmacological/material and contextual infuences on nicotine use
practices (Drope et al. 2018, Lee, Grifn and Melvin 2009).
The ‘settings’, or social and physical contexts, within which individuals are immersed
must also be accounted for to understand if, how, and to what efect diferent individu-
als will use available nicotine-containing products. For the purposes of informing tobacco
regulatory policy, strong scholarly emphasis has been placed on examining the physical to-
bacco retail environment, which varies in density of tobacco retail outlets and in tobacco
product availability, pricing, and advertising between neighborhoods, municipalities, and
states (Coxe et al. 2014, Lee et al. 2015, Luke et al. 2016). The relevance of the social di-
mensions of context to tobacco use has received less attention. Despite strong evidence that
socio-structural inequities shape nicotine use practices, such as structural discrimination
that varies geographically (Hatzenbuehler et al. 2013, Moon, Pearce and Barnett 2012),
these factors rarely enter into public health discourses as intervention targets that can reduce
tobacco-related disparities and harms (Frohlich et al. 2012, Graham 2012).
Tobacco scholarship will continue to lack a nuanced understanding of the drivers,
motivations, experiences, and practices of nicotine use for diferent groups of people if
it does not engage with the interwoven nature of drug, set, and setting. This is import-
ant, not only because of the knowledge gap it leaves, but because of the social distance
that exists between most tobacco researchers, interventionists, and regulators and the

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individuals who use nicotine (Haines-Saah 2013). Many public health professionals who
desire to reduce health inequities related to tobacco and nicotine are constrained in their
ability to relate to the motivations and experiences of people who use them. This is likely
due to lack of frst-hand experiences with the drug, and, because, compared to the pop-
ulations they wish to understand and engage, public health professionals are usually more
socially privileged and difer in their experiences relating to everyday social contexts
(e.g., being personally naïve to experiences of social minority stress). If public health as
a feld fails to understand and acknowledge the nicotine use experiences, motivations,
and practices of diferent groups of people, it will continue to struggle to engage these
populations in health equity interventions.
Given this need for understanding and engagement of ‘hard-to-reach’ populations who
use nicotine, it is surprising that research documenting lived experiences of nicotine use
is sparse when compared to the large body of literature examining trends in prevalence of
and ‘risk factors’ for tobacco use (Wellman et al. 2016). This relatively small body of mostly
qualitative work has begun to document the lived experiences of nicotine use for diferent
groups. For example, sexual and gender minority individuals have reported that smoking
enhances their ability to experience a sense of belonging to community (Bennett, Ricks
and Howell 2014, McQuoid et al. 2019), to express resistance against oppression by rejecting
dominant anti-smoking societal norms (Sanders et al. 2019), and to cope with ongoing daily
stressors associated with social minority discrimination and stigma (Antin, Hunt and Sanders
2018, Matthews et al. 2017). Nicotine users have described the pleasures of using nicotine,
including its meditative and therapeutic qualities as a practice (McQuoid, Keamy-Minor and
Ling 2020, Tan 2013b). Nicotine can pleasurably enhance or moderate the efects of other
drugs, such as alcohol and cannabis (Akre et al. 2009, Gubner et al. 2017). In a fnal example,
the value of nicotine use practices in being able to positively alter experiences of time and
space and stabilize the space-time organization of everyday routines (Graham 1993, Keane
2002, McQuoid et al. 2018a, Tan 2013b) is likely heightened within the hectic coordination
of schedules and scarce down-time that characterizes much of contemporary work, family,
and study life in Western countries (Southerton 2009). In short, there is evidence that nico-
tine use practices and experiences are diverse, nuanced, and vary between people, between
situations, and across space and time, and that nicotine use can play a capacity-enhancing
role in the lived experiences of diferent groups of people.
This chapter considers the potential for greater engagement with the interwoven
elements of drug, set, and setting to enhance researcher and practitioner understandings
of nicotine use practices and experiences and engage ‘hard-to-reach’ groups in health
equity-focused eforts. The following section highlights some recent approaches in to-
bacco scholarship published in English that have engaged with the interplay of the drug,
set, and setting elements of nicotine use practices, although not explicitly drawing from
Zinberg’s analytic framework.

Engagement with drug, set, and setting in tobacco scholarship

In the past two decades, or so, scholars have begun to excavate the experiences and practices
of nicotine use that have been buried under more biomedically- and regulatory-focused
research agendas. This work has drawn primarily from de-centered or ‘more-than-human’
theories, social practice theory, and theories of place, power, and performativity to engage
in diferent ways with the drug, set, and setting elements of nicotine use.

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More-than-human accounts of nicotine use

A few cultural geographers, anthropologists, and sociologists have drawn from more-than-
human theories to analytically de-center humans when examining nicotine use practices
and experiences. Marković (2019a) engaged Lefebvre’s rhythmanalysis (Lefebvre 2004) and
more-than-human theories (Whatmore 2002) to account for nicotine’s chemical afordances
(i.e., the ‘drug’) in their analysis of smokers’ experiences in the workplace. They described
the circadian rhythms of nicotine with the timing of cigarette smoking as the confguration
of an eurythmia that, once established, avoids nicotine withdrawal. This rhythmic rela-
tionship was then put into analytic dialogue with the abundance of other rhythms circu-
lating within smokers’ everyday contexts. Markovic examined workers’ experiences of the
arrhythmias created by spatial restrictions on smoking and intensive employer demands on
workers to account for their time and productivity. This analytic approach allowed for an
acknowledgement of the agency and afordances of non-humans (‘drug’) as well as humans
(‘set’) within everyday contexts (‘setting’), bypassing the risk of framing smokers as passive
victims of addiction.
Markovic drew from Deleuze and Guattari’s assemblage thinking to explore vaping as
a ‘skeuomorphic assemblage’ that converges between technology, the body, and everyday
physical and social contexts (Marković 2019b). The author considered the spatio-temporal,
sensorial, and embodied diferences between cigarette smoking and vaping to delineate ways
in which vaping produces distinct experiences of place. For example, the discrete and fexible
material afordances of vaping devices make them easier to use in places where cigarettes
cannot be used and give the individual more access to space and time while using nicotine,
but do not ofer the experience of a set apart space and time that is aforded by the material
constraints of cigarettes (see also McQuoid et al. 2018a).
Thompson, Pearce, and Barnett (2009) utilized Foucauldian (Foucault 1994) and
Deleuzo-Guattarian (Deleuze and Guattari 1988) frameworks to understand the unstable,
or ‘nomadic’, social identities associated with ex-, secret, and social smoking practices. For
example, they examined occasional, or ‘social’, smoking identities. These identities are ne-
gotiated within social contexts that are dominated by public health discourses that empha-
size the addictive powers of nicotine and perpetuate a binary conceptualization of nicotine
use practices: non-smokers (which comprised ex-smokers and never-smokers) and current
smokers. The authors trace how occasional, or ‘social’, smoker identities assemble feetingly
within a particular set of materialities and conditions (temporality, space, person, cigarette)
and then disassemble to produce a non-smoker identity (Thompson et al. 2009, 575).
Tan has productively employed the concept of afect from non-representational theory
(Anderson and Harrison 2010, Duf 2010) to provide sensual, spatial, and agentic accounts
of smokers and smoking practices (Tan 2012, 2013a, 2016b, 2016a, 2013b). The interplay of
the drug, set, and setting elements in nicotine use practices and experiences is clearly reg-
istered in Tan’s work. For example, Tan examines how smoking spaces both enhance and
diminish smokers’ capacities to engender a sense of well-being for themselves (Tan 2013b).
The material properties of the ‘drug’ (cigarettes) produce smoke, which is socially imbued
with stigma and shame as it travels between bodies, polluting spaces of encounter between
smoking and non-smoking bodies (setting). This forces smokers into sanctioned or hidden
smoking places, where they avoid or reduce social criticism of their smoking practice (Po-
land 2000) and manage their ‘spoiled identities’ (Gofman 1963) as smokers. In this sense,
smoking spaces are largely disabling for smokers. However, Tan also recovers the agency of
smokers and the enabling qualities of smoking spaces by highlighting how smoking practices

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can create liminal spaces within routines, spice up monotonous spaces and times, and pro-
vide a way to stabilize after crisis or disruption: ‘Hence, smoking spaces are set apart from,
but simultaneously enrolled in the space-times of banality’ (p. 178). Tan also highlights how
smoking spaces can be meditatively and therapeutically solitary, as well as highly social, as
the segregation of smoking spaces heightens the social connection potential for smokers
within these spaces.
Other work has focused, in particular, on rematerializing the often neglected ‘drug’ ele-
ment within social science research on nicotine use practices, drawing from new materialist
approaches (Dennis 2018) and actor network theory (ANT) (Keane 2013). Keane examined
nicotine replacement therapy (NRT) as a non-human agent that is enrolled in a therapeutic
network. Through this network, nicotine becomes an agent of health that is mobilized to
transform the nicotine user’s identity from ‘smoker’ to ‘non-smoker’: ‘[NRT] gives life to a
model of health in which an addictive drug performs as a resource in the construction of a
free subject: the non-smoker’ (Keane 2013, 194). Dennis used a new materialist approach to
consider the particular feeting and momentary pleasures of smoking that arise from relations
between air, smoke, and an unbounded body that may be experienced, not only as extended
into space through exhaled smoke suspended in air, but also as yielding; ‘an exit into infnity,
into air’ (Dennis 2018).

Place-embedded social practices of nicotine use

Another recent approach that has been employed in tobacco scholarship and implicitly en-
gages with drug, set, and setting is social practice theory (Cohn 2014, Maller 2015, Reckwitz
2002, Shove, Trentmann and Wilk 2009). This work prioritizes the patterned, routine, and
habitual ways in which people live their lives to understand nicotine use (Blue et al. 2016).
Rather than focusing on ‘risk factors’ of individuals to engage in potentially health-harming
or -enhancing behaviors, it understands social practices, including nicotine use, as hav-
ing lives of their own in competing for, winning, and losing practitioners who reproduce,
transform, or abandon social practices over time and across space. Considered this way, the
evolution of nicotine use practices can be traced, and ways in which these practices compete
for or lose practitioners can be observed. Blue et al. (2016) proposed social practice theory as
a way to move ‘beyond behavior’ by understanding how nicotine use practices depend upon
the ongoing integration of ‘(1) materials (objects, consumer goods, and infrastructures), (2)
competence (including understandings of the situation, practical know-how), and (3) mean-
ings (including embodied understandings of the social signifcance of the practice and past
experiences of participation)’ (Blue et al. 2016, 42).
Keane et al. (2017) drew on social practice theory to interpret written survey responses
from Australian vapers, delineating ways in which the materials, competence, and meanings
of vaping practices are distinct from those of cigarette smoking. My colleagues and I built
on this by using social practice theory to understand the regular use of multiple nicotine-
containing products by relatively large numbers of young Americans (McQuoid et al. 2018a).
Drawing on accounts of the everyday routine activities and contexts of young adults who
regularly use at least two nicotine-containing products, we traced distinctions between the
materials, competences, and meanings of cigarette smoking, vaping, and smokeless tobacco
use (‘dip’ and ‘chew’) practices, fnding that each nicotine use practice has a distinct and
complementary role to play within young adults’ everyday contexts and routines. My col-
leagues and I also considered how smoking practices are mobilized in everyday routines by
young Americans with non-binary sexual orientations (e.g., bisexual, pansexual, and queer)

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to help navigate everyday contexts within the dominant binary sexual landscape. We did
this by integrating the methodological emphasis on everyday routines and mobility found
in social practice theory and space-time geography (McQuoid, Thrul and Ling 2018b) with
Foucault’s analysis of sexuality and power (Foucault 1978, 1988).
Frohlich et al. (2002) drew from social practice theorists, especially Anthony Giddens,
to emphasize social structure, social practices, and agency in understanding ‘collective life-
styles’ of smoking in diferent neighborhoods in Quebec, Canada. Their framework empha-
sizes the importance of the physical, material, and psycho-social features of neighborhoods,
as well as the social meanings ascribed to people’s actions and their local neighborhoods, to
understand local practices of smoking. Closely related to this is Pearce et al.’s (2012) emphasis
on place-based ‘practices’ and place-based ‘regulation’ in understanding pathways linking
place with health-related behaviors like smoking. Glenn et al. (2017) applied the collective
lifestyles framework to understand place-based social inequalities in smoking across diferent
neighborhoods of Montreal, Canada. They used focus groups to elicit discussion regarding
the social norms, practices, and agency related to smoking, and grouped neighborhoods by
socio-economic status for analysis. Haines-Saah et al. (2013) also drew from the collective
lifestyles framework, leveraging focus groups and young adults’ photographs about smoking
and smoking cessation in Vancouver, Canada to understand the interplay between cessation
and the presence of a local collective lifestyle that emphasizes healthy living and outdoor
physical activity.

Spatial politics, identity, and performativity of nicotine use

Foucauldian concepts of ‘governmentality’, Gofman’s work on stigma, and Bourdieu’s for-
mulation of ‘habitus’ have had the longest-standing employment in research on lived ex-
periences of nicotine and tobacco use. This body of work has largely focused on smokers’
experiences of and responses to spatial smoking restrictions and anti-smoking public health
campaigns (Bell 2013a, Bell et al. 2010, Collins and Procter 2011, Dennis 2011, Ritchie,
Amos and Martin 2010, Tan 2013a). There is, perhaps, a slightly stronger emphasis on the
interactions of ‘set’ with ‘setting’ than on the ‘drug’ element of nicotine use in this work.
Poland’s earlier analysis of the ‘purifcation of public space’ (Poland 1998, 2000) has been
highly infuential in this regard. Poland explored the (in)formal enforcement of spatial smok-
ing bans as an illustration of class-based confict over control of public space. Barnett et al.
(2017) discussed the unintended consequences of smoking bans and smoking denormaliza-
tion on society’s least advantaged groups, exploring these processes of denormalization as ‘an
ongoing dance of power (Foucault), stigmatization (Gofman) and taste and class (Bourdieu)’
(Barnett et al. 2017, 129).
While much of this work has focused on cigarette smoking practices within the con-
text of tobacco denormalization, Lucherini et al. explored the uptake of ENDS, or ‘vapes’,
through the lens of performativity – the accumulation of meaning of habits over time and
space (Lucherini, Rooke and Amos 2018). In-depth interviews with young adults in Scot-
land revealed how embodied and spatial practices of cigarette smoking and vaping were in
some ways similar and in some ways diferent, meaning that the performativity of vaping had
yet to settle into a shared set of social norms in step with cigarette smoking performativity,
which has become almost universally stigmatized as a practice.
The intersections of gender and sexual orientation identities, social context, and smoking
stigma have also been examined through a focus on power, identity, and performativity (Antin
et al. 2017, 2018, McCready, Glenn and Frohlich 2019, Sanders et al. 2019). Sanders, Antin,

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Hunt, and Young (Antin et al. 2018, Sanders et al. 2019) explored the meanings of smoking for
sexual and gender minority youth and adults in California, United States, through in-depth
interviews. They examined the meanings of smoking for sexual and gender minority people
within the context of aggressive tobacco denormalization and structural inequities (e.g., rac-
ism, sexism, classism, homophobia, and transphobia). Within this social context, the meanings
of smoking for sexual and gender minority participants included serving as an act of resistance
to social oppression, as a tool for self-care, and as a way of exerting control over day-to-day
circumstances. In a more explicit engagement with place, McCready et al. (2019) used Gof-
man’s theory of stigmatization to understand the relationship between neighborhood-level
deprivation and young women’s experiences of smoking stigma.

Conclusion
The three areas of engagement with the drug, set, and setting dimensions of nicotine use
that I sketched above represent important progress in providing more nuanced accounts of
nicotine use practices and experiences. The in-depth understanding of nicotine use that
these types of accounts provide could serve as a bridge between public health practitioners
and the populations they wish to engage. However, these approaches are still very much in
the minority within the tobacco research feld. Reluctance to fund and do this kind of work
may be linked to a fear on the part of public health that acknowledging what tobacco does
that is ‘useful’ or ‘desirable’ for people may undermine dominant tobacco control discourses
(Bell 2013b). These discourses emphasize the addictive power of nicotine to explain use mo-
tivations and emphasize the negative health efects of tobacco in order to denormalize it as a
practice (Kolte and Schmidt-Semisch 2002). As with other drugs (Zinberg 1984), it is likely
feared that acknowledging the positive experiential dimensions of nicotine use, and the way
that it manifests in a diversity of ways as a practice, could be perceived as condoning its use
and have the efect of rolling back tobacco denormalization eforts.
Ironically, I would suggest that it is by analytically engaging with all three elements of
nicotine use (drug, set, and setting) in tobacco research, and by exploring nicotine use prac-
tices and experiences in depth, that public health can fnd a way out of this bind. One path
forward is ofered by critical drug scholars who have invited researchers to consider drug use
experiences as emerging dynamically and relationally from the interplay of space, embodi-
ment, and practice. Rather than conceiving of the ‘smoking experience’, or other nicotine
use practices like ‘dipping’ or ‘vaping’, as an isolated relationship between the individual and
a tobacco product, nicotine use practices, experiences, and motivations are better understood
as emerging dynamically within particular situations or contexts. In other words, the act of
using nicotine is but one element in a broader assemblage. Duf characterizes the drug use
context as ‘an assemblage of relations drawing together diverse experiences of space and
spatialisation; embodiment and becoming; conduct and social practices’ (Duf 2007, 504).
Malins (2017) employs Deleuze and Guattari’s concept of fows of desire to understand the
many experiences, practices, and motivations of drug use that emerge within diferent drug
use contexts. People seek out and ‘plug into’ fows of desire by forming assemblages with the
world around them and we register these connections to desire fows as emotionally charged
experiences, such as pleasure, excitement, transgression, agitation, and belonging.
In this way, nicotine use practices can be understood as part of the assemblages that
people form with the world around them as they seek to plug into (or out of ) diferent
registers of desire fows. Shifting public health’s focus from warning against the potential
harms of nicotine-containing products to emphasizing alternative ways of plugging into

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the capacity-enhancing experiences that diferent groups of people seek within nicotine use
assemblages may ofer a way of engaging and supporting these groups, rather than alienating
them by continuing to perpetuate experiences of the ‘stigmatized smoker’ (Frohlich et al.
2012, Poland 1998, 2000) or framing them as victims of targeted tobacco marketing (Barnett
et al. 2017). As Malins suggests, this would:

… shift the focus away from stopping people taking drugs, to instead connecting them
to new assemblages, such that they might continue to plug into desire fows, albeit
through assemblages that might be healthier for them.
(Malins 2017, 131)

As an example, this approach could be used to engage with young smokers who are increas-
ingly adopting the practice of ‘social smoking’, which is characterized by light and intermit-
tent smoking that often occurs in nightlife social settings that include alcohol (Thrul, Bühler
and Ferguson 2014). While the usual public health approach would be to focus on ‘educat-
ing’ young people by presenting them with the health risks associated with this pattern of
smoking (Schane, Glantz and Ling 2009, U.S. Department of Health and Human Services
2014), research has shown that the potential threat of future health efects of smoking does
not motivate behavior change for people in earlier stages of life (Gough et al. 2009). Rather,
social smoking interventions could focus on promoting the capacity-enhancing experiences
that many young people seek to plug into when engaging with nightlife assemblages where
social smoking often takes place, while shifting social smoking out of these assemblages
(McQuoid, Keane and Ling 2021). To conclude, it may be by engaging with drug, set, and
setting to dive deeper into the complexity, richness, diversity, and often contradictory nature
of nicotine use experiences and practices of diferent groups of people in diferent places that
public health researchers and practitioners may fnd bridges between their health preserva-
tion and promotion priorities and the lived experiences of the people they wish to beneft.

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 17
‘UNINHIBITED PLAY’
Te political and pragmatic dimensions of
intoxication within queer cultures

Kane Race, Kiran Pienaar, Dean Murphy and Toby Lea

Introduction
Could intoxication be understood as a politically signifcant activity among sexual and gen-
der minorities? The question is likely to meet with some resistance. But approaching intoxi-
cation as an activity that grapples with the political organisation of society is not the same as
recommending it as a promising strategy. We usually think of intoxication as a state of the
individual body, or else a set of social or cultural or psychologically driven practices that put
bodies into such a state. Since the conventional aim of these practices is to alter, manage or
change the self in the world (Partanen 1981), the self emerges as the most pertinent locus of
action and this produces the practice as personal in nature, relevance and consequence. To
frame intoxication as a political tactic is to refuse this personalising efect by situating it his-
torically and exploring the kind of practical response to certain problem-situations it might
embody. The question becomes, ‘how has intoxication emerged as a practical strategy that
enables certain, more or less efective, navigations of social norms around sexuality and gen-
der?’, remembering that those norms are part of the political ordering of society.
The higher rates of drug and alcohol use found among LGBTQ+ people compared to
broader population samples are mainly attributed to ‘minority stress’ by the researchers con-
cerned (Dentato et al. 2013, Goldbach et al. 2014, Lehavot & Simoni 2011). Intoxication
emerges as a form of self-medication here: a way of coping with the negative efects produced
by lived experiences and expectations of stigma, discrimination and victimisation. This fo-
cus has been criticised for ‘overlooking the meaningful ways in which … consumption
intersects with identity, sociability, place, space and community formation for queer youth’
(Hunt et al. 2019, p. 382). Indeed, when the hypothesis of minority stress fails to line up
statistically signifcant correlations, some studies concede that gay socialising ‘often occurs in
bars, where alcohol is served and other drugs may be available’ (Rosario et al. 2004, p. 1630),
usually before recommending alternative, drug-free social spaces for minority individuals.
Alcohol and other drug (AOD) use is typically approached within this literature as a problem
in and of itself, that is symptomatic, in turn, of another social problem (‘minority stress’). Little
wonder there are calls for greater attention to meanings, contexts and experiences of pleasure
from a growing cohort of researchers in the felds of critical drug and sexuality studies (Den-
nis & Farrugia 2017, Holt & Treloar 2008, Paasonen 2018, Pienaar et al. 2020a, Race 2009).

272 DOI: 10.4324/9780429058141-22

 ‘Uninhibited play’

Without wishing to deny the realities these diferent approaches confgure, the binary
choice they create between the competing fgures of problematic self-medication and un-
troubled social or recreational consumption is hardly satisfying. It is not simply that recre-
ational intoxication can lead to problems or that self-medication can bring pleasure; we are
left wondering about the relevance of intoxication within the practical situations commonly
confronted by those stigmatised on the basis of their sexual orientation and/or gender ex-
pression. Minority stress is conventionally defned as exposure to victimisation and discrim-
ination, expectations of rejection and hostility, internalisation of negative attitudes about
homosexuality and concerns about disclosure of identity (Meyer 2003). There is nothing
very sexy about this defnition, it must be said. If the injuries of social minoritisation were
enough to explain disproportionate substance use within a particular population, one might
expect it to hold true for other stigmatised minority groups that routinely sufer from dis-
crimination and victimisation (ethnic and racial minorities, for example) but this is not
borne out by the research evidence in any consistent way (Gillmore et al. 1990, Shih et al.
2010, Carter et al. 2017). In the ‘minority stress’ account of LGBTQ substance use, more-
over, the individual is produced as the primary locus of injury: stigma becomes a condition
of the self. The identities of sexual and gender minorities are ontologised, with intoxication
produced as a means of palliating the injuries these damaged identities have incurred. But
for Gofman (1963), stigma is embedded in relational dynamics; it creates problem-situations
that social actors variously navigate. What if intoxication were transposed from its current
makeshift status as a plaster for the wound of sexual stigmatisation and reconfgured as a
pragmatic means of carrying out certain discredited activities?
In this chapter, we aim to develop such a pragmatic, performative account of the mean-
ings, uses and efects of intoxication among gays, lesbians, bisexuals, transfolk and other
assorted queers. Rather than intoxication standing as a toxic means of palliating damaged,
static identities, we approach it as a practical – even creative – strategy that, for all its risks
and toxicities, can enable individuals and groups to circumnavigate and disrupt prevailing
gender and sexual norms. We do not deny that stigma, discrimination, social exclusion
and sexual normalisation act as structuring constraints within the life-worlds and practi-
cal repertoires of LGBTQ+ groups and individuals: rather, our aim is to switch gears and
translocate accounts of LGBTQ+ substance use away from the ontological register of patho-
logical self-medication and towards the more performative and pragmatic key of tactical
responsiveness to the sociomaterial situations that stigma, discrimination and normalisation
create or make manifest.1 We seek a more dynamic account of queer intoxication, in other
words, that turns attention towards the practical question of what intoxication does for those
who subject themselves with it. Intoxication is what some people do to allow certain things
to happen – not simply a confrmation of injured being. As Judith Butler has maintained,
gender and sexuality should not be mistaken for stable identities or inner truths. Rather, we
might attend to ‘the mundane way in which bodily gestures, movements, and enactments
of various kinds constitute the illusion of an abiding gendered self ’ (Butler 1988, p. 519). In
this chapter, we seek to engage this performative register of self-practices. For certain social
subjects, certain bodily movements and enactments matter, such as drinking, getting high,
getting out of it or getting wasted. But how, and why should this be the case?
In what follows, we explore the value of disinhibition as an alternative explanation for
the complex relations between sexual and gender minoritisation and queer investments in
intoxication. Frequent reference was made to notions of disinhibition in the 42 qualitative
interviews we conducted with LGBTQ+ Australians as part of the Chemical Practices: En-
hancement and Experimentation study in which we asked our participants about the contexts

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and motivations of their drug and alcohol practices. This made us want to fnd out more
about scientifc and everyday discourses of inhibition and disinhibition, their histories and
how they operate. In fact, the concept of disinhibition already has considerable traction in
scientifc research into gay and bisexual men’s substance use: in HIV behavioural research, it
is liberally and often reductively used to explain HIV risk-taking and naturalise its purported
connection to substance use (for critiques of this tendency, see Race 2009, pp. 164–179;
Reinerman & Leigh 1987; Rhodes 1996, Worth & Rawstorne 2005). While substance use
emerges simplistically as the cause or explanation of continued HIV risk-taking in much of
this discourse, some psychological research in the area ofers a more nuanced theorisation of
the conditions that motivate some gay and bisexual men to use drugs to cognitively ‘escape’
awareness of HIV risk (McKirnan et al. 1996). If drugs and alcohol can be understood to be
disinhibiting, this work is provocative for making this attribute a factor that informs people’s
motivations for use, rather than the more common and less plausible move of making sexual
risk-taking the unwitting efect of consuming intoxicating substances. Drawing on a notion
of disinhibition, McKirnan and colleagues maintain that ‘sexual risk does not stem from a
lack of community norms or personal standards, but from a desire to escape cognitive aware-
ness of very rigorous norms and standards’ (1996, p. 665). Here, drug use is said to facilitate
a process of cognitive disengagement from such norms that allows people to act on their
desires. Insofar as they subscribe to a notion of drugs and alcohol as disinhibiting agents,
these psychological perspectives align with the cruder assertions found in the behavioural/
epidemiological HIV literature. They take the important step of interrogating the norma-
tive conditions and moral climate in which disinhibition ‘makes sense’ for certain subjects
in certain contexts.
This chapter elaborates the concept of dis/inhibition in relation to queer identities
and cultures organised around drug and alcohol use, focusing on the generative efects
of intoxication for sexual and gender minorities. While associations have been estab-
lished between gay male sex and the disinhibiting qualities of drug consumption, we are
not aware of any research that identifes this script in the discourse of other sexual and
gender minorities, including queer women, non-binary and trans people, as our research
does. The frst part of the chapter presents a genealogy of dis/inhibition and draws out
its connections to the regime of sexuality whose contours of emergence from the late
nineteenth century are famously traced by Foucault (1976). We then consider how disin-
hibition has been conceived and handled by symbolic interactionists in social research on
intoxicated sex. The fnal section explores how notions of disinhibition and ‘uninhibited
play’ are valued and mobilised more broadly in the discourses of LGBTQ+ people who
use drugs and alcohol in Australia today. We explore how drugs and alcohol are said to
participate in the construction of social and intimate assemblages that expand the pos-
sibilities of agency, identifcation, self-experimentation and connection for minoritised
subjects in subcultural practices and everyday life. Read together, the genealogy of dis/
inhibition and our empirical accounts of LGBTQ+ drug and alcohol use suggest that
dis/inhibition and intoxication have been animating forces in historic practices of queer
and trans world-making.
A full description of the research and recruitment methods we employed for the
chemical practices study appears elsewhere (Pienaar et al. 2020a). The study received
ethics approval from the University of Sydney Human Research Ethics Committee (Ap-
proval number 2017/735). We asked study participants to specify their gender pronouns,
sexual and gender identities, and the pseudonyms we use to refer to them in this and
other publications.

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 ‘Uninhibited play’

Dis/inhibition: a history
Using disinhibition to account for practices of intoxication among subjects problematised
on the basis of their sex is a useful starting point for our intervention. Minority stress is
not the only theoretical inheritance that one might cite to work within and against the
disciplinary formation that concerns us. But while disinhibition promises an alternative ac-
count of the signifcance of intoxication for sexual and gender minorities, it is nonetheless
necessary to subject this concept to critical-historical scrutiny. Inhibition can be situated as
part of nineteenth-century eforts to consolidate neurophysiology as a hard science that in-
corporated moralistic attitudes about human conduct into the depths of human physiology.
As Roger Smith has demonstrated, the emergence of inhibition over the nineteenth century
entailed a gradual reformulation of religious, moral and political powers of control in terms
of the brain’s control over the nervous system in a move that transformed understandings
of moral regulation into natural phenomena (1992). Massive shifts in Western epistemes of
power/knowledge over this period brought the human life sciences into focus as categorical
sources of knowledge about the proper functioning of bodies, subjectivities and populations
on the basis of the specialised access they claimed to the laws of nature (Foucault 1976). The
concept of inhibition emerged as part of attempts to understand how orderly conduct could
be achieved at the level of bodies: how the mind controls the body or the brain controls the
operations of the nervous system. Drawing on reifed concepts of the will, bound up with
prevalent beliefs about morality of character, the felds of psychology, medicine and physiol-
ogy came to conceive inhibition as a regulatory mechanism that enacts a hierarchical relation
between the brain (the mind) and the body’s nervous system and physiological functioning.
Concerns about social order and the proper functioning of society were thus transposed into
a biological register and treated as natural phenomena. This made disorderly, uninhibited
subjects notionally available to scientifc diagnosis, analysis, adjudication and correction.
One of the key sites for the elaboration and articulation of these theories were studies of
intoxication. In his 1865 treatise Stimulants and Narcotics, the English physician Francis Anstie
claimed the efects of alcohol and hashish ‘ought not to be called a stimulant at all … they
are, in fact, the results of a partial and highly peculiar kind of paralysis of the brain’. Invoking
emerging formulations of inhibition, he wrote, ‘the apparent exaltation of certain faculties
should be ascribed to the removal of controlling infuences, [rather] than to the positive
stimulation of the faculties themselves’ (1865, pp. 80–81). As this explanation indicates, the
concept of inhibition enfolded prevailing conceptions of moral order and social control into
a theory of nervous action that hinged on the hierarchical organisation of internal faculties
and functions, implanting historically specifc expectations about orderly human conduct
into the bodies and brains of persons.
Parsed in this way – as a historical process that over the course of the nineteenth century
individualised and biologised moralistic attitudes about personal control and socio-sexual
order – the concept of inhibition can be recognised as a palmary instance of precisely the
same scientifc-political and epistemic shifts that produced the homosexual as ‘a type of
life, a life form, and a morphology, with an indiscreet anatomy and possibly a mysterious
physiology’ (Foucault 1976, p. 43). While Foucault’s account of the perverse implantation
specifes the homosexual in this passage, these historical developments are just as pertinent
for the formation of trans and gender-diverse subjectivities and identities. Indeed, as Da-
vid Valentine observes, ‘the implicit pathology of homosexuality was seen to be evident
in what contemporary social theorists would deem visibly physical and behavioural mark-
ers of non-normative gender expression’ (2007, pp. 40–41, italics in original). We fnd it

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ftting, at any rate, that the biopolitical production of psychologised genders and sexualities
fnds its counterpoint in an equally biologising and biologised series of counter-strategies or
counter-corporealisations over the course of the ensuing century: the individual and collec-
tive consumption of psychoactive substances within sexual and gender minority subcultures
with the precise, if variously materialised, aim of efecting disinhibitions.
Inhibition conceived the social regulation of persons in terms of a natural process of ratio-
nal self-control, reconfrming prevailing conceptions of the ‘ordered life’ that had hitherto
held currency while re-inserting them into the neurophysiological bodies of the future. At
issue in seemingly diverse behaviours such as drinking, masturbation, non-reproductive sex-
uality and insanity was loss of self-control, or some failure in the body and brain’s inhibitory
mechanisms: this is what made them cohere as conditions. Through this apparatus of bodily
production, social norms and collective values were internalised as controls in and of the
human organism, while the social, sexual and economic mores of the Victorians were im-
planted directly into the bodies of those constituted as ‘moderns’. In his history of sexuality,
Foucault argues that sex made it possible to group together ‘anatomical elements, biological
functions, conducts, sensations and pleasures and make use of this fctitious unity as a causal
principle’ (Foucault 1976, p. 154). The history of inhibition demonstrates how the efcient
reproduction of the social and corporeal order was taken to rely on the self-regulating activ-
ity of subjects, especially in matters sexual. The appropriate exercise of inhibition was taken
to ensure the proper organisation of the body politic as well as the individual bios of citizens,
the entire developmental life of productive bodies. Failures in inhibition allowed the lower
and baser faculties of the body to impose themselves on the social order with unnatural, an-
tisocial and destabilising tendencies. They were thus psychiatrised and rendered biologically
legible.

Licencing licentious conduct

If, as noted above, the psychiatrisation of homosexuality and ‘sexual inversion’ in the late
nineteenth century invested ‘unnatural’ sexualities with an ‘indiscreet anatomy and possibly
a mysterious physiology’ (Foucault 1976, p. 43) – part of what Foucault called ‘the perverse
implantation’ – then it makes a perverse kind of sense that the subjects thus constituted
should turn to the consumption of intoxicating substances professionally attributed with the
power to paralyse the equally mysterious physiological mechanism of inhibition to counter
their lived sense of oppression. But there is a twist here. Certainly, Anstie’s (1865) assertion
that intoxicating substances do their damage by inducing a ‘peculiar kind of paralysis of the
brain’ still fnds ample expression over a century later in the medical apothegm that the ef-
fects of intoxication are produced ‘not by “stepping on the gas” but by paralyzing the brakes’
(Muehlberger 1956, p. 40). But despite its likelihood of passing the ‘pub test’2 and the appar-
ent sedimentation of this theory into the murky terrain of common sense, scientifc attempts
to locate the ‘brakes’ supposed to be physiologically responsible for inhibition have little to
show for their eforts.3 Indeed, a review of physiological research in the area concludes that it
is not possible to understand disinhibited behaviours in terms of underlying neuronal activity
and recommends instead a focus on cognitive expectancies; those culturally emergent scripts
that variously serve to organise experiences of drinking and taking drugs (Woods & Mans-
feld, cited in Reinerman & Leigh 1987, p. 442).
These scripts are nothing if not heterogenous and manifold, as historical and anthropo-
logical research on ‘drunken comportment’ has roundly demonstrated. Indeed, the cultural
and historical examples of drunken comportment that MacAndrew and Edgerton amassed in

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their wide-ranging study of the topic led them to conclude that intoxicated behaviour is less
the product of ‘alcohol’s toxic assault on the seat of moral judgment, conscience, or the like
[than] the particular meaning(s) attached to drunkenness in a given culture’ (MacAndrew &
Edgerton 1969, p. 165; see Reinerman & Leigh 1987 for an overview). Drinking can make
people excitable or morose, aggressive or sociable, horny or withdrawn, violent or thought-
ful depending on the cultural conventions and network of meanings that organise and invest
its use in particular contexts and in conjunction with particular activities. Drinking does not
always or even often induce the loss of control that Anglo-Christian modernity would have
us believe. How ironic, then, that the most likely determinant of uninhibited behaviour is
the cultural association between intoxication and the projected failure to control the ‘baser
instincts’ that medicine and neurophysiology have reiterated, invested with white-coated
authority and remain ever so keen to substantiate. It turns out that association is parochial
and hardly the only way of organising bodies (MacAndrew & Edgerton 1969, Rhodes 1996).
If the script of disinhibition is a cultural resource that a few life sciences have essentialised,
it has also become a motherload of cultural expectancies that give shape to intoxicated be-
haviour. But there is a further twist in this story of biological investiture that redoubles the
practical utility of intoxication-as-disinhibition. Barbara Critchlow puts it plainly in her
1983 discussion of drinking and responsibility: ‘When people see substances as disinhibitors
due to their pharmacological properties, they accept that intoxicated people may do things
they would not normally do’ (1983, p. 452). That is to say, the popularity of the scientifc
theory of disinhibition as part of ‘common sense’ makes it possible to mobilise what some
sociologists have called ‘deviance disavowal’ (Davis 1961). ‘By deviance it is meant: a vio-
lation of a norm; by disavowal it is meant that a person denies his or her deviant status i.e.
denies that an expectation has been violated’ (Wilmot 1981, p. 14). Tim Rhodes conveys the
practical appeal of this meaning-arrangement for stigmatised sexual subjects:

Because they are commonly believed to be ‘disinhibitive’ [alcohol and stimulant drugs]
may provide socially acceptable excuses for engaging in sexual behaviours in which
people may want to engage but perhaps know they should not
(Rhodes 1996, p. 756)

On this rendition, intoxication acquires further value by accumulating the capacity to pro-
vide a cultural alibi for disapproved sexual and social activities.
As a countertactic, this practice was clearly familiar within North American gay culture
at the cusp of the modern gay movement. It even fnds its way into the groundbreaking 1968
play The Boys in the Band (Crowley 1968), renowned for its early portrayal of modern gay
life, when the characters laugh about the ‘Christ-was-I-drunk-last-night syndrome’ that ev-
idently operated as a way of dodging moral reprobation around homosexual activity among
this peer group of gay men.

You see, in the Christ-was-I-drunk-last-night syndrome, you really are drunk. That
part of it is true. It’s just that you also do remember everything. [General laughter]. Oh
God, I used to have to get loaded to go in a gay bar!
(Crowley 1969, p. 42)

For sexually discreditable subjects, then, one of the uses of intoxication is the simple prag-
matic opportunity it afords to engage the mechanism of ‘deviance disavowal’ to account for
‘unnatural’ behaviour when challenged. Proud gay advocacy has its time and its place, but

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 Kane Race et al.

perhaps liquor is quicker, after all? Disinhibition permits a practice of ‘normative substantia-
tion’ (Race 2009): a counter-strategic manoeuvre that works by attributing deviations from
sexual and gender norms to the anatomy of a substance whose toxicity is said to interfere
substantially with the physiological balancing act that is inhibition: you are made to lose
control of yourself.

Sexual drifing
Deviance disavowal is a good device to have up your sleeve when the simple acts entailed
in ‘you doing you’ come up against the risk of punishment, moral opprobrium and vio-
lence. But deviance disavowal can only serve as a partial explanation for intoxication’s
appeal among abjected sexualities and genders. Surely, there is more to it than that. How
does ‘disinhibition’ feel for sexually unacceptable subjects? What does it make possible
beyond the convenience of a provisional licence? In his 2009 work on cultures of ‘ex-
ceptional sex’ in gay life, Race found that disinhibition – and in particular ‘uninhibited
sex’ – was highly valued among gay male participants in hookup circles (2009, p. 176).
How else to explain the scores of hookup app users that consider ‘uninhibited play’ a
preference worth explicitly specifying on their thumbnail profles? Whether this phrase
is meant euphemistically to denote sex without condoms or ‘chemsex’ in a given instance
is a moot point for present purposes (on chemsex, see Bourne et al. 2015, Race 2017): far
from being bound up in a structure of apology or disavowal, uninhibited sex is valued here
precisely as a qualitatively superior experience of sex. It evokes a kind of sex that escapes
the moral rigidity of antiquated proprieties and other prudish hang-ups, the sort of sex that
breaks itself free from the straightjacket of normative decorum that is imposed to restrain
us from having or even entertaining the idea of having nasty, dirty, piggy, carefree sex (to
borrow some terms from gay men’s sexual vernacular; see Florêncio 2020); the normative/
biological impulse to slam down the breaks when the slightest indication is given that mild
will run to wild at any rate. Free from such encumberments, uninhibited sex has the status
of a select commodity in today’s gay sexual marketplace – widely asserted, highly coveted
and more or less enthusiastically encountered.
In a 1981 article on sexual drinking, Richard Wilmot provides one handle on the process
of valuation that turns disinhibition from an excuse for bad behaviour or apologetic source
of embarrassment into a desired and desirable property:

Sexual encounters in America are conditioned by the puritan ethos, which is to say, that
they are conditioned by inhibition. When sexual encounters are so conditioned, they
quite naturally lend themselves to the ‘ceremonial’ use of an intoxicant which has come
to be culturally defned as a sexual disinhibitor.
(p. 6)

If the sexual setting is one of inhibition, Wilmot argues, the intoxicant emerges as a cultural
antidote because it ‘causes one to relax in situations that have been culturally defned as rigid’
(1981, p. 10). Wilmot is concerned with the interactional dynamics that lead sexual drinking
to result in sexual anomie among some of his (markedly heterosexual) informants. The sex-
ual scenario is cast as ‘complicated to begin with and it grows increasingly more so with the
inclusion of alcohol’ (p. 7). Sex requires us to throw ourselves into a ‘situation of company’
in which status is sought and sounded out, and in which rebuttal and rejection are anticipated
as ever-present, potentially painful and demoralising possibilities.

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If ‘status anxiety’ involves such poignant questions as: Does this person fnd me sexually
masculine or sexually feminine? And/or, does this person really love me or are they
being insincere? The anticipation of a rebuf provokes the anxiety. This provocation of
‘status anxiety’ can produce the physical manifestations of embarrassment and timidity
that lead in turn to more anxiety.
(p. 8)

For Wilmot, ‘drinking alcohol as related to sex becomes meaningful only in relation to the
intention to reduce inhibitions’ (p. 11). In company in which sexual drinking is anticipated
and/or encouraged, participants ‘acknowledge that a systematic alteration is involved, one
which radically reconstitutes what it is for them that is going on’ (p. 11). In this sense, drink-
ing serves to frame the situation as sexual, though not unproblematically or unambiguously,
as it turns out. One way ‘status anxiety’ is dissipated is through the use of intoxicants to
frame and reframe, navigate and disavow, excuse and enable the taking of risks that such
high-stake games are felt to necessitate.
Alcohol reduces the tensions that inhere in status anxiety and on this basis is claimed to
disinhibit. ‘But the release of inhibitions does not follow any clear-cut guidelines’, Wilmot
perceptively observes. ‘It is something that must be negotiated between the parties con-
cerned’ (p. 10). The task is made all the more vexing and complicated because of the ‘inter-
actional drifting’ that alcohol afords:

The negotiation of interactional limits is the game of sexual drinking. Persons drift
about on an interactional level when they become intoxicated because it is expected that
they do so. Interactional expectations are set-up … during alcoholic intoxication that
can be (and usually are) non-specifc, ambiguously defned, and easily broken.
(p. 12)

Motivations become ambiguous, intentions misconstrued, jokes are taken seriously, intimate
appeals ignored. Bon courage!
The problem, as Wilmot sees it, is that intoxication frames the sexual – or is that social? –
encounter in ambiguous ways. Frustration, demoralisation and anomie result from the per-
ceived clash between the playful, theatrical, make-believe key in which intoxicated sexual
interactions occur and the sexual intentions underlying the encounter, which he describes as
‘very serious concerns’ (p. 11).

Sexual drinking keys the encounter as a form of play – more specifcally as a form of
erotic make believe. Freedom from inhibition during times of drinking allows for the
non-utilitarian… for idle enjoyment and play. Things are not to be taken seriously. It
is a time for relaxation and sociability. This is how alcohol intoxication is keyed in our
society – a release from the serious practical business of ‘getting on in life’. Yet, when
this symbolic interpretation of what alcohol is supposed to do is superimposed over the
very serious subject of sex, the scenario becomes miskeyed.
(p. 11)

A very heteromasculine discord.4

Wilmot’s analysis is refreshingly explicit about the materialisation of sex as a generally
problematic object, freighted with all kinds of status anxiety, personal vulnerabilities, moral
ambiguities and cultural rigidities. Imagine how compounded these pressures become when

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one’s sexuality and/or gender expression is deemed not only to be perverse and problem-
atic, but ‘everywhere present in [you], at the root of all [your] actions because it was their
insidious and indefnitely active principle, written on [your] face and body because it was a
secret that always gave itself away’ (Foucault 1976, p. 43). If heterosexual couples turn to the
drink to make sex easier to negotiate, queers can hardly be blamed for ordering something
stronger.
Little wonder Foucault was in favour of jettisoning the false binary of repression and
liberation and replacing it with something altogether diferent. In place of inhibition/de-
repression, he promoted playful experiments with bodies, pleasures, knowledges, relations
and even drugs to unlock their multiplicity and inventive possibilities (for a discussion, see
Race 2017, pp. 3–7). If the notion of disinhibition installs an unwinnable battle between
inhibition and desire into the physiological constitution of the docile subject, a critical-his-
torical genealogy of dis/inhibition is useful ‘because it indicates that being intoxicated com-
monly involves a transition between social roles, or a modifcation of social status’ (Bancroft
2009, p. 52). And, one might add, the creation of entirely new roles, relations, afective
capacities, bodily volatilities and dynamics.
For Wilmot (1981), intoxication in sexual scenarios enables ‘interactional drift’, a ‘loos-
ening’ within which the status anxieties and other tensions inherent in the sexual encoun-
ter are accommodated, allowing the interaction to take on new moods and modalities.
But where Wilmot makes the tension he perceives between seriousness and playfulness a
source of demoralisation, thwarting and frustration, queer partiers help us appreciate the
possibility of transforming sexual drifting from a problem into an artform. As it happens,
play turns out to be one of the key modalities that gays, other queers and trans people have
engaged to make sex and gender expression more expansive and enjoyable in contempo-
rary queer settings and cultures (Race 2015, 2017). On gay hookup apps such as Grindr, for
example, ‘looking to play?’ is one of the most common opening lines, serving to frame the
encounter in advance as fun, casual and obligation-free. From queer and trans play parties
to gay male party ‘n’ play scenes, from pup-play to role-play, from kikis to kink, play has
come to connote an experimental relation to sex, bodies and their manifold potentialities
that is worlds away from the ‘profoundly serious, potentially romantic’ hues with which
some commentators persist in painting the modular sexual encounter (Reinarman & Leigh
1987, p. 451, Wilmot 1981).
Constituting sex as play makes it possible to ‘highlight improvisation driven by curiosity,
desire for variation and openness towards surprise’ as ‘things that greatly matter in sexual
lives and scholarly attentions’, Susanna Paasonen proposes (2018, p. 3). As sexual bodies
‘move towards diferent scenes, fantasies, bodies and objects, and become attached to them’,
she writes, ‘the forms, identities and subjectivities of participants are reorganised’ (p. 3). For
Paasonen playfulness ‘intermeshes and overlaps with those of improvisation, exploration,
curiosity and experimentation, yet it also stands apart from them in foregrounding pleasure
and bodily intensity as key motivations for sexual activity’ (p. 2). Paasonen’s evocative ren-
dition of the playful, dynamic, open-ended and performative dimensions of sexual pleasure
puts a new, more positive spin on the unexpected detours, perplexing blockages, alternate
routes and partial connections of sexual drifting, constituting its complicated trajectories,
unpredicted deviations and wasteful expenditures as possible sources of pleasure, explora-
tion and intensity. In order to bring out the resonances that chime across this framing of
sex as play and queer and gender-diverse practices of intoxicated pleasure, sexual sociability
and uninhibited sex, we devote the remainder of this chapter to our analysis of in-depth,
semi-structured interviews with LGBTQ+ people who use drugs.

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Uninhibited play
Unsurprisingly, the disinhibition script is widely evident in queer and gender-diverse peo-
ple’s accounts of negotiating their gender and sexual identities and exploring sex. For ex-
ample, Fuego credits alcohol with helping them explore sex outside of heteronormative
expectations in the context of their conservative upbringing:

In terms of like sexuality and sex, I guess alcohol originally was sort of bound up in
my exploration of my sexuality. Like, you know, making out with boys and that sort
of thing. Well, it wasn’t necessarily dependent on alcohol, but yeah, that took away my
inhibitions because I went to a Catholic high school and grew up in the country, and
I don’t know if I would say it was frowned upon but that’s the way it felt anyway in
school. So, like, it wasn’t really easy for us to sort of pursue, you know, things that sort
of deviated from the norm.
Fuego (23, pansexual, gender diverse)

Similarly, Nico suggests that AODs were helpful for suspending the material efects of shame
and connecting with their partner in the context of early sexual experiences:

So one of my girlfriends, when we frst started being intimate […] alcohol was hugely
benefcial for me because there was so much shame, like internalised queer-phobia
around […] my feelings of desire for her. I just felt deeply ashamed and […] when we
were intimate, I would completely get out of my body and into my head […] and that
was such a disconnected experience it wasn’t enjoyable for either of us. But when I was
under the infuence of drugs, I felt that shame melt away, I could just be in my body and
experience it as the sensual, pleasurable experience that it was. Like without having any
of those stories in my head about who we supposedly were and what we were doing,
and it just felt good.
Nico (40, queer, non-binary)

In Nico’s account, the afrmative intensities of pleasure efectively override the trappings
of constitutive shame, enabling them to ‘be in [their] body and experience it as the sensual,
pleasurable experience that it was’. The capacity of ‘disinhibiting’ substances to help con-
sumers overcome status and performances anxieties in addition to other hesitations around
queer sex such as constitutive shame was also valued in chemsex practices. For example,
Dalston, a 44-year-old cisgender gay man, explains:

I [inject crystal methamphetamine] mainly [for] the rush, you know, and the fact that it
strips you bare. So all these preconceptions or worries or ruminations that you might be
having about, ‘What if?’ or […] ‘Am I doing this right?’ they tend to be replaced by an
instant carnal, feshy craving. It knocks out all the big worry [and] enables me to focus
very, very sharply on what I’m doing and just get in a zone, you know. I guess it’s like a
fow-state, where you’re not self-conscious, you’re just cock-in-mouth, that’s it. You’re
present, you’re focused […] It’s a transformation.
Dalston (44, gay cis man)

The Christian legacy of a moral and existential battle between the spirit and the fesh, which
informed early conceptions of inhibition, is clearly evident in Dalston’s description of ‘the

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rush’ producing ‘an instant carnal, feshy craving’. But this is regarded less as an existential
failing than a pragmatic afordance of the practice that makes the realisation of sexual op-
portunities less awkward. Other participants spoke of the value of disinhibition not just for
realising sexual possibilities but also for developing a more expansive, daring, social sense of
queer personhood. For example, Dane suggests:

I love taking these drugs. I think they clarify a lot of things. I think they illuminate a lot
of things. I have learnt that I am a lot freer than I have been led to believe I am. I have
a lot more agency over my own body and my experiences and my feelings. I have learnt
that I have a lot more agency over my sexual experiences. I have become a lot more con-
fdent sexually taking these drugs. They have allowed me to let go of certain hang-ups
and translate those over into non-high drug experiences. They have allowed me to push
the limits of gender with my friends and feeling uninhibited to kind of play with that.
Dane (30, gay cis man)

Dane’s experience with drugs has, on his account, been ‘clarifying’, ‘illuminating’, and provided
a greater sense of agency over his body, experiences, feelings and self that he has translated over
into non-drug contexts. His comments demonstrate how the frame of ‘uninhibited play’ enables
a process of interactional drifting that connects sex with other socio-sexual activities such as ex-
perimenting with diferent gendered performances together with friends.
As we have mentioned, the framing of sex as ‘play’ and fun contrasts with how sex is invested
with ‘profoundly serious’ ends in some heterosexual discourse. This playful framing was very
common among our study participants and it enabled them to consider the diferent ways in
which diferent drugs enhanced sexual experiences, producing new bodily intensities:

I’ve had some extraordinary, wonderful experiences with wonderful people on these
drugs [crystal meth and GHB] that I’ve thoroughly enjoyed. And [I’ve] had really great
experiences with people on a regular basis with no expectation, just a lot of fun and a
lot of sex, great sex.
Drew (46, gay cis man)

GHB makes the experience of sexual things like getting fucked or giving someone head
or something a lot more intensely sexual. It’s like amping the sexualness of it up. It’s
also a lot more arousing. Just makes you more aroused I think, like the touch or getting
touched. I like it, I like taking it especially in combination with the other [drugs].
Dane (30, gay cis man)

For Rhianna, a 42-year-old queer woman, smoking crystal enables her to connect with her
partner and enter into a more experimental space with her. In a passage that recalls Dalston’s
‘fow-state’ above, she presents her experience in the following way:

So the positive for me [of smoking crystal] is feeling like I’ve really connected with that
person again, [the person] that I have chosen to be with and love. And on an intimate
level for me, I think why I get really excited about [smoking crystal] is sexually for me
I feel like I actually get really connected with my partner after smoking [crystal…] I
get experimental in the moment with this person. So, I feel connected with her in that
moment and I feel open.
Rhianna (42, queer, cis woman)

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For Ursula, a 25-year-old cisgender lesbian, the use of stimulants similarly enhances sex by
multiplying possibilities of connection:

Sex on drugs […] just makes sex better. It has made sexual experiences [better] And
emotional experiences where I’ll be naked with someone, and not necessarily had sex
with them. It gives it a diferent level of how well you can connect with that other per-
son, even if you are just talking shit on a mattress for six hours.
Ursula (25, lesbian cis woman)

By including ‘talking shit on a mattress for six hours’ in her account of better sex, Ursula
recalls the kinds of interactional and sexual drift associated with sexual intoxication in the
literature (Wilmot 1981, Reinarman & Leigh 1987). But for Ursula this is not a source of
disappointment or a problem: it enhances her enjoyment and the intimacy of the erotic en-
counter. For Dane, who enthuses about the use of drugs such as GHB to enhance sex (above),
these modes of interactional and sexual drifting can help constitute joyous occasions of social
play and gender experimentation with his friends:

We are constantly using [drugs] to like entertain one another and like perform for one
another and kind of be silly with one another. We will, for instance, maybe have some
crystal, take some [MDMA] caps and go dancing and just kind of have the best time like
doing a show for one another, playing dress-ups for one another, trying on things. Most
of us are putting on drag. I think we are all willing to push the boundaries of what is
socially acceptable with one another and I think that’s what brings us together as friends
as we kind of reject ideas of how we are meant to be. You also get a kind of escape from
the reality that we all have to live in and [we get to] kind of exist together in a diferent
place. And these [drugs] defnitely are a big part of that.
Dane (30, gay cis man)

The ‘diferent place’, or heterotopia (Foucault 1971), that Dane invokes here could well be
taken to stand for, and sociologically characterise, the vibrant practices of queer partying –
pleasure, dancing and sexual sociability – that take place in queer subcultural spaces and
cultural events, which characteristically involve the prolifc use of various stimulants
(Race 2017). Dane’s account demonstrates how scripts of sexual disinhibition have a wider
purchase than simply making the realisation of ‘deviant’ sex possible: they are involved
in queer world-making, in making the places, spaces and sociabilities entailed in queer
community-formation enjoyable, possible, appealing and meaningful for many LGBTQ+
people, as spaces in which the boundaries of what is socially acceptable can be pushed.
Michael Warner (2002) has proposed the concept of queer counterpublics to convey the
sense in which queer world-making depends upon assembling collective horizons of activity
for queer self-experimentation. He writes, ‘a culture is developing in which intimate rela-
tions and the sexual body can in fact be understood as projects for transformation among
strangers’ (p. 122). We are suggesting that drug use plays an active part in making at least
some of these collective, interactive settings possible: dance parties, clubs, bars, drag scenes
and partying with friends have queer counterpublic efects. As Avery, a cisgender gay man
of similar age to Dane, ventures:

I would say MDMA has helped shaped the way I feel about gender. I probably see
a lot more gender expression and therefore feel more confdent in being a bit more

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explorative in my gender. I started doing drag about three years ago and I don’t ever
perform on any drugs, but instances of being on MDMA before that have helped me
get there in terms of the community that I experience generally with MDMA. I would
say that the community that I meet in a space where I tend to take MDMA has opened
my eyes to a broader spectrum of gender and broader options for experimentation and
playfulness with gender than the outside world, outside of the pink bubble of the queer
night club. I think I’ve been on a bit of a journey with my own gender and I have ex-
perimented with more feminine manifestations in the real world because of the way that
I’ve felt in these spaces.
Avery (31, gay cis man)

These accounts of drag and gender experimentation in the context of stimulant use might
serve as a riposte to analyses of chemsex and party ‘n’ play cultures that reduce these scenes
and practices to normative instantiations of gay masculinity. But they also indicate the rel-
evance of the cultural script of disinhibition for the elaboration and cultivation of a wide
range of gender-non-conforming identities and practices.5 For example, Nico, a 40-year-old
non-binary participant, recounted:

I had started questioning my gender and then I was so scared of what was coming up
for me and then I went out with a friend one night. We did ecstasy and I was dancing
and I had this extremely vivid, like visual and felt sense of myself (even though I mean
I’m nonbinary, but I’m defnitely sort of trans-masculine) and I saw myself as this man
[…] just all of the physical characteristics. And it felt so real and it was such a profoundly
afrming experience for me. In that moment I was like, ‘I haven’t been making all this
stuf up, this is what’s really happening for me’. It just sort of crystallised all of those
questions that I’d been asking myself.
Nico (40, non-binary)

Mira, a 25-year-old transwoman, told us, ‘LSD has been really good […] for me unpacking
a lot of things in terms of my gender and sexuality’. She spoke of the value of MDMA for
removing and reconfguring feelings of anxiety about her body during sex:

I’ve had sex on both MDMA and LSD wildly […] I like both for diferent reasons actually
because MDMA is amazing at removing a lot of gender dysphoria. I have a very complicated
relationship with my genitals especially with their functionality because a lot of time [my
gender] doesn’t match with that. But with MDMA it just feels great because you know, you
don’t have that same anxiety. You don’t have that same internal narrative. It allows you to
connect to your physical form and your sexuality a lot easier. It’s just like MD is good for
accepting the equipment that I have now. And universally it has been a deeply emotional
experience. There’s a lot of crying usually, because just like overwhelming happiness. It’s just
like, ‘Oh my god, something like this feels so good and so right’. So often, you can feel like
that you’re mismatched wires and just for a little while to feel like everything just works, that
is an amazingly fun experience and good emotionally.
Mira (25, queer, trans woman)

If MDMA is good for reducing dysphoria and making the body feel right, LSD is also sex-
ually productive for Mira, though in a way that suggests transcending certain dimensions of
the gendered body:

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LSD is good because the times I’ve had sex on LSD, I have lost a certain level of spatial
awareness. So, I kind of forget I have a body, which is a very interesting experience. But I’ve
also had like hallucinatory experiences on LSD, mimicking like a mental perception of, you
know, like PIV [penis-in-vagina] penetrative sex, which is something that obviously really
appeals to me. And that has been a very interesting experience and again that ties back into
the like using [drugs to reduce] gender dysphoria and like coming to terms with things.
Mira (25, queer trans woman)

This role of intoxicants in afrming and experiencing an alternative and desirable sense of
gendered self was also apparent in Nico’s account:

There was another time where I was smoking weed and just walking down the street
and I again had a very clear visual and felt sense of myself as a man and as a man primar-
ily attracted to other queer men, and I looked, and felt, at ease, and like I knew myself,
who I was, and that everything was okay.
Nico (40, non-binary)

Meanwhile, Maddox comments on how MDMA can facilitate a sense of bodily ease, eleva-
tion, self-afrmation and smoothness in social and party settings:

[MDMA] lifts all of me up and I am able to be like, ‘Okay, this is my body and I feel
good in it’ like I forget my main issues with my body and I think about the good things.
And sometimes I will get really vain. Like I will take a bunch of selfes or something. I
go, ‘Oh, I look so good’ […] like the way that I feel in [my body] like the smoothness,
like the freedom. If I am high in some way it really afects like how I look at [my body]
and how I experience it, and it will make me feel better.
Maddox (19, non-binary, queer)

Interestingly, it was not only trans and non-binary participants who emphasised the consti-
tutive role of drug use in afrmative gender expression. A number of cisgender participants
also commented on this relation, illustrating how struggles with gendered norms can play
a formative role in the elaboration of a range of queer sexual and social identities. Julian, a
33-year-old queer cisgender man, conveys something of this when he confdes:

I haven’t always been as comfortable with the more feminine side of me. But now I guess
I understand that my more feminine qualities are actually just part of my masculinity.
Like being the sissy boy or being the efeminate boy growing up and not liking things
that boys liked or were supposed to like, like sports and that kind of stuf. Maybe in
some ways, my drug use was about coming to terms [and fnding] self-acceptance […] of
how my gender is expressed [in terms of things like being] emotional, soft, […] having
like a gay voice, liking to bottom, the enjoyment of the arts.
Julian (33, queer, cis man)

Reading these self-accounts through the lens of intoxication/disinhibition provides a partic-

ular vantage point from which to appreciate how the struggle with norms around gender and
sexuality is real and pertinent for a much wider range of sexual and gender-diverse subjects
than is sometimes asserted, even while the particular ways these norms are countered, em-
bodied, reconfgured, rejected or resolved in the form of specifc gender and sexual identities

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may difer substantially, with diferent social implications and consequences (see Halberstam
2017, Valentine 2007). Moreover, if practices of intoxication set sexual interaction and cor-
poreal expressivity to the key of play and playfulness, as Wilmot proposes and many of our
study participants’ accounts suggest, we can see how these interactive scenes of ‘uninhibited
play’ become signifcant in the performative experimentation with, and elaboration of, di-
verse sexual and gender identities and practices. As Susanna Paasonen writes:

playful sexuality and sexual play are not antithetical to the felt gravity of sexual selves
or identities but means of trying and acting them out, as well as for opening them up to
variation and change. A focus on playfulness allows for conceptualising sexual selves as
being in constant, more or less subtle, transformation.
(2018, p. 3)

Queer spaces and practices of intoxication might be understood, then, as richly diferentiated
gatherings of sociocultural and material possibilities and self-enactments that some sexual
and gender-diverse people work with to style themselves and try new things; to fnd out
who they are and who they might be. Participation in queer counterpublics ‘does not simply
refect identities formed elsewhere’; as Warner suggests, ‘it is one of the ways by which its
members’ identities are formed and transformed’ (2002, p. 121).

Conclusion
This chapter has argued that disinhibition ofers a more promising conceptual framework to
account for LGBTQ substance use than theories of minority stress alone because it opens up
the question of what people do with drugs and how these doings help to transform the material
pressures that sex and gender norms pose. This moves the scene of LGBTQ intoxication away
from a model of palliative consumption and directs our attention to the constitutive efects of
queer practices of intoxication – the sense in which these practices participate in the convocation
of interactional modes and social pleasures that bear material signifcance for the elaboration of
new identities. The concept of disinhibition recognises the enduring subordination of queer de-
sires and gender-non-conformity to heteronormative, cis-normative imperatives but – unlike the
theory of minority stress – casts intoxication as a practical strategy that grapples with this situation
in multiple ways. More than practices whose transformative afects are confned to the self, our
research demonstrates the signifcance of ‘uninhibited play’ for queer and trans world-making
and identity-formation, for expanding the possibilities of corporeal self-expression, and for the
transformations that queer counterpublics make possible (Warner 2002). Centring disinhibition
enables a better appreciation of the constitutive efects of drug and alcohol use, directing attention
to what practices of intoxication allow subjects collectively to achieve. Considering the impacts of
queer and gender-diverse subcultures on popular culture more generally and historically, we can
see how these forms of playful experimentation have contributed to the multiplication of sex and
gender possibilities and a concomitant expansion of frames of sex and gender intelligibility (see
Butler 2004 on grids of gender intelligibility).
Contrary to the theses of the life sciences, disinhibition does not represent some triumph
of the body’s baser instincts over the neurophysiological seat of moral adjudication, but could
be regarded as a complex social loophole, a more or less accepted perforation in the disci-
plinary conventions of sexual and gendered propriety. Sexual and gender minorities have be-
come adept at taking advantage of such loopholes to explore corporeal inclinations and facets
of the self whose expression would normally be regarded or experienced as unacceptable.

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In the process, they have learnt not simply to act on pre-existing desires, but also about the
great multiplicity of social, sexual and corporeal pleasures and identifcations, their creative
potential. This multiplicity is evident, not only in the wide range of things that queer and
trans people do with drugs, but in their responses to the terminology of ‘intoxication’, which
a number of our participants regarded as reductive (see Pienaar et al. 2020b):

I guess the word ‘intoxicated’ to me just doesn’t describe the experience. And the person
who uses the word, ‘intoxicated’ is either pretending or has no experience of actually
being under the infuence of some sort of drug […] Just trying to sort of box it of […] I
think it’s just ‘state change’ and there are so many diferent ways of changing one’s state,
whether it’s through the infuence of some sort of chemical or you know like meditation
or breath work or dreaming or whatever. Like they’re all just, it’s all just, state change.
It’s all just part of that spectrum of consciousness.
Nico (40, queer, non-binary)

The notion of ‘state-change’ Nico proposes here conveys how a queer theory of disinhibi-
tions ofers a more capacious angle of view onto LGBTQ+ drug use, not merely as a form
of self-medication (understood as the attempt to return the body to a prior state of mental
and/or physical health) but rather as a future-oriented strategy of ‘counter-corporealisation’,
a form of queer world-making in which drugs are deployed as catalysts in experiments with
the horizons of the body, gender, sexuality and subjectivity more broadly. On our reading,
queer disinhibitions are more than a means of ‘deviance disavowal’, and they cannot be re-
duced to the crude binary of repression/liberation; they are a creative artform that, through
playful and interactive experimentations, makes the places, spaces, sociabilities, connections
and performances entailed in queer counterpublic activity enjoyable, appealing and mean-
ingful for many LGBTQ+ people. Something to look forward to. Something that has given
rise to new possibilities of existence – hence their political signifcance.

Acknowledgements
The research reported in this paper was funded by an Australian Research Council Discov-
ery grant (DP170101373) awarded to Kane Race, Toby Lea and Kiran Pienaar. It was con-
ducted by researchers from the University of Sydney, Monash University and the University
of New South Wales’ Centre for Social Research in Health (CSRH). CSRH is supported by
a grant from the Australian Department of Health. The interviews were conducted by Dean
Murphy, David Vakalis, Kiran Pienaar and Kane Race.
The authors would like to thank the study participants for sharing their experiences so
generously and expansively. We also thank the project advisory panel for their insights and
expertise; the Australian LGBTQ organisations that kindly assisted with recruitment; the
editors of this Handbook for their encouragement and for being so patient with us; and the
feedback on an earlier version of this paper we received from two anonymous reviewers,
whose readings, suggestions and insights we drew on to improve the chapter.

Notes
1 On the performativity of stigma in the context of addiction, see Fraser et al. (2017).
2 The ‘pub test’ is an Australian term often used in media and political discourse to describe the
general opinion of ‘everyday Australians’. Often used as a proxy for ‘public opinion’, the term

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suggestively connects public sphere theory to practices of social drinking in this setting. We use
the term advisedly: who, after all, is the everyday Australian?
3 Alcohol has been shown to elevate cortisol – a hormone implicated in arousal – but the search for
a physiologically discernable regulatory mechanism that selectively disinhibits certain behaviours
has not been successful (see Reinarman & Leigh 1987).
4 The researcher’s observations were made in the context of a study of (hetero)sexual drinking (his
informants were six heterosexual couples). But we also take them to be indicative of a certain
teleological approach to sex that prioritises pre-defned objectives (sexual conquest, penetration,
orgasm) while bracketing other pleasures – the enjoyment, signifcance and possibilities of which
have been elaborated by queers and feminists – as frustrating distractions from such ‘serious’ ends.
(See generally Paasonen 2018, Jagose 2013 and Chapter 1.)
5 There are of course important diferences between many trans identities and drag. It is nonetheless
interesting that drug use was variously associated with gender experimentation, transformation
and afrmation by participants who nominated transgender, non-binary and cisgender identities
for themselves, respectively.

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 18
RITUAL TO REFLEXIVITY –
FROM PROMOTION AND
PROBLEMATISATION
OF INTOXICATION TO
PROPORTIONALITY
John O’Brien

Introduction
This chapter ofers a social theoretical examination of ‘excess’ and its regulation by drinkers
in drinking occasions. Social theory attempts to ofer an integrative account of social change
and is oriented in particular to the question of the meaning and efect of modernisation.
This is of value in alcohol studies, as research on drinking and drunkenness tends to pres-
ent them in a fragmentary and negative manner, being highly specialised and focused on
problems, obscuring the wider role and shaping of drinking, excess and their social context.
Modernisation could also be argued to be the single greatest infuence on drinking culture,
profoundly efecting availability and the mode of consumption. The chapter thus examines
one of the major dimensions of modernisation: deritualisation, which is a central theme in
so much social theory from Durkheim, to Weber, to Foucault to Bauman. It presents an
ideal-type distinction between the strongly ritualised drinking of smaller-scale, less complex
societies and the destructuring of the drinking ritual in complex, modern societies. The
ritualisation of drinking has a moderating efect on acute and chronic harms resulting from
it, as well as producing culturally constructive outcomes. But ritual is conservative, and due
to its scripted nature, is not ‘creative’. Modernisation also does not see the disappearance of
ritual. Drinking rituals continue, but in an altered form, with major signifcance for the type
of drinking and degree of excess.

Promotion and Problematisation, or Proportion?

Drinking is deeply entwined within social life and is clearly a normal aspect of human cul-
ture at large, as all human groups have used some form of psychoactive substance, and nearly
all have used alcohol (Sherratt, 1995b: 34). Discourse on alcohol intoxication as a whole
however has a schizoid quality. Alcohol use is promoted on the one hand through several of
the axiomatic ‘goods’ of modernity, such as freedom, choice, equality and participation in
the public sphere. These values have their corresponding expressions in drinking: in liberal-
isation of alcohol markets and drinking culture, alcohol as a feature of consumer culture, the

290 DOI: 10.4324/9780429058141-23

 Ritual to reflexivity

right to drink to ‘excess’ indicating social and political participation, and a utilitarian argu-
ment that private ‘vice’ is a public good in reference to how it generates jobs and revenues.
However, there is a powerful ‘problem perspective’. The focus of scholarship on drinking
has tended to be on problems associated with alcohol as an intoxicant. Drinking is the subject
of ‘problematisation’, whereby alcohol use and intoxication become something to be known,
an object of discourse and something to be governed (see Bacchi, 2015). Concepts and
movements such as paternalistic regulation, temperance, abstinence, prohibition, the disease
model, alcohol problems model and public health, which frame alcohol negatively as an in-
herent danger, are products of processes that are constitutive of Western modernity, such as
Protestantism and ‘civility’ and their culture of individualism, self-control and responsibility
(Levine, 1992; Valverde, 1998). Problematisations are a product of exploitative national tax
systems and state alcohol or opium monopolies and the political tactic of denigrating dom-
inated groups as inherently associated with uncontrolled intoxication also, which produced
anti-alcohol and drug movements (O’Brien, 2018). In the contemporary era, alcohol has
become the target of public health policy due to its strong implication in morbidity and
mortality (Babor, 2010). Public health policy, under the guidance of the WHO, has devel-
oped a goal of reducing alcohol consumption to the lowest possible level, using the rationale
that all consumption involves risk, with no safe level of consumption, and most importantly
due to the fnding that the overall level of consumption increases the risks stemming from
consumption for the cohort of problem users (Butler et al. 2017: 14–16). The current public
health consensus is part of the long-debate about how alcohol should be controlled, which
has gone through phases of free-market permissiveness, paternalism, prohibition and the AA
two-population addiction model. Discourse on intoxication is thus largely either individu-
alistic, narrow or politicised.
Intoxication itself is a compromised term, as it has considerable roots in nineteenth-century
medical science, criminology and the moralisation and politicisation of drunkenness in tem-
perance movements. The term contains a sense of danger and biological reductionism, as it
literally denotes poison. It’s etymological provenance in the late sixteenth century points to
an association with spirits which were prominent in the nascent consumer culture, and with
‘peculiar substances’ – novel psychoactive substances – from the emerging European system
of global trade, both of which were linked with a paranoia over threats to the established
order by the dynamic society these substances were a part of. Even the term alcohol, de-
scribing a chemically distilled substance rather than a beverage, signifes a pharmacological
understanding that fragments the substance into something shorn from its context.
Redefning the question of ‘intoxication’ as a question of ‘proportion’ – what is consid-
ered proportionate and what is considered disproportionate – would provide a more holistic
viewpoint on the question. ‘Drink’, ‘glass’ or other native terms better capture alcohol as a
culturally embedded social practice, and ‘drunk’ better denotes the cultural defnition that
a socially sanctioned measure or defnition of what is proportionate has been passed. Latin
languages, deriving the word for intoxication from ēbrius, even more directly refer to what
is ‘out of measure’. The Platonic notion of the golden mean is relevant here, as is Aristotle’s
(2009) idea that virtue is the middle road between vicious extremes – an ethos that native
terms for ‘intoxication’ implicitly contain. Philosophy embedded in language is furthermore
expressed in social practice, as the Mediterranean region appears to have a Hellenic cultural
inheritance that emphasises the ritualisation of consumption, which has salutary efects.
Virtue ethics did not spring from a philosopher’s head, but from a way of life, part of which
was the ritualisation of drinking and a strong value placed on drinking proportionately in
these contexts – and a problematisation of hubris – which drunkenness was emblematic of

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(Nelson, 2005; Rinella, 2010; MacLachlan, 2014). Proportion could thus be seen to be the
result of a social learning process that inculcates a pragmatically useful form of conduct, in
that it provides the schemes for dealing with recurrent action problems, which have emerged
through trial and error, with pragmatic solutions crystallising into rituals, habits and institu-
tions, which ultimately gain objectivity and power over individual people while also acting
as a resource for them (Bateson, 2000: 273; Berger & Luckmann, 2007: 43–44, 46, 48). Such
an action problem is the question of how to drink proportionately,1 which is a feature of
every drinking culture.

Learning to Measure Drinks: Culture and Ritual

Drinkers learn to drink proportionately. Constructive drinking could be described as in-
volving a learned sense of proportion of what is in due measure, with use protected from
what is culturally defned as excess, so that ‘goods’ are achieved through it. These goods
are drinking that is supportive of circles of recognition that are supportive of identities, the
capacity to modulate pleasure and risk, and minimise harm.
An alignment of drug, set and setting establishes the practices, cognitive frames and be-
havioural scripts that allow the regulation of consumption and the controlling of the expe-
rience (Zinberg, 1984). Indeed, most alcohol use is non-problematic as people have learned
how to produce safe and positive outcomes through an appropriate tuning of the elements of
drug, set and setting, with the majority of consumption used to facilitate pleasurable socia-
bility (Peele & Grant, 1999). ‘Drugs’ are an aspect of the material culture of a group, which
present particular spectrum of possible experiences. ‘Set’ is the mental frame, intention and
expectation that the user brings to their use. From a developmental perspective, what is cul-
turally acceptable drinking behaviour is learned in every society. People learn the rules of the
game for when, where, with whom, and how to consume, and what is excess. Every culture
has various defnitions of types of excess and ideal forms of ‘drunken comportment’. Users
will have a learned sense of proportion also, meaning a set of internal controls that dictates
the right way, the right time and the right place to consume.
Becker (1963) showed how users have to learn how to consume psychoactive substances
properly, with this often requiring a considerable amount of skill, and how to interpret the
feelings that a substance provokes. They learn what to expect from using a substance, with
the ‘expectancy efect’ crucial in framing the nature of the experience, making it a cultural
process rather than simple drug-administration of a particular concentration of alcohol in the
blood (McAndrew & Edgerton, 1969; Room, 2001). As McAndrew and Edgerton (1969: 88,
italics in original) famously stated: ‘[o]ver the course of socialization, people learn about drunkenness
what their society “knows” about drunkenness; and accepting and acting upon the understandings thus
imparted to them, they become the living confrmation of their society’s teachings’.
‘Setting’ refers to the context of use, meaning both the immediate environment of use
and the broader cultural environment. Alcohol itself plays an important role in constitut-
ing this broader cultural environment. Culture is a meaningful web of symbols that guides
conduct (Geertz, 1973), and drinkers have an ear for what they are drinking as well as taste,
as drinks are part of the symbolic web of social life. It is an important metaphor in culture,
as with the vine, grapes, wine, its ritual consumption and drunkenness in the Abrahamic
tradition representing the favour and disfavour of God. Alcohol like other psychoactive sub-
stances is also an important element of non-verbal symbolic communication (Gusfeld, 1987:
75–76; Sherratt, 1995b: 11). Drinks and the manner in which they are used is a code that
communicates messages about the meaning of events, values, attitudes towards the world,

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 Ritual to reflexivity

social status, afliation to various communities, gender identity and so on. Ritual is an im-
portant aspect of setting, institutionalising stylised and rule-bound modes of consumption.
The emotions that underpin ritual action and the prescriptions and proscriptions involved
are unusual for the strength with which they are held (Heath, 1988: 397), tending to be
linked with the ‘strong evaluations’ of a culture.
However, when the constellation of drug, set and setting becomes disrupted and un-
dermined (which we will turn to in a subsequent section), rather than a cosmic order that
produces constructive drinking, the outcome can be problematic for users, either through
the development of dependency or through chaotic experiences of drunkenness. This can
be due to problems with the setting due to stigmatisation, lack of informal social controls or
consumption happening in aversive environments; set due to inexperience, mental health
problems or trauma; and drug due to the potency, adulteration or inability to know the dose
taken (Hartogsohn, 2017).

Ritual Drinking
Rituals are special occasions, requiring some collective preparation and rehearsal, have hence
a dramatic function, are particularly meaningful and bound by rules and a strong sense of
what is proportional and equally what is proscribed. They can be extraordinary – as with f-
esta drinking, or banal – as where wine is incorporated as a foodstuf in meals, where despite
the quotidian character it retains a special character as a focus of a daily ritual. Alongside the
small number of abstinent societies, which have rituals focused on psychoactive substances
other than alcohol, there are various ritualisations of drinking across and within societies.
There is constrained ritual drinking, such as that of Orthodox Jews. There is banal drink-
ing where alcohol is a food as in certain Mediterranean wine-drinking societies. There is
communal festa drunkenness characteristic of medieval European and certain developing
societies (Room & Mäkelä, 2000). There is the everyday drinking of ‘wet’ and occasional
binges of ‘dry’ societies (Levine, 1992), and heroic and modern drinking (Partanen, 1991).
There is also considerable diversity within a culture based on the social feld of alcohol con-
sumption (Lunnay et al. 2011).
Ritual is a fundamental character of drinking in all of these types of culture nonetheless.
It possesses consistent elements. It is a specifed place, time and manner of consumption,
and with drinking nested within other activities and goals. They are usually pleasurable and
exciting – involving a modulation of risk and pleasure (for example, with drinking games),
are directed at action (as in a festival marking the start of the university year and the work
and sacrifces that must be made), marking transitions (such as New Year or gaining adult
status), transmit implicit values (with drinks often expressing gender, regional, national and
class identities), conjure or reinforce bonds (with drinking inducing a shared ‘fow’ state,
making the same steps and sharing – as in the rounds system), and articulate status and ex-
clusions (as with the gendered nature of very many drinking rituals).

Te Ritual Process
A more elaborated ideal type of ritual drinking can be given through the concept of the
ritual process. The discussion that follows will necessarily be brief and will sufer from some
diachronic and synchronic fuzziness in the description of drinking patterns, as it is a broad
overview, but the hope is that the points will stand. The concept was developed by the cul-
tural anthropologist Victor Turner in the 1960s, and since then it has been endlessly used to

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 John O’Brien

conceptualise how alcohol and other psychoactive substances are used. It describes a process
through which there is a separation from normal social roles, an entering into a special con-
stellation of greater freedom, possibility and equality, which is nonetheless strictly regulated,
which comes to an end with participants fnally returning to the social order. The middle,
in-between phase, which he labelled ‘liminality’, is the critical one, denoting the moment of
fraternity, sorority and liberty which the consumption of alcohol facilitates and symbolises.
The ritual process provides social control over consumption. Goody (2002) has argued
that small-scale societies, in which the ritual process plays a signifcantly larger role than
in complex modern societies, can be characterised by high levels of self and social restraint
and consideration to others, expressed in moderate drinking occasions. This is because the
ritualisation of drinking occasions and the complex web of obligations that are dramatised
within them impose limits on behaviour. Alcohol use is tied up in the suspension of the so-
cial order, and through this refreshes it. Drawing on Victor Turner (1969), and his work on
rites de passage, it is evident that the use of psychoactive substances is dramatic, and a means of
symbolically keying a periodic shift of society into liminality (or in more prosaic language, a
’time-out’) where the roles and hierarchies of the social structure are temporarily suspended,
and people enter an in-between phase of refection, creativity and less regulated action. In
its classic form, the ritual process is a signifcant event in the life of a community, but it has
similarities in more prosaic drinking rituals, as with Mediterranean drinking, where an
aperitif marks the entrance in a somewhat liminal moment of greater freedom and equality
which a glass of wine symbolises, and a cofee signalling the return to social structural roles.
A movement from structure to anti-structure is frequently associated with such use of psy-
choactive substances (Gusfeld, 1987; Pedersen, 1994; Heath, 2000).
It is the argument of Victor Turner (1969) that the ritual process is a cultural universal.
Anthropological and cultural sociological scholarship tends to emphasise relativism and so-
cial constructionism, noting the wide variety of drinking patterns, historical contingency
and social change, serving as evidence of the constructed nature of drinking occasions.
However, as Heath (2000: 160) notes, ‘it is striking that drinking often seems to serve similar
purposes in very diferent cultures and contexts’. The reason for this underlying sameness
can be explained by the fact that drinking occasions tend to take the shape of grand and
mundane rituals, that conform to Turner’s (1969) model of the ritual process. Drinking occa-
sions, as forms of the ritual process, mark and structure temporal and life-course transitions,
which ofer a time-out from the normal roles and routine of mundane social hierarchies,
where, accompanying the ‘liminality’ where fellowship and freedom are experienced, there
is a dramatisation of sharing, which alcohol plays a central role in.

Transition
As noted above, the ritual process structures transition, and accordingly rituals cluster around
the major life transitions of birth, coming of age, marriage and death, along with the range
of other transitions marking changes in status, rank, role or the lifestyles, where individuals
or groups step into a new identity. Rituals involving alcohol, other psychoactive substances
and sanctioned excess are cross-culturally associated with transitions and initiations (see
Douglas, 1987: 4; Heath, 2000: 125, 168, 196; Bancroft, 2009: 59; Babor et al. 2010: 15–16).
For example, the birth of a child is often marked by a drinking occasion, as is the entry of the
child into the community (Heath, 2000: 24, 82). A ritual marking one’s right to drink often
accompanies the acquisition of adult status. Courtship and marriage tend to be wrapped up
and marked by rituals involving alcohol. Initiation into a group, or clique, or institution

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such as a university or army also is expressed by a particular grand drinking ritual and cycle
of petty rituals. Drinking occasions often mark a change in the circumstances of the wider
community, such as the accession to the throne of a new ruler, or in commemorations of a
victory or defeat symbolically marked with toasts (Heath, 2000: 30).
As a psychoactive substance, alcohol plays a useful role in structuring time, by subjectively
breaking up its fow, through commencing a new type of time with distinct qualities. Along-
side the high points of ritual, the cycle and rhythm of cultivation of the inputs and the pro-
cess of production also structured time, for instance, in how the stages in the production of
wine structured the year in Southern Europe and the Near East. Alcohol rituals play a keying
role, indicating the move to a new form of time, patterning movements between structure
and anti-structure (Gusfeld, 1987: 84), which varies between occasional crescendos of rare
but highly signifcant events, to the more mundane regular peaks of everyday life, such as
how cofee, cigarettes, aperitifs, post-work drinks and night caps mark the passage through
diferent phases of the day. Ritual modes of drinking have long structured weeks, through
marking the weekend or Sabbath, which includes wine in its central rite. Transitions in
the year are marked by alcohol rituals, such as saturnalia, harvest (including specifc rituals
marking the harvest of ingredients for alcohol, or the maturation of drinks, such as wine
harvest, Oktoberfest and the Dionysia) and carnival preceding the fasting of Lent (Heath,
2000: 20). This function of alcohol rituals in structuring time was of course much more
important historically before clock time whose ascendance is a response to social complexity
(see Netting, 1964), though of course it lives on in a secondary role.

Controlled Decontrolling
In the phase of liminality, there is ‘anti-structure’, where greater freedom from limits is
allowed, with such decontrolling occasionally going so far as to become ‘carnivalesque’,
involving an inversion of hierarchies and a reversal of the normal structures of social life
(Bakhtin, 1984: 123). McAndrew and Edgerton (1969) conceptualised drinking rituals that
involved sanctioned excess as ‘time outs’, in which there was ‘cultural remission’, where
people could step outside of the normal responsibilities of social roles, with the rules of
social conduct simplifed. These are however not based on a pharmacologically driven disin-
hibition but rather on the symbolic cue it provides for a loosening of strictures (McAndrew
& Edgerton, 1969). Thus, rather than ‘intoxication, what takes place is controlled decon-
trolling, where norms that are bent are done so in a socially acceptable way, and in a way that
has an established social role’ (Bancroft, 2009: 52).
This is expressed in greater informality, transcendence of mundane roles, looser limits, a
greater freedom for people to express themselves and greater emotional and afective free-
dom, with the possibility of ribaldry and vulgarity, at times more sexual freedom, foolish-
ness, horseplay, aggressiveness and assertiveness (Gusfeld, 1987: 79, 83; Gefou-Madianou,
1992: 12). There is often heightened competitiveness in these moments where consumption
runs alongside contests such as drinking games, games of skill such as cards, games of taste,
competitive displays of waste, debating or slagging. There may not merely be licence for this,
but in some cultures, there is even an expectation that drinking will lead to such conduct,
with consumption symbolically framing and delimiting such behaviour in social life. It is
not simply that alcohol promotes relaxation through its physiological efects, but also that
its presence and use symbolically frame situations as having this meaning (Heath, 2000).
Rituals involving alcohol consumption are also moments where normal cognitive restraints
are lowered. In the phase of liminality, participants are encouraged to think about the basic

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assumptions of their culture, and what lies behind the obvious and the taken for granted
(Turner, 1969). Drinking rituals are of course moments for more free discussion and debate,
as well as greater playfulness with morality. Furthermore, in the liminal phase, an object is
often used as a vehicle for refection, which in an abstract way symbolises deep cultural val-
ues and community. Many cultures use psychoactive substances as such an object (Sherratt,
1995a: 6). For example, for the Kofyar, beer acts as a ‘locus of value’, serving as a metaphor
for the state of social relationships, and as a way of articulating the good life (Netting, 1964:
378). Similarly, wine plays the same role in Christianity, or in much of the pre-Islamic po-
etry of the Middle East, and in Islam and various Protestant sects, Mormons, and among
Alcoholics Anonymous, alcohol is important alternately, in a negative way, as a way of sym-
bolising the threat to good order in social relationships.
Decontrolling is controlled by how rituals are delimited and enclosed. Drinking rituals
take place in a ‘recognised social context’ (Douglas, 1987: 4) that is enclosed in space and
time (Heath, 2000: 137). Drinking occasions are bound by temporal divisions, which dictate
when consumption can and should occur, involving what types of drink, alongside what
types of behaviour and with what types of other people. As well as time, there are particular
spaces where these should occur, which are often set apart from everyday life, or specially
constructed and laid out for the purpose. The word ‘liminality’ stems from the Latin ‘limen’,
meaning ‘threshold’, which is stepped over to enter into the out-of-the-ordinary (Turner,
1969: 94). ‘Leisure’ stems from licere, meaning ‘to be allowed’, which shares the same root as
‘licence’, thereby indicating that freedom and control are diferent aspects of the same con-
cept. Indeed, decontrolling is intimately connected to self-control, as greater freedom goes
alongside a demonstration that one can stay within limits, as in the moment of loosening
there is a demonstration that the person is a competent actor. As Turner (1969) explained,
liminality is a type of destructuring that is prestructured, as the ritual process organises the
experience of decontrolling in an ordered and planned manner, with people experiencing a
freedom that is simultaneously acted out according to a script. Drinking rituals thus contain
a ‘within-limits clause’ (McAndrew & Edgerton, 1969), which ‘implies culturally shared
expectations and permissiveness, not a generalized pharmokinetic disinhibition’ (Heath,
2000: 197). A crucial fnal limit is the presence of masters of ceremony, who play the role of
maintaining order and directing the action, ensuring that the disordering remains orderly.
These fgures are representatives of tradition and community. Some contemporary drinking
rituals continue to have masters of ceremonies of sorts, in the shape of publicans, hosts and
toastmasters, though these are residual fgures compared to elders in traditional rituals or the
symposiarchs who orchestrated symposia.

Communitas
‘Communitas’ is one of the characteristics of the liminal, middle phase of rituals, which
involves a strong feeling of equality and fellowship with others, due to how the liminal
personae have been stripped of the markers of their social structural identities of rank, status,
property and so on, and are levelled, even becoming structurally indefnable, playing with
fundamental categories of identity (Turner, 1969: 95, 102, 104, 106). Drinking occasions
can of course be opportunities for displaying status, but they have been very often inter-
preted as moments where factionalism and individualism are restrained, with the emphasis
shifting to oneness, equality and fraternity. The reason most often given for drinking is
indeed the experience of ‘communitas’, though through the common language terms of
sociability, bonding, solidarity and the pleasure that fows from this (Gusfeld, 1987: 79, 82;

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Gefou-Madianou, 1992: 1, 11; Heath, 2000: 196; Hunt et al. 2005: 239). For this reason,
it has a long history as an icon of associational life in guilds, fraternities, clubs, professional
associations, political factions and machines and so on.
One of the main ways that communitas is produced is through gift-giving, which is dra-
matised in these rituals, which establishes an asymmetry and obligation between the parties,
setting in train a process of reciprocity that a relationship is built on (see Mauss, 1992, Tu-
torsky, 2016 for an application to alcohol), with what is exchanged symbolising a recogni-
tion of the other’s identity. Though this could be seen as a mere pleasantry, historically it
was in fact the centre of social life before a legal order and markets come to underpin the
social order, seen, for instance, in the drink exchanges among the elites of early civilisa-
tions, through which allegiances and peace were maintained (Enright, 1996). Gift giving in
rituals involving alcohol is produced through a number of techniques, to establish a com-
munion. Alcohol is typically given as a gift in some way, and it is reciprocally exchanged
then. Hospitality is given as a gift, of which alcohol is an almost universal symbol. Drinking
frequently takes place in the context of a meal, which is paradigmatic context of sharing. The
etiquette that surrounds consumption is a means of giving and receiving respect, in turn,
for instance through serving the other and observing the niceties of the ritual. Toasting is a
near-universal feature of drinking rituals, where words are given to articulate the personal
linkages between participants. There is a giving of oneself over to the ritual and the enthusi-
asm of the group, becoming fully involved in collective practices that go alongside drinking,
such as singing, chanting, dancing, stories and games. Part of this is the incorporation of the
same substance into one’s body as others. Finally, there is frequently gift giving of alcohol
or something in the context of the drinking ritual, to the ancestors, spirits and gods (Heath,
2000: 176).

Benefcial Rituals?
Psychoactive substances are frequently not associated with harmful health and social out-
comes because of how they are intertwined into a cosmic order of ritual, myth, systems of
reciprocal exchange, nested in an overall sense of proportion. Strong drinking rituals can
result in culturally constructive outcomes of moderation and meaning-making. Partanen
(1991: 213), for example, has noted that ‘the ritualization of drinking, its ceremonial uses,
do, in fact, exert a dampening efect on more extreme forms of drunken comportment’.
Even where such ritual drinking could be considered extreme, as in Heath’s (1958) example
of the Bolivian Camba, or Beccaria’s (2010) study of the Alpini, there can be a remarkable
lack of problems considering the intensity, scale and duration of such events. Even among
heroin users, widely considered to be the most powerless of psychoactive substance users in
the face of their addiction to an intoxicant, it has been shown that use takes place in social
rituals which are the frameworks that self-regulation and harm reduction strategies occur
within (Grund, 1993). Indeed, Zinberg et al. (1975) have argued that ‘[c]enturies of experi-
ence with intoxicants point clearly to social control, not prohibition as the only humane and
reasonably successful means of managing their use’, whereby use is permitted within ritual
contexts and customs.
A startling though contested fnding of anthropological research on small-scale societ-
ies, whose cultures have not yet been fatally disrupted by being incorporated into the orbit
of a metropolitan power, is that drinking and psychoactive substance use at large tend not
to have pernicious social and health outcomes due to the way they are intertwined into a
cosmic order, or an ordered totality, composed of ritual and associated myth and systems

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of reciprocal exchange (see Heath, 1958; Room, 1984; Tutorsky, 2016; Hartogsohn, 2017).
Heath (1988: 398) explains that ‘the idea that drinking is associated with problems is absent
in many cultures, and the idea that it might be a major factor in the aetiology of a debilitating
disease is highly unusual’. The argument goes, in brief, that alcohol use is normative, linked
with benefcial outcomes rather than harms, due to its consumption in a ritually bound
context involving considerable social control, with the substance seen as sacred rather than
a permanently available mundane item, and is linked with the reafrmation of social bonds
and hierarchies.
Such an argument is likely to be contested through the observation that modernity has
simply created a confict between the rewards that psychoactive substances have provided
in human evolution and the contemporary environment, through the enormous increase
in availability of potent substances in the form of refned, purifed and synthetic drugs and
distilled spirits and modern beers, in the same way that obesity and diabetes are the result of
the confict between evolved tastes and the availability of fats and sugars (Nesse & Berridge,
1997). However, humans have always lived in substance-rich environments, with techno-
logical means for allowing the administration of more potent doses developed early, and
moreover, despite this, all groups entirely foregoing certain forms of intoxication, though
they are technically freely available.
The ritualisation of alcohol consumption has been ofered as an explanation for the almost
universal consumption of alcohol by Orthodox Jews and the very low levels of ‘alcoholism’
(Bales, 1944; Snyder, 1958). The higher level of consumption of secular Jews is linked with
their removal from the constraints of tradition and ritual participation. Ritualisation has
though continued despite the secularisation of Jews through the cultural legacy of a strong
presence of elders to teach moderate consumption patterns, strong norms about who can
drink and how, strong sanctions to enforce these norms, enacted in recognised ritual settings
(Glassner & Berg, 1980). In Western, contemporary societies, something similar has been
found. Alcohol problems are more likely the more consumption is distant from community
and family life, with problems tending to ‘occur in inverse proportion to the “communal
orientation” of diferent groups’ (Heath, 2000). Where drinking primarily occurs in the
context of a meal, and where young people drink in orbit of adults, problems are less com-
mon (Brodsky & Peele 1999: 196). The link is not absolute of course, for example, with the
traditionally very high levels of consumption in France linked with chronic diseases such as
cirrhosis.
Groups experiencing cultural breakdown have the most severe alcohol problems. In
American alcoholism research, Irish Americans have been the other to Orthodox Jews. The
explanation ofered is the deritualisation of drinking. This occurred through the cultural
trauma of the Great Famine which devastated the peasantry, followed with an aggressive
civilising ofensive led by the Catholic Church that attacked popular ritual. Subsequently,
the Irish were stigmatised as an outsider group in the USA compounding the ethnic stig-
matisation of them in the UK that labelled them as drunkards, triggering an ambivalence
towards alcohol alongside a self-fulflling prophecy of living up to deviant labels. Finally, the
aforementioned lack of established rituals made ‘drunkenness’ more likely (Stivers, 2000).
The considerable difculties of other groups can be found in the destruction of cultural
frameworks and the ritual context of consumption through colonisation, internal colonisa-
tion and deculturation, such as communities previously isolated from the state and markets
that become quickly dominated by metropoles (Tutorsky, 2016). The experience of many
Native American groups and other indigenous people who have sufered cultural trauma
has been even more extreme, while re-construction of traditional practices, spirituality and

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culture has been associated with more positive outcomes in alcohol use (Stone et al. 2006:
237). The enormous increase in alcohol-related morbidity and mortality in Russia following
the collapse of Communism was linked with rapid cultural change, the undermining of a
way of life and consequent fracturing of rituals (Cutler et al. 2006: 98).

Ritual and Conservatism

Much of the literature on the ritualisation of alcohol in cultural anthropology has an implicit
message about its benefcial efects as a moderating and regulating force. However, a norma-
tive question is: to whom are these rituals benefcial? More recent scholarship has examined
drinking rituals as an expression of power dynamics, which was underplayed in earlier schol-
arship (such as many of the studies referred to above), which have a functionalist bent (Di-
etler, 2006). Victor Turner’s analysis of ritual equally is functionalist to a degree, emphasising
order more than power. Drinking rituals however are about articulating status as well as
equality, as inclusion implies exclusion, and the experience of equality and sameness implies
diference from those outside the circle. Ritual often concentrates people in coordinated
action for the recognition of rank based on age, gender, kinship, status, class, status group or
party. Indeed historically, there have been prominent outsider groups with respect to rituals
involving drinking: children, women, slaves and other outsider groups, who cross-culturally
have been partially or fully excluded (Gefou-Madianou, 1992: 7).
Furthermore, women (to choose just one of the outsiders to ritual) are often in supporting,
subordinate positions (Beccaria, 2010). This is sometimes presented as relatively benign due
to it amounting to the expression of diferent systems of honour for the genders, rather than
absolute social exclusion – for example, with women dominant in the domestic sphere, and
men dominant in the public sphere, including its drinking rituals (Gefou-Madianou, 1992).
Although this runs counter to the strong norm of mass culture, equality and autonomy in
modern society, this feature could also be read as a way of dampening status competition
between drinkers and reducing costs and anxiety related to this, through the separation of
gender spheres. In pre-capitalist societies, women are often the producers and suppliers of the
drink men consume from which they derive some status (Dietler, 2006). Women have played
prominent roles as ‘keepers of men’ in drinking rituals. Women have historically played a
large role as mistresses of ceremonies in drinking rituals (such as ladies in royal courts, inn
keepers, geishas or shebeen queens), acting as hostesses who prepare and serve drink, acting
as a moderating infuence by coordinating the action and checking excesses through their
power as an insider-outsider (Gefou-Madianou, 1992).
The ritual process in its ideal-type, classical form does not exist in complex, plural-
istic societies, and is instead replaced by ritual-like forms, as we will see in the follow-
ing section. Indeed, ritual is associated with features that modern reform movements have
problematised – hierarchy, authority, exclusion and social policing of taboos. This is not
merely a normative point. Mary Douglas (1987), who coined the term ‘constructive drink-
ing’ to describe the culturally constructive nature of ritualised drinking studied by an-
thropologists, elsewhere (1996: 106–125) noted an unwarranted tendency to romanticise
‘traditional societies’. The reality is that when people are presented with the choice to leave
traditional societies, they invariably do so in order to engage in an agentic construction of
personal identity. As alcohol becomes a commodity with the marketisation of societies, the
hold of the right to drink as a patriarchal and gerontacratic privilege tends to lessen, and a
cash economy allows historically outsider groups such as women the ability to participate in
drinking occasions that were previously closed to them, frequently sparking resistance and

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outrage from the formerly privileged insiders (Suggs, 1996). There has also been a criticism
of research focusing on the integrative and constructive role of drinking as ignoring polit-
ical economy, ignoring the role of class and the capitalism also (Singer, 1986). While this is
an important observation, it is equally important to note that for the greater part of human
existence, psychoactive substance use was shaped more by local practices, with capitalism a
historically recent social form, that has undermined ritual by increasingly replacing ritual
with market-based relations.

Te Liminoid. Ritual in Modernity

Deritualisation?
Any quick search of the terms ‘alcohol’ and ‘liminality’ will show hundreds of results, serv-
ing as evidence for the power of this concept. However, the concept is frequently used out of
the context of Turner’s (1969) own theory, as his interpretation was that ritual and liminality
did not exist in the form he described from his anthropological feldwork in modern soci-
eties. It is odd then how frequently ‘liminality’ is used to describe contemporary drinking.
On a superfcial level, this model can apply to grand community rituals, the festive cycle of
communities and religious traditions, ‘binges’ typical of friends partying at home or in the
night-time economy, self-created rituals of get-togethers and mealtime customs, the skid-
row drinker who fnds belonging and relief in the reciprocity, hustle and consumption of al-
cohol, and the solitary compulsive drinker in a rut of returning again and again to alcohol as
a symbol of escape and attachment. The superfciality of lumping so many disparate types of
drinking together is an indication of the loose manner in which the concept has been used.
The rituals involving drinking of traditional and conservative societies do not exist per se in
complex pluralistic societies. This is the source of some of the problematic application of the
concept of liminality for understanding excess. The grand rituals that once structured lives and
communities are in rapid decline, replaced by the evanescent transitory and choice-based ar-
rangements of liquid modernity, meaning that this age-old basis of informal social control plays
a role in regulating consumption less and less it would seem. The traction of cultural traditions
in general appears to be decreasing, seen in the rise of a globalised form of consumption focused
on hedonism, in contrast to the myriad drinking worlds of the past (Gordon et al. 2012). But the
role of ritual in structuring drinking and drunkenness changes rather than disappears.
The previous overview of the way that the ritual process provides social control to drink-
ing occasions, combined with prominent anthropologists claims that this results in a mod-
eration of harm in the contexts where this constellation exists, raises the question about
what is going on in modern societies? A quick explanation would be the classic argument in
Durkheimian social theory that the traditional mechanisms of social integration and regula-
tion have been undermined in modern societies. An ideal-type distinction between ‘small-
scale’ and ‘complex societies’ is, of course, just that – an abstraction that is conceptually
useful, as of course in reality all societies sit on a messy continuum, and societies labelled as
complex have features of simple societies and vice versa. However, Berreman (1978: 226–
228, 234) does note that the terms are on balance useful. In the same way that Durkheim
(2002) showed that certain groups and demographics had a cultural immunity to suicide,
certain groups possess a cultural immunity to alcohol problems. Mediterranean societies
have possessed such a relative immunity historically because of the way alcohol was woven
into the ‘matrix of the personal, social, and religious lives of the people of these societies’
(Gefou-Madianou, 1992: 22).

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A Durkheimian reading, emphasising the controlled nature of consumption in simple

societies, and the anomic nature of consumption in complex societies is a staple of alcohol
studies. Bacon (1962) explained the more problematic nature of consumption in complex
societies because of their more secular and individualistic nature which provided weaker
social controls. In addition, complexity and the demand for controlled conduct due to the
complexity, discipline and the pressures of coordination make alcohol incompatible with
many spheres of life, thus acquiring a sense of deviance, while also being pervasively avail-
able, and a technique of catharsis for dealing with the emotional strains of a highly ra-
tionalised society. Shilling and Mellor (2011: 17, 27–28, 33) more recently have argued that
the ‘embodied intoxication’ of efervescent assemblies that characterise small-scale societies,
which is often facilitated by psychoactive substance use, are problematised by the modern
emphasis on autonomous individualism. In turn, psychoactive substances that promote in-
dividual self-control and provide energy and focus, such as tobacco, cofee and sugar, which
are moderate in their efects but harmful over the long-term, become socially acceptable,
while drug-experiences that lower the boundaries between people and undermine individ-
ualism become the focus of restrictions. Thus, substances such as alcohol became prohibited
initially from defned areas of social life, later becoming more generally proscribed. Parallel
to this process, social diferentiation created specialised arenas for diferent aspects of life,
such as work, family and leisure, resulting in collective intoxication being restricted to do-
mains with little substantive connection to wider social life (albeit networking continues
to be important), and with specialised agencies such as courts, public health and professions
replacing communal authorities in the role of regulators of collective intoxication, making
control both abstract and something that ceases to be the absolute authority of members of
a community. Consumption, hence, no longer in a direct sense connects a person to wider
society and is at risk of being unregulated and disordered (Shilling & Mellor, 2011: 31–32).

Te Transformation of Ritual?
Rituals are pragmatic, evolving, not set in stone, can be disrupted and lost, and equally can
be invented. To paraphrase Joseph Campbell: when society does not provide rituals to struc-
ture transitions, people will invent their own. Humans are animals oriented to and in need of
ritual (Rappaport, 1999). The organic invention and adaption of rituals is indeed crucial for
articulating what is proportionate and mitigating harms associated with excess. Within con-
temporary societies, cultural responses to symbolise and ritualise consumption are associated
with a reduction of risk, where users themselves ‘invent’ their own social controls through
ritualising use, creating stylised and patterned occasion for consumption surrounded by re-
spected actions and behaviours that are proscribed and taboo (Moore, 1993). There seems to
be a strong preference for an established ritual context for use, regardless of the consumers,
substance used and how honoured, stigmatised or dangerous it is considered, or how chaotic
the context of use could be considered. For example, in skid-row drinking, there is the ‘bot-
tle gang’ where solidarity and reciprocity are enacted, which involves strong norms of how
drink should be taken and how others should be treated – with most of the harms stemming
from drinking experienced not a result of the ritual but the efects of the marginalisation and
stigmatisation of such individuals (Spradley, 1999: 118). In these rituals, there is a stigma for
individualistic intoxication – breaking the ‘norm’ of the sanctioned degree of decontrolling.
It could be argued in fact that the ritual makes the best of such bad circumstances that the
universal behaviour of seeking psychoactive experience takes place in. The infuence of an-
thropology, ethnography and sensitivity to the ‘drug, set and setting’ model has also resulted

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in creative ritualisations of use through the invention of new masters of ceremony in the
guise of harm reduction workers, who, for example, assist revellers to modulate pleasure and
risk, drink and use other psychoactive substances in a manner that supports identity and cir-
cles of recognition, rather than threaten negative outcomes. An example of this is the work
of volunteers in the night-time economy and clubs who ofer advice, assistance and care
when it is needed (Carmo Carvalho et al. 2014).
Nonetheless, rituals have difculty in ‘bedding down’ in modern societies. While Victor
Turner argued that the ritual process was a cultural universal, he also noted that it was ex-
pressed quite diferently in modern societies, and that the ritual life that structured societies
in the past no longer exists for the majority in the true sense. As discussed above, one of
the major ritual occasions involving alcohol and intoxication is the initiation of the young
as full members of the adult community. It is illustrative of the change in the nature of rit-
ual to examine how drinking is involved in initiation rituals in contemporary cultures, to
demonstrate the reduction in informal social control that runs in parallel with the dimin-
ished function of the ritual process. To capture the process of fragmentation and banalisation
of ritual, Turner (1974) developed the concepts of the ‘liminal’ and the ‘liminoid’. The
liminoid is diferent from the liminal as the length of time spent in an in-between state is
greatly extended, communities have less control over proceedings and those involved do so
less as pure participants and more as semi-attached spectators, with their involvement not
compulsory but based on choice. The in-betweenness is more of an individual than a collec-
tive passage also, which is quite detached from the major institutions of society rather than
being fundamental to the process of joining them, and they involve more of a critical stance
towards the establishment. Thus, when contemporary researchers speak about the liminality
of drinking occasions (see Hobbs et al. 2000; Gerard, 2004; Hayward & Hobbs, 2007), such
as in night-time economies, it would be more appropriate to label the conduct as liminoid,
rather than liminal.
The grand rituals that marked the transition from one identity or state to another are de-
creasing in importance (Pedersen, 1994), as the coordination of social life takes place largely
through the abstract mechanisms of clock time, abstract markets and a legal-bureaucratic
order. For example, the right to drink is no longer on the basis of the admission of a group
of young people into a heretofore closed aspect of the collective life of a group but is rather
based on the abstract limit of chronological age. As a result, the role of alcohol in mark-
ing transitions has been banalised, as it becomes a way of ‘keying’ a shift into moments of
scheduled hedonism that are weakly related to concrete communities (Demant & Stergaard,
2007: 519–520). Nonetheless, drinking rituals among the young go on, but in the format
of the liminoid. The rites of passage as described by Turner took place over a defned and
short period of time. In contemporary society, the entirety of adolescence, young adulthood
and beyond can be seen as a betwixt and between phase. Thus, the phase of social drinking
occasions becomes greatly extended, before the acquiring of social structural roles of career
and family lead people to disengage from youth drinking culture, despite the social capital
that they had previously accumulated there and the profound experiences they may have had
in this milieu (Northcote, 2006).
Rituals involving alcohol have also become increasingly individualised and democratic,
losing their association with kin, Church, political community, the cycle of religious holi-
days or community festivities linked with natural cycles of the seasons, or with the initiation
into a concrete institution such as university or the army. Very old rituals and practices
associated with them can live on, but in a residual form, that is little understood by those
who partake in them (Beccaria & Sande, 2003; 99, 101). This is because ‘a distinct rite de

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passage towards adulthood is no longer dominant’ involving traditional rituals that drinking
is an aspect of, because traditional forms of encompassing communities that a young person
could be initiated into largely no longer exist (Demant & Stergaard, 2007: 519). Indeed,
rituals involving drinking increasingly do not refer to even the family, with drinking occa-
sions largely organised by young people themselves, on the basis of an education-based peer
group, whose horizon is global youth culture, devising and managing their own gatherings,
with a more experimental use of alcohol, away from social structural fgures such as teachers,
parents and other establishment fgures (Beccaria & Sande, 2003: 112). Thus, they lack one
of the key features of liminal rituals: masters of ceremony, with peer groups of the young
enacting their own drinking rituals. Masters of ceremony that do exist are highly abstract,
such as the socially engineered night-time economy venues that encourage particular be-
haviours, or the vague cultural notion of the ‘uni-experience’, as well as the internalisation
of what has been learned in the family and concern over what they would think. In the ab-
sence of traditional types of masters of ceremony, these ‘shadow rituals’ created by the young
themselves (Henriksen et al. 2011), there are fears that these will have reckless and abusive
features ( Johnson, 2011).
Involvement in this type of ritual is based more on choice than obligation, with them
existing for the purpose of reafrming fuid bonds. Consuming alcohol and intoxication
plays a role of symbolising commitment to the fragile group. Demant and Stergaard (2007:
533) explain that ‘These fragile friendships can be seen as a fuid sociality which constantly
demands attention and reassurance. Partying, then, is also a way to reafrm friendship and
is therefore an integrated part of adolescents’ everyday life’ (517). Turner (1974: 87) himself
noted the functionality of alcohol in the context of the liminoid in achieving ‘fow’, through
its ability to narrow, focus and limit attention. The production of collective experiences
is one way to anchor such protean groups, with alcohol quite useful due to its ability to
‘make things happen’ (Measham, 2004; Banister & Piacentini, 2008), to force the action,
and create striking events, which are somehow embarrassing and shocking, that a sense of a
‘legendary night’ is based on (Banister & Piacentini, 2008: 314–316; Haydock, 2015). The
emphasis on conjuring extraordinary experiences makes drinking occasions more associated
with transgression and activities normally forbidden (Lalander, 1997: 35). Many researchers
have seen in contemporary youth drinking a calculated and intense loss of control, at times
to the extent of there being ‘complete and utter disorder’ (see Lalander, 1997: 34; Haydock,
2015). This represents a signifcant change in drinking culture, as while a loss of control has
been taboo in Mediterranean drinking culture, even in Anglo-Saxon culture it has been
normative to combine heavy drinking with a determination to not manifest visible signs of
intoxication (see Beccaria & Sande, 2003, Haydock, 2015: 4). Thus, as the ritual process has
been diminished, the power of informal social control has been diminished also.

Conclusion: From Ritual to Refexivity

More recent scholarship on drinking has emphasised a ‘strategic/agentive analytical frame-
work’ over a functionalist framework (Dietler, 2006). This is not merely a matter of chang-
ing theoretical fashion, as it refects how social change has diminished the role of ritual in
drinking culture and has destructured it, literally leaving people as agents faced with greater
choice, in contrast to the constraining nature of traditionalist societies. While the ritual
process is a social process that clearly involves a degree of agency as it must be enacted and
performed, it is also socially determined to a considerable extent due to its role in reproduc-
ing the social structure. Behavioural control, in the context of deritualisation, comes less

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from ritual as an aspect of the social structure and more from refexivity, involving a more
individualised navigating of risk. Refexive practices of the self increasingly are what shapes
consumption, in the form of ‘art of existence’ (Duf, 2004) in the shape of the art and ethics
of moderation and pleasure, a conscious modulation of the balance between risk and excite-
ment, aesthetic and cultivated attitudes with respect to choices made, and using drinking to
perform one’s ethical orientation to the world. This connection can be seen in the profound
link between drinking and self-expression and creative scenes in modernity, but also in a
weakening of the ritual framework that moderated drinking in traditional and conservative
societies.

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 PART V

Alternative Approaches for

Studying Intoxication
 19
INTOXICATION MADE VISIBLE
Te sober sciences of intoxication, euphoria,
and overdose in the laboratory

Nancy D. Campbell

“[A] silent spring of intoxicants … fows through our lives and our bodies.”
—Ronald K. Siegel, Preface to the second edition of Intoxication: The Universal Drive for Mind-
Altering Substances: The Universal Drive for Mind-Altering Substances (2005)

Flows of intoxicants bubble forth from the “silent spring” of which clinical pharmacologist
Ronald K. Siegel wrote, shaping the modern world and continuing to do so (Courtwright
2002, 2019; Ghiabi 2018; Herlinghaus 2013). Rendering the so-called universal drive for in-
toxication visible for the sake of laboratory science requires pharmacologists to navigate the
specifcs of dangerous proximities between acute toxicity, therapeutic dose, chronic admin-
istration or “addiction,” overdose, and lethal dose. This chapter explores how experimental,
clinical, and behavioral scientists made intoxication tractable to laboratory sciences wherein
routine observation and experimentation with human and animal subjects can be reliably re-
produced.1 Experimental infrastructures designed to produce knowledge about intoxication
evolved as sober scientists grappled with objects, subjects, and efects that are ambiguous,
difcult to verbalize or quantify, but sometimes lethal. This chapter begins with experiments
at the world’s frst laboratory dedicated to producing knowledge about intoxication and
addiction, the US Public Health Service Addiction Research Center (ARC) in Lexington,
Kentucky. I focus on an exemplary single-subject study of intoxication conducted by Abra-
ham Wikler (1952) and a handful of studies on barbiturate intoxication by that laboratory’s
research director, Harris Isbell, in the years immediately following World War II (Fraser,
Shaver, Maxwell and Isbell 1953; Fraser, Wikler, Belleville, Essig and Hill 1956; Hill, Bel-
leville, Wikler 1957; Isbell, Altschul, Kornetsky, Eisenman, Flanary and Fraser 1950). The
chapter traces the emergence of behavioral pharmacology and its absorption by addiction
neuroscience, concluding with recent clinical studies in an “overdose laboratory” directed
by John Strang, who anchors the National Addiction Centre in the United Kingdom. The
chapter showcases how laboratories operationalized concepts of intoxication, euphoria, ad-
diction, and overdose; how conceptual practices are conserved even as established research
practices, methods, and protocols are supplanted by new techniques and technologies; and
implications of these research dynamics and lexical shifts for today’s more integrated knowl-
edge of intricately biosocial processes such as intoxication and addiction.

DOI: 10.4324/9780429058141-25 309

 Nancy D. Campbell

We begin with UCLA psychopharmacologist Ronald K. Siegel’s naturalization of intoxi-

cation as a fourth “universal” drive joining hunger, thirst, and sex through seemingly “natu-
ral” experimental designs that defy categorization. He arranged encounters between plants,
humans, and nonhumans, observing both intentional and accidental intoxication events,
such as dizziness (Siegel 1989, 1984, 1979-1980, 1979a, 1979b, 1976, 1973, 1971; Siegel and
Brodie 1984, Siegel and Jarvik 1980a, 1980b, 1975). He portrayed plants as producing elab-
orate chemical defenses against being eaten, animals as adopting “safe feeding strategies”
to circumvent botanical guile (Hagen and Sullivan 2018, 104; Siegel 1989, 14). Credit-
ing plant-animal interactions with “turning poisons into intoxicants and forming the new
chemical bond we call addiction,” Siegel depicted human taste for intoxicants as a natural
evolutionary passion, fondness, even craving or habit (1989, 14, 51) and addiction as an “un-
natural” pathology borne of “stubborn preoccupation” (Siegel 1989, 53). Humans evolved
social norms to limit consumption and make intoxication episodic rather than chronic. Sie-
gel’s was a science in which periodicity and place refected “drive intensity”:

Captive primates will show a remarkable drive to intoxicate themselves even in a roomy
laboratory cage. Whether for reasons of exploration, curiosity, stimulation, tranquiliza-
tion, dispelling boredom, or depression laboratory primates have willingly pursued such
a vast array of intoxicants … [that] they appear to medicate mental needs …
(Siegel 1989, 99; Siegel and Jarvik 1980a, 1980b)

Experimental accounts of animal self-medication extended capacity for intentional intox-

ication to rodents, dogs, and nonhuman primates, particularly rhesus macaques. The latter
pervaded the twentieth-century laboratories within which pharmacological researchers
evolved techniques to discern efects of chronic administration, the buildup of tolerance,
the behaviors and efects associated with abrupt and gradual withdrawal. It was difcult
to get nonhuman primates to self-administer or “self-medicate.” Animal subjects seemed
to lack that “universal drive” to such a degree that laboratory workers had to invent
techniques for getting laboratory animals to ingest the drugs that humans use and abuse
(Campbell 2007).
Rendering intoxication visible and discernible to instruments and observers was
no easy task. Few laboratories were equipped to study neurophysiological and behav-
ioral phenomena associated with intoxicated states. Intoxicating events are experienced
within social contexts that structure them—even when they occur in laboratories. So-
cial, political, and economic processes and situations produce and modulate intoxicat-
ing events to the point that “bodily experiences themselves difer depending on the
social ritual in which those experiences are enacted” (Collins 2004, 304). Altered states
of consciousness are infected with meanings ranging from the comforts of satiety to
the energetic pleasures of “collective efervescence” (Durkheim 1912; Room 2013). An
auto-antonym, “addiction” contains both active and passive dichotomies of obligation,
compulsion, and choice (Rosenthal and Faris 2019). Although derived from Greek (tox-
ikos), “pertaining to arrows or archery,” the term migrated into European vernaculars
through Latin (toxicare) “to smear with poison” (Shrank 2012). Invoking a targeted le-
thality, intoxication acquired associations with drunkenness, fantastical dream-states,
and fugue-states (Withington 2010, 2014). English renders intoxication and addiction
negative as regards self-governance. When the sciences of addiction and intoxication
were translated into instruments, methods, and scales designed to make intoxication
tractable to modern pharmacological reason, the meaning of intoxication tilted away

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from pleasure, and towards toxicity, abuse liability, and lethality. Experimental situa-
tions were inventively engineered to measure “liking” for a drug using a conditioned
place preference paradigm (Prus, James and Rosecrans 2009). Socially contextualized
setting remains at the margins of laboratory science, requiring different modes of at-
tention attuned to social relations, language, custom, ritual, and consumption practices.
Critical social studies of addiction have recently taken on the challenge of evolving a
processual, material, and relational approach to behavioral and substance-based “addictions.”
Postpositivist approaches pressure not only the epistemological underpinnings, but the con-
ceptual practices and material relations through which addictions have been investigated as
matters-of-fact (Dennis 2019; Dennis and Farrugia 2017; Fraser and Moore 2011; Fraser,
Moore, and Keane 2014; Fraser and valentine 2008; Gomart 2002, 2004; Latour 2004; Mol
1999, 2002; Rhodes and Lancaster 2019). Conjoining this critical project are postpositivist
histories designed to show how laboratory-based sciences of addiction and intoxication, in
concert with studies situated in drug users’ social worlds, make evidence (Rhodes and Lan-
caster 2019). This chapter extends insights of this evidence-in-the-making conversation to
laboratory-based sciences of intoxication in an effort to improve integration of social worlds
with laboratory-based knowledge production.

The disappearance of desire from addiction research

Intoxication fit poorly into early twentieth-century psychoanalytic frameworks. Lawrence
Kolb, author of the first diagnostic system for addiction, argued against facile associations be-
tween addiction, intoxication, and criminality. Propensity to addiction was defined in terms
of degrees of psychopathology (Acker 2002; Kolb 1925a, 1925b, 1925c). Kolb pioneered animal
models of addiction at the National Hygienic Laboratory in Washington, DC (forerunner of
the National Institutes of Health; Harden 1986). When he became the Chief Medical Officer of
the US Narcotic Farm in 1935, Kolb hired clinical researcher Clifton K. Himmelsbach to direct
a small laboratory that Congress had mandated to find a cure for opiate addiction (Campbell
2007). Himmelsbach plotted the regularities of “withdrawal,” which he and Kolb dubbed the
Morphine Abstinence Syndrome (Himmelsbach 1941; Kolb and Himmelsbach 1938). Studies
were coordinated by the Committee on Drug Addiction and Narcotics (CDAN), charged with
preventing addictive pharmaceuticals from going in the U.S. market (Acker 2002; Campbell
2007; Eddy 1973; Herzberg 2020; May and Jacobson 1989).
Scientists at the US Narcotic Farm had access to “postaddicts,” human subjects who were
seasoned users of smoking opium, and oral, sniffed, or injected morphine or heroin, and
who willingly volunteered to subject themselves to these substances for the sake of science.
Officially named the Addiction Research Center (ARC) in 1948, the laboratory joined the
National Institute of Mental Health (NIMH). Newly established in 1948, the World Health
Organization (WHO) released an ARC-influenced report in 1950, defining addiction as an
“overpowering desire and need (compulsion) to continue taking the drug and to obtain it by
any means.”2 Following Himmelsbach’s method and Kolb’s criteria, investigator Abraham
Wikler conducted a single-subject study at the ARC from fall 1947 to spring 1948. “A Psy-
chodynamic Study of a Patient During Experimental Self-regulated R ­ e-addiction to Mor-
phine” followed the progress of “re-addiction” in a healthy volunteer who had previously
failed at cure and stated his intent not to abstain from morphine or heroin use after discharge.
The study raised questions such as why “addicts” (the term used) preferred morphine to
alcohol; why they used morphine “when, presumably, the ‘euphoric’ effects can no longer
be experienced”; whether “actively addicted” persons could lead “socially productive” lives;

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and even “What does the addict mean by ‘normal’?” Given “the addict’s oft-repeated state-
ment that ‘morphine makes me feel normal’,” Wikler’s subject gradually rebuilt tolerance to
very high dosage and did not voluntarily taper of morphine when the end of the study was
in sight.
One of few qualitative studies ever produced at the ARC, such a study would not pass
ethics review today.3 The timing presaged the Committee’s 1950 authoritative redefnition
of “addiction” as “drug dependence,”4 defned as a “state of periodic or chronic intoxica-
tion, detrimental to the individual and to society, produced by repeated administration of
a drug.” Skirting the pejorative “addiction,” the Committee renamed itself the Committee
on Problems of Drug Dependence in 1965, advancing the new defnition within the WHO
Expert Committee structure (1957, 1964). Wikler’s single-subject study coincided with Is-
bell’s studies of chronic barbiturate intoxication (discussed below). Wikler’s article included
far more psychodynamic detail than other ARC publications. His subject was a 44-year-old
orthodox Jew from Detroit who started smoking opium at age 19, became “addicted” at age
22, and commenced injecting at age 33. Gambling and “bootlegging” landed him in both
federal narcotics farms. When at Lexington, he had previously participated in morphine
experiments. Interviewed more than 30 times during the two-month study, he shared mem-
ories, dreams, sexual experiences, fantasies, and arrests, recorded in detail. His motive for
participating was revelatory: “Why not—if I can get even with the government and cheat
them out of some time?”
Along with monitoring vital signs, regular EEGs, and detailed tracking of total dosage
and frequency of morphine consumed during experimental re-addiction, the prose of the
paper was so evocative that the reader can practically smell the cigarette smoke of the day
room in the research ward. The subject’s response to his frst shot reads like a thick descrip-
tion of intoxication: “his skin was fushed, he rubbed his nose and appeared very happy.
The fush subsided in a few seconds. On interrogation, he said the sensation was comparable
to sexual orgasm.”5 He became “loquacious,” speaking spontaneously with “pep,” which
Wikler interpreted to mean “freedom from anxiety about doing what he wants to do.”
Dreams were dutifully recorded in an almost psychoanalytic register. At the time, Wikler
was himself enrolled in psychoanalytic training with Erwin Straus (Chessick 1999). Hospi-
talized at NIH in Bethesda for nearly a year soon after the study ended, Wikler’s research
trajectory shifted course towards a more neurobiological framework called “adaptational
psychodynamics” (Rado 1969).
When working within the psychoanalytic framework, Wikler interpreted his subject’s
need for euphoria as resulting from “oral narcissistic cravings” (1952, 20). “Euphoria” pre-
sented a problem for a scientist of Wikler’s ilk—not only was it difcult to operationalize,
it was entirely too subjective, too interior, too “difuse and nonspecifc” (CDAN 11, 380).
While chronic opiate intoxication afected “primary motivations such as fear of pain, sexual
conficts, probably hunger and some other things” (CDAN 11, 380), it could also gratify pri-
mary needs. The problem, as all persons living with addictions know and as Wikler found,
was that tolerance diminished euphoria to small “thrill[s] (orgasm[s])” just after injection. Al-
though “artifcially-induced” cravings ofered new gratifcations that displaced “other ‘nat-
ural’ primary needs,” they did not displace “‘pharmacogenic’ need,” a term Wikler adopted
from Sandor Rado,6 the eminent post-Freudian psychoanalyst who founded the Center for
Psychoanalytic Training and Research at Columbia University.
Adaptational psychodynamics was Rado’s attempt to make psychoanalysis palatable to
American scientifc appetites. He located the root of addiction in abnormally intense desires
for “narcotic elation” (Adaptational Psychodynamics, 1969, 263). He saw compulsive drug use

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as the manifest efect of a repetition compulsion, an “impulse neurosis” (Fenichel 1950, 368)
or form of “narcotic bondage” (Rado 1957, 1963). The physiological changes associated with
the “superpleasure” of intoxication were said to bypass the brain’s adaptive processes, silence
danger signs, and displace “ordinary pursuits and rewards of healthy life,” allowing gran-
diose delusions and infantile impulses to uproot “reason, foresight, and judgment” (Rado
1969, 264–265). For Rado, intoxication and addiction were symptoms of immaturity, signs
of arrested development.
Once returning to Kentucky, Wikler steered hard into the animal research that occupied
his later career. Human craving and desire went underground in the behavioral research
that dominated the late twentieth century, resurfacing when neuroscientists started studying
anticipatory “priming” efects. ARC publications migrated toward neuropharmacology and
physiology. But assumptions that intoxication was an artifcial and immature route to grat-
ifcation that displaced more “natural” and “mature” routes still fower in the twenty-frst
century. Wikler provided a foundational plank for framing addiction as an artifcial route
to satisfying naturalized needs, arguing that “individual personality, the specifc efects of
single and repeated doses of morphine, and the cultural attitudes towards opiate addiction,
contribute to the etiology of narcotic addiction” (1952, 22). Behaviors were modulated by
the psychodynamic substrate of primary and secondary needs. Those with adequate “neu-
rotic defenses” could handle morphine and were “not apt to become narcotic addicts, nor are
socially-acceptable, mature individuals” (1952, 22). Wikler did not see himself as studying
“culture,” “society,” or “personality,” but instead showed as clearly as he could the “specifc
efects of single and repeated doses of morphine.”
ARC protocols mandated that no experimental drug be administered within six months
of release. Although Wikler turned his back on the study of personality dynamics, the single
subject impressed him because the subject could have calculated when the experiment would
end and tapered of high-dose, pharmaceutical grade morphine so as to avoid withdrawal.
But he didn’t. On the study’s announced fnal day, he had eight injections totaling 1,000 mg
of morphine. His “post-reduction period” was abrupt, miserable, and accompanied by con-
stant drug-seeking as he exited the experimental situation and moved back into the general
population of a carceral institution, his anonymous mark on the sciences of intoxication in-
tact. Open-ended experiments, in which a laboratory-housed human subject could “choose”
dosage and frequency, became next to impossible due to the historical circumstances gov-
erning human research in the postwar period.

Chronic barbiturate intoxication

Consulted far too late in the process of a mysterious drug-related death, Dr. Harris Isbell
could do little but watch as a fellow physician admitted to the U.S. Public Health Service
Narcotic Hospital in Lexington, Kentucky,

died during withdrawal because he failed to tell the physician in charge of his case that
he had been maintaining a constant state of intoxication with Nembutal taken orally,
the quantity later being estimated by his wife as about ffty capsules a day.7

By the late 1940s, well before the U.S. Food and Drug Administration required clinical
trials, Nembutal numbered among a vast array of barbiturates. Clinical reports gave rise
to the question of whether death resulted from barbiturate overdose, abrupt withdrawal,
or both. The serious nature of this acute intoxication motivated Isbell to publish the frst

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English-language studies on chronic barbiturate intoxication and withdrawal in human be-

ings (Isbell, Altschul, Kornetsky, Eisenman, Flanary and Fraser 1950). A steady stream of
publications issued from the ARC documenting the dangers of barbiturates and recom-
mending policy changes (Fraser 1954, 1957; Fraser, Eisenman, Wikler and Pescor 1954;
Fraser, Wikler, Belleville, Essig and Hill 1956; Hill, Belleville and Wikler 1957).
At the time of the fatal incident, ARC researchers were documenting a clinical protocol
for reversing opiate overdose; they hoped to extend that work to develop an “antidote” for
barbiturate poisoning (Campbell 2007, 2020). Chronic use of barbiturates was not then
considered “addiction,” a view promoted to physicians by drug manufacturers (Rasmussen
2012, 27). By the late 1940s, some 672,000 pounds of barbiturates—or 24 doses for each
person in the United States—were manufactured and consumed annually, an amount far in
excess of that required to meet the nation’s therapeutic needs.8 Concerned that barbiturates
were being indiscriminately prescribed, the ARC embarked—with a “great deal of trepida-
tion,” according to Isbell (1978, 35)—on a landmark series of studies on the clinical pharma-
cology of chronic barbiturate intoxication and withdrawal. They ensured that none of those
who volunteered for the study were epileptic or psychotic. To safeguard against a death on
the research ward, participants were observed round-the-clock while recording data on neu-
rophysiological and “subjective” efects correlated with “objective” measures. Scientists frst,
ARC researchers viewed most physicians as dangerously under-educated about dependence
potential and withdrawal. Their studies confrmed that “chronic barbiturate intoxication”
produced a severe and at times deadly withdrawal syndrome—one that could result in sei-
zures or temporary psychosis (Rasmussen 2012, 38).
Barbiturates were involved in roughly one quarter of all acute poisonings in the
U.S. general hospitals by 1950. Having determined that delirium tremens were signs of
withdrawal from alcohol (Isbell, Fraser, Wikler, Belleville, and Eisenman, 1955), Isbell
and colleagues saw themselves as guardians of public health in the midst of a “synthetic
food” (Isbell 1978, 32). Integral to the international drug control community anchored
by the United Nations and WHO, ARC scientists presented data to the WHO Narcotics
Expert Committee in January 1952. They recommended stricter controls on “addicting
non-opiate sedatives,” as they called them. Despite not being derived from opium, they
argued, barbiturates possessed the “power to addict individuals that use them regularly
in quantities larger than would be prescribed medically” (Maurer and Vogel 1954, 102).
Two pieces of evidence were adduced to show that non-medical use of barbiturates
resulted in physical dependence: the degree of intoxication, often said to mimic severe
alcoholism, and the severity of “withdrawal illness.” Because barbiturates were often
used by individuals deemed “respectable” such as healthcare professionals and patients
with legitimate illnesses, they eluded the label of an “addicting” or “dependence pro-
ducing” drug (Herzberg 2009, 2020). They retained their hold in the marketplace until
the psychopharmacological revolution of the mid-to-late 1950s yielded the so-called
happy pills—the minor tranquilizers and benzodiazepines that were the frst blockbuster
prescription drugs (Herzberg 2009; Tone 2009). Physicians and patients migrated away
from the barbiturates as “cure-of-almost-all” drugs as their lethality became clear and
their use less respectable. By the late 1950s, those using barbiturates for non-medical
purposes were considered a new type of drug addict who maintained “constant state of
intoxication in which they escape reality” (Maurer and Vogel 1954, 21–22). Nothing
cemented these understandings so clearly as ARC studies documenting a dangerous
withdrawal syndrome, and showing cross-tolerance between alcohol and barbiturates in
animals as well as humans.

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Problems of euphoria: mood changes in the mid-twentieth-century

drug sciences
The US cities experienced a postwar spike in heroin injection as opiates and technologies to
administer them became widespread. CDAN (“the Committee”) convened pharmaceutical
industry representatives from companies innovating in the analgesic arena; government bu-
reaucrats, including the notorious director of the Federal Bureau of Narcotics, Harry J. An-
slinger; contract researchers such as Henry K. Beecher of the Harvard Anesthesiology Lab at
Massachusetts General Hospital; and intramural researchers such as Isbell and Wikler. When
the ARC hosted the 11th postwar CDAN meeting at the US Narcotic Farm in Lexington,
Kentucky, on January 9–10, 1953, participants discussed how to set “euphoria” on scientifc
footing. Wikler mused:

By an odd coincidence we have been concerned with the problem of euphoria for many
years. Our frst defnite conclusion is that the term ‘euphoria’ means very diferent
things to diferent people, to the same person at diferent times, and also to groups of
individuals after administration of diferent drugs … To interpret what euphoria means
is no easy task but we feel we can interpret what the individual means by euphoria by
observing how he behaves verbally and non-verbally, by recording his statements and
his behavior in a given setting
(CDAN 11, 378)

Behaviors were predictable but “only if the situation is clearly delineated” because “feelings
of unusual well-being” difered from one another (CDAN 11, 378–380). Whether euphoria
could be “captured” in the neurophysiological sense depended on how the experimental
situation was structured.
The ARC research ward was structured to control and capture all aspects of the setting
that might impinge upon subjects’ “moods”—except, curiously to our eyes and ears, ciga-
rette smoking and window bars. Observers were understood to afect subjects’ “mood” and
experience of drug efects. For instance, Isbell recalled administering 30 mg of morphine to
a post-addict who was not yet tolerant. He turned

pale, gags, and heaves; but ask him how he feels and he is fne, wonderful. You ask him,
‘You are vomiting and all this, but you are fne?’ and he replies, ‘Yes, it’s such a good
sick.’ Now is that euphoria, or isn’t it?
(CDAN 11, 382)

If experimental situations could alter drug efects, then investigators had to ask, “Under
what conditions are these [drugs] administered, to whom, and what for?” (CDAN 11, 379).
Even anticipatory anxiety about potential pain attenuated morphine’s efects to the point
that Wikler urged recognition of “the fact that the action of a drug depends upon the par-
ticular experimental condition under which it is studied” (CDAN 11, 379). A proponent of
setting-diferentiated efects due to observing wounded soldiers as requiring less morphine
by contrast to postoperative patients in hospital wards, Beecher considered “postaddicts”—
especially “chronic volunteers”—to be “pharmacological sophisticates” in a “long-standing
and complex drug-person relationship that does not exist in non-addicts” (Beecher 1959,
339). Some “hint of a diference,” Beecher implied, led institutionalized post-addicts to
always experience the euphoria of intoxication, whereas non-addicts rarely did (CDAN 11,

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381). Post-addicts persisted in experiencing intoxication even when they were “addicted”
and thus tolerant to some opiate efects.
Mid-twentieth-century laboratory studies of intoxication wrangled “euphoria” and
“dysphoria” into “mood” and “mood changes.” Investigators of intoxication attempted
to minimize observer efects. By “manipulating the situation,” investigators realized
that they could block or intensify drug efects: “there is no better way to antidote the
efects of analgesic drugs, subjective and objective, than to make measurements and ask
questions at stated intervals” (CDAN 11, 381). Although intoxication was not simply
a matter of mood—dosage “in the addict range,” route of administration, and social
environments that “triggered” injection events could accentuate drug efects—mood
was actively explored by American investigators in the 1950s. In 1955, Beecher, Louis
Lasagna and John von Felsinger published “Drug-induced Mood Changes in Man” in
the prestigious Journal of the American Medical Association ( JAMA), a landmark study con-
ducted at the ARC and Massachusetts General Hospital in Boston and partially funded
by the Committee.
“Mood Changes” was a crucial consolidation of statistical methodologies underlying
clinical trials. Emerging technologies, study designs, and sophisticated vocabularies and
methodologies enabled diferentiation between neurophysiological markers of intoxication.
Desires for intoxication—so central to psychopathological, psychoanalytic, and pharmaco-
dynamic accounts produced by Kolb, Rado, and the early Wikler—were swamped by a new
focus on behavioral consequences of disease. The US-based scientifc community persuaded
the WHO to retire “addiction,” in favor of the more neutral and scientifc sounding “drug
dependence” in the mid-1960s.9 This period marked a migration of scientifc study of in-
toxication away from culture, desire, and personality, and toward behavioral approaches that
dominated the next decades.

Scientifc succession: behavioral pharmacology comes of age

Behavioral pharmacology constituted itself as efciently positivistic in the 1960s, dealing
with knowable behavior patterns and displacing conceptual kernels and practices from older
lexicons such as psychopathology or adaptational psychodynamics (Campbell 2007). Work-
ing with human and nonhuman subjects, behavioral pharmacology was premised on the
concept that drugs reinforce behavior, positively or negatively:

Ultimately … we’ve got to explain the behavior of the intact, integrated organism. The
behavior is always right. It is ultimately the job of the biologist to be able to predict that
behavior because the behavior is the reality.10

The precise language of reinforcement was not assumed coextensively with “euphoria,” as
this would yield an inaccurate and

almost hedonistic kind of conception of drug abuse … Yes, in fact drugs do produce
positive mood changes in humans. However, individuals continue to take [drugs] un-
der circumstances and at times when there is absolutely no evidence of positive mood
changes. It is highly likely that the bulk of the times when addicts take drugs are not as-
sociated with ‘let the good times roll.’ This preoccupation with talking about euphoria
and positive reinforcement as if they’re synonymous is sloppy thinking.11

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Getting nonhumans to self-administer drugs that humans do was no small feat, according
to the US clinical and behavioral pharmacologists who accomplished it.12 My interviewees
emphasized how animals were housed, fed, and drugged, and how they created apparatus and
equipment to modify laboratory spaces prior to the commercialization of such. George Bigelow
described a group housing method in which the animal-participants had individual “apartments”:

They could leave the apartment and go down to the social area and then come back
through what was called the “entry chamber” and cue in their personal ID that would
unlock their apartment door, and go back to the individual chamber. That experience
was the beginning of my real behavior analysis scientifc experience and interest. I had
a little bit of exposure to some experiments in which Jack Findley had trained large
primates to stick their arm out through a little hole to receive injections.13

Techniques evolved for managing a morphine-dependent monkey colony at the University

of Michigan, as well as tinkering with methods, layout of physical space, and apparatus de-
signed to measure schedules of drug self-administration in terms of frequency, intensity, or
“motivation”—all were lively sources of human and nonhuman iteration, invention, and
interaction inside and outside laboratories (Campbell 2007).
Behavioral pharmacology was a conceptual methodology based on a paradigm called
“drug self-administration.” This investigatory mode was developed for purposes of drug
abuse liability testing and comparative pharmacology. While it resembled Pavlovian and
Skinnerian approaches called “classical” and “operant” conditioning, drug abuse liability
testing was used to innovate pharmaceutical analgesics and to determine whether or not
they might be liable to abuse (Campbell 2007). Never mentioning “intoxication,” behavioral
pharmacologists traced interactions between acute and chronic efects, pharmacokinetics
and dynamics such as dosage, the human or nonhuman organism being studied, and setting
(Goldberg and Schuster, 1967; Schuster and Woods, 1968; Wikler and Pescor 1967).
Drug studies aimed to maintain the lives of their nonhuman subjects, but also determine at
what dosage a compound would be lethal. Social context or setting matters in terms of whether
or not acute efects will be lethal or not (Hartogsohn 2020). Siegel described an experiment
in which rats were given a single “lethal dose” (LD) of heroin (1989, 144). Only one-third of
morphine-dependent rats (i.e. “addicted” rats) died if dosed in their “home cage.” In unfamiliar
territory, the dose proved lethal for two-thirds. Behavioral pharmacologists manipulated multi-
ple experimental conditions to render human and nonhuman drug and alcohol use discernible
within the learning paradigms of the late 1960s—drug self-administration and conditioned place
preference remain in use today. Despite the invasiveness of drug self-administration, which re-
quired animals to be caged, catheterized, or clothed in special vests which they often customized
by chewing, results were understood to have concordance with human studies. Yet, problems of
variation remained—individuals clearly adapted to drug exposure diferently.

Beyond tolerant subjects: minding the thin line between

intoxication and overdose
Tolerance is a form of neuroadaptation that does not protect against efects of chronic intox-
ication and overdose. Depicted as a too-muchness of intoxication, opioid overdose brings
lethal risks difcult to render tractable to clinical investigation outside of anesthesiology. Re-
searching what happens in socially situated overdose frst took place through epidemiological

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 Nancy D. Campbell

or statistical methods, only recently migrating to clinical settings. The intractability of

overdose stems partly from opioid pharmacology—a thin line threads between intoxica-
tion, therapeutic efect, and lethality, or in the suggestive vernacular of the UK, between
“gouching,” “going over,” and dying. Overdose varies by individual levels of tolerance, risk
profle, and protective factors, and because overdose events are typically but unpredictably
prolonged, those seeking to intervene must be trained to recognize its signs and symptoms.
Overdose is now understood not simply as an acute lethal event or form of excess death,
but as a reversible process. Behavioral or neuroscientifc methods have little utility for studying
overdose because they are designed to keep participants alive, managing contingencies in com-
plex task environments. Overdose was frst studied in autopsied tissue (Darke and Dufou 2016;
Hubbard 2019). Clinical researchers have had difculty creating the conditions within which
to study the physiology of acute opioid intoxication. Breathing itself is refracted through place;
gender, racial-ethnic, and social class formation; occupation; and metabolism (Braun 2014; Ken-
ner 2018). “Individual and situational variability of respiratory depression caused by intravenous
heroin is poorly understood” (Jolley, Bell, Raferty, Moxham and Strang 2015). Intoxicated
subjects make poor interviewees and are imprecise navigators of tasks; they present legal liabili-
ties and raise suspicion that investigators are plying human subjects with illicit drugs. Not until
experiments in heroin-assisted treatment in Europe and the UK ofered opportunities for study-
ing acute efects of opioids immediately after injection did research capacity expand.
During the 1990s, John Strang, Director of the National Addiction Centre and Head of the
Addictions Department at King’s College London, realized that there were moments of more
acute vulnerability to overdose death into which interventions could be put. In “Death Matters,”
Strang (2015) parsed available data showing that risk of overdose mortality increased at three key
moments: after prison release, before commencing methadone maintenance, and after it.

There was something else striking about the data: there was localization in time and
context which had surprisingly been overlooked by the big data-capturing machines. In
the transit zone between time in prison and post-release return to the community, there
was a horrifc concentration of deaths.
(Strang 2015, 28)

The Kings’ College group undertook “socio-psychological autopsy of the overdose situa-
tion” (Strang 2015, 28). They set out to

identify specifc dangerous patterns of drug use, specifc times and locations of increased
risk and interventions which could potentially prevent the fatal outcomes. For the time
being these remain, all too often, uncharted territories which are yet to be investigated.
However, unless progress is made, the large excess mortality will continue unchecked.
As intervention-interested researchers we can make a real diference, and it is our scien-
tifc and public responsibility to do so.
(Strang 2015, 33)

Remodeling himself as an “amateur pharmacologist,” Strang and colleagues designed and

built an “overdose laboratory,” the human subjects of which were among the forty or so
British heroin maintenance patients from a clinic operating from 2008 to 2016 (Strang 2010).
Far from the frst such experiment (Hartnoll, Mitcheson, Battersby, Brown, Ellis, Fleming
and Hedley, 1980; Perneger, Giner, del Rio and Mino 1998), European heroin mainte-
nance has confrmed the efcacy of agonist maintenance with methadone or heroin, now

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a widely adopted standard of care and subject of a Cochrane review (Ferri, Davoli and
Perucci 2011; Oviedo-Joekes, Brissette, Marsh, Lauzon, Guh, Anis and Schechter 2009;
Fischer, Oviedo-Joekes, Blanken, Haasen, Rehm, Schechter, Strang, and van den Brink
2007; March, Oviedo-Joekes, Perea-Milla and Carrasco 2006; van den Brink, Hendriks,
Blanken, Koeter, van Zwieten and van Ree 2003; van den Brink, Hendriks, Blanken and
van Ree 2002). According to the author’s interview with John Strang,

Ours had about 15–20 people in it and the others were even smaller. It was incredibly
intensive and incredibly interesting. This new treatment looked very encouraging as a
way of turning around people who looked untreatable … [I]t also meant that we had
an extraordinary research opportunity, quite apart from the heroin treatment, because
it also meant that we could study what happens when an intravenous heroin injector
injects pure diamorphine intravenously or intramuscularly, with no contaminants or
anything else. It allowed us to study what actually happens physiologically … [W]e
were able to capture what happens to their oxygen levels, showing plummeting oxygen
levels in the frst fve minutes after injection and then coming back up. So we were able
to study what were in essence small degrees of acute overdose – and we presume that
the phenomena we were able to observe were the same as overdoses which lead to death
except that, in our study sessions the extent of overdose was much less severe. These
individuals were taking a dose of heroin which had been individually titrated and was
deemed clinically to be their appropriate regular maintenance dose.
(2017, 16–18)

Once answering basic respiratory physiology questions, the group undertook research that
could not have been posed in an unsafe environment. Strang compared the overdose labora-
tory to an Intensive Care Unit (ICU) dedicated to experimental work and elaborated upon
the questions that could be asked and answered:

We have more work of this kind now. We have ethics approval where we’re going to look
at taking that same population and saying what if you increase the dose of heroin in that
experimental fashion by ten percent? Or by twenty percent? How much more does that
change? How much further is the oxygen drop? Or does dose not really make that much
diference? The studies don’t answer the questions completely, but they do tell you how
critical the precise dose is (this is termed the Therapeutic Index which tells you how much
safety margin there is between a dose that is efective and a dose that is lethal).
(17–18)

Overdose studies designed to meet the highest evidentiary standards of randomized, con-
trolled clinical trials (Blanken, Hendriks, Koeter, van Ree and van den Brink 2005; Haasen,
Verthein, Degkwitz, Berger, Krausz, and Naber 2007; Strang, Metrebian, Lintzeris, Potts,
Carnwath, Mayet, Williams, Zador, Evers, Groshkova, Charles, Martin and Forzisi 2010;
Strang, Groshkova, Uchtenhagen, van den Brink, Haasen, Schechter, Lintzeris, Bell, Pirona,
Oviedo-Joekes, Simon and Metrebian 2015) enrolled pulmonary specialist Caroline Jolley
to continuously monitor respiration.). enrolled pulmonary specialist Caroline Jolley to study
the biological mechanisms of the lungs with continuous respiratory monitoring.

It remains unanswered, both within the feld of addiction or in general medical set-
tings, whether more intensive respiratory monitoring can reduce the risk of signifcant

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 Nancy D. Campbell

opioid-associated respiratory depression. The fndings of our study highlight the need
for careful physiological studies of the mechanisms of overdose in heroin addiction.”
( Jolley, Bell, Raferty, Moxham and Strang 2015)

Not since the ARC could intoxication be studied in a clinical research ward designed from
ground up. Studying overdose required scientifc ingenuity. “Unprecedented natural labora-
tories” sprouted in Australia, Canada, Germany, Spain, Switzerland, and The Netherlands.
Social, material, and legal circumstances of the NAC allowed ethical investigation of over-
dose in ways once foreclosed by political, technical, and ethical constraints, or inhibited by
lack of scientifc interest. Human subjects enrolled were fully consenting, opioid-tolerant in-
dividuals who were not acutely intoxicated or undergoing withdrawal. Not unlike Wikler’s
single subject, each had “failed” multiple attempts at conventional treatment. Neurophysi-
ological measures included pupil size measurements, pulse oximetry, capnography (used to
measure CO2, airfow, and metabolic changes in ventilation during anesthesia), and electri-
cal methods such as “parasternal intercostal muscle electromyogram recordings (EMGpara)
to detect acute reductions in neural respiratory drive (NRD) to determine the added value
of advanced physiological monitoring over pulse oximetry alone.” What would have been
unfamiliar to Himmelsbach or Wikler was “breathing science,” and precision instruments
resulting from “the quantifying spirit” in Braun’s history of the spirometer.14
Subjects at the ARC would have been disqualifed if known to sufer illness or dis-
ease such as diabetes or COPD. By contrast, nine out of ten subjects in the 2015 London
study had COPD and were on a variety of drugs besides heroin. Researchers could not
identify enough subjects enrolled in prescription heroin trials who were not carrying a
COPD diagnosis (9). Subjects enrolled at least in part because of the prospect of subjec-
tive efects of intoxication; they “await[ed] their scheduled injection of diamorphine” in
such an “aroused state” that researchers feared they might hyperventilate. Some found it
impossible to sit quietly. Recreating overdose in the laboratory requires subjects already
well-adapted to maintenance, as non-tolerant subjects could not handle such doses and
the vital mechanisms of tolerance, a complex adaptation to a respiratory depressant, re-
main incompletely known. Although patient-subjects experienced subjective “highs,”
acute respiratory depression was identifed even in tolerant subjects undergoing acute
intoxication. It remained unanswered whether intensive monitoring could reduce risks
associated with respiratory depression. Overdose and intoxication remain elusive in lab-
oratory and clinic, even as they are commonly enacted beyond the artifcial spaces in
which the sciences of intoxication are made.

Conclusion: the limits of positivism for the sciences of intoxication

Pleasure and desire stubbornly reside within intoxication, exerting a pull that exceeds the
sense-making capacities of sober positivism. Scientists who pursue intoxication tread so
carefully that even after decades of research, the seemingly simple mechanisms of overdose
and intoxication remain unknown and under-studied. Multiplicities abound, and with them
arise the need for less sober sciences—nonreductive sciences that can take into account both
the social complexities of overdose and the puzzles of individual variation. Experimental sit-
uations may be organized to produce interpretive fexibility and qualitative accounts that en-
large scientifc knowledge of pleasure, in addition to pain, toxicity, abuse liability, aversion,
and lethality. Setting and social context organize the experience not only of intoxication but
of craving, euphoria, tolerance, withdrawal, dysphoria, and lethality.

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From the 1990s Decade of the Brain came the public-facing notion that intoxication
“hijacks” the brain-reward system by substituting artifcial compulsions or “addictions” for
natural pleasures. Addiction neuroscience narrated this displacement as catalyzed by the

activation of the reward pathways (positive reinforcement) [that] transfer information

of previously neutral stimuli (reward-stimulus associations; conditioned reinforcement),
loss of executive functions (hypofrontality), and a compromised reward system (hyper-
activity of the anti-reward circuits; negative reinforcement) to converge in the drug
addict to produce compulsive behavior.
(Koob and LeMoal 2006, 451)

By routing behavior away from natural rewards and tilting it toward more pleasure than hu-
man brains were built to handle, individuals become “tolerant” or used to intoxicated states.
Tolerance was framed as a form of neuroadaptation. Addiction neuroscientist George Koob
explained this in layperson’s terms on a late 1990s Bill Moyers’ television special, “Close to
Home: The Hijacked Brain, Part 2.” Gesturing toward his orchard, Koob spoke of the fnite
nature of “natural” pleasure governed by regulatory processes in the brain, explaining that
“our brains are built to experience a certain amount of pleasure.” Acute intoxication—“ar-
tifcial pleasure created by drugs”—led the brain to expect things that “difer from natural
pleasures.” This crucial displacement presumes that addiction’s displeasures set in with toler-
ance, a desensitized state that inures the brain to once pleasurable efects.
Incorporating techniques and tasks developed by behavioral pharmacologists, which, in
turn, built upon open-ended explorations of human intoxication like those produced at the
ARC, addiction neuroscience conserved some conceptual kernels from older lexicons. Cur-
rent investigators are rarely aware of continuities between notions that chronic intoxication
displaces natural pleasures by artifcial rewards. In the language of neuroscience, compulsive
appetitive behaviors arise from “activation of the reward pathways” and a “powerful drive
from the ‘dark side’, a negative motivational state (dysphoria, anxiety, distress, guilt, etc.)”
strengthened by “environmental associations and dysregulated executive functions” (Koob
and LeMoal 2006, 451). Neurobiological states of dysregulation are typically described as
normally functional mechanisms “gone awry” (Volkow and Li 2004). Both the pleasures
and dangers of the silent spring of intoxicants have been rendered tractable. However, social
context remains less accessible to laboratory science. What remains needed is deeper com-
prehension of the conversations among postpositivist researchers (Dennis 2019; Dennis and
Farrugia 2017; Fraser, Keane, and Moore 2014; Fraser and Moore 2011; Fraser and valentine
2008), who disrupt the dubious claims and unities through which intoxication events have
been subjected to the neurobehavioral sciences. These works emphasize pleasure and posi-
tive afect, countering overemphasis on risk, harm, and vulnerability that obscures the full
meaning of intoxication, euphoria, dysphoria, and overdose.
Finally, the ethics of the research summarized in this chapter remain to be discussed. The
bioethical regime put into place in the US and the UK after World War II foreclosed studies
of the kind performed at the ARC. As requirements for clinical trials were put into place
in the early 1960s, new “technologies of respect” confgured new human subjects (Reubi
2013) and thus installed new relations between the researcher and those researched (Stark
forthcoming; Stark and Campbell 2018; Campbell 2007). Such technologies instilled greater
social distance between researchers and subjects—helping to shift clinical researchers to pre-
clinical projects and foreclosing consideration of craving and desire. Pharmacology, after
all, is a science that radically expanded in the face of industrial demands for experimental

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 Nancy D. Campbell

systems involving nonhuman subjects as a strictly necessary prelude to trials involving hu-
man subjects after the early 1960s. Multiple sciences now contribute to knowledge about
human and nonhuman intoxicant uses, to which this volume attests. No longer a silent
spring, the sciences of intoxication now present opportunities for integration between social
and scientific pursuits.

Notes
1 On scientific legitimacy, respectability, and sobriety, see Danielle Giffort, Acid Revival: The Psychedelic
Renaissance and the Quest for Medical Legitimacy (Minneapolis: University of Minnesota Press, 2020).
2 On contentions over definition, see WHO Technical Report Series, No. 21, 1950, 6 and O’Brien,
Volkow, and Li (2006).
3 The ARC practiced a precocious version of informed consent, as documented in oral history
interviews with Himmelsbach (who believed that subjects should be “dealt into” experiments in
which they participated). See Campbell (2007); Himmelsbach (1972, 1994).
4 WHO Technical Report Series, No. 21, 1950, 6 and O’Brien, Volkow and Li (2006).
5 Psychodynamic psychoanalyst Sandor Rado called the psychic effects of the intoxicants “pharma-
cothymia” or the “pharmacogenic orgasm” (1926, 1933). Referred to in the vernacular as “getting
high” or “the rush,” this effect is the primary indicator that a phenomenological, subjective state
of opioid intoxication has been reached.
6 Similarities to neuroscientific theories from the 1990s and 2000s abound; see Koob and Bloom
(1998); Koob and LeMoal (2006, 2005, 2001).
7 David W. Maurer and Victor H. Vogel, Narcotics and Narcotic Addiction, 3rd edition (Springfield, IL:
Charles C. Thomas, 1954), 108. The case report appeared in Fraser, Shaver, Maxwell, and Isbell
(1953, 1319). Investigators emphasized that there had been no previous report in English docu-
menting the sole cause of death as abrupt abstinence from barbiturates; of the three cases published
in German, two were complicated by acute organic disease in ways that made it impossible for
barbiturate withdrawal to be regarded as the sole cause of death.
8 The U.S. Tariff Commission figures were used by Isbell and co-authors to contextualize their
1950 article. There were similar issues in the United Kingdom and several European countries.
9 For an unsuccessful attempt, see the seventh report of the WHO Expert Committee on Addic-
tion-producing Drugs in 1957, followed by adoption of “drug dependence” in the fifteenth report,
WHO Technical Reports Series 273 (1964). This shift was promoted by the US scientific addiction
research community, which advocated destigmatization in the form of more precise scientific
nomenclature.
10 Author’s interview with C. Robert Schuster, June 16, 2004, San Juan, Puerto Rico, 49.
11 Author’s interview with C. Robert Schuster, June 16, 2004, San Juan, Puerto Rico, 51.
12 Author’s interviews with George Bigelow ( June 2004), Joseph V. Brady ( June 2007), Roland
Griffiths ( June 2004), Louis Harris ( June 2003, January 2007), Chrys-Ellen Johanson ( June 2004),
Travis Thompson (February 2016), C. Robert Schuster ( June 2004), and James Woods ( June
2004), among others central to the making of modern behavioral pharmacology.
13 Author’s interview with George Bigelow (2004, 2).
14 London was historically the site for manufacture of precision instruments and institutionalization
of statistical analysis, anatomy, and physiology.

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 20
TRIP REPORTS
Exploring the experience of
psychedelic intoxication

Jonas Bååth and Johan Nordgren

Introduction
While it is sometimes said that the truth is told by children and drunkards, popular belief
has it that an intoxicated person lacks trustworthiness. This belief implies a methodological
problem for the study of intoxication in human experience. Experiences of intoxication
can only be produced while ‘under the infuence’, implying the combination of the ‘inner’,
subjective experience of intoxication and the social and material contexts of that experience.
Clinical scientists use standardized surveys to analyze the research subjects’ individual ex-
periences (see e.g. Barrett, Johnson, and Grifths 2015), and seek to defne the mechanics
of psychedelic experiences and possible therapeutic outcomes (dos Santos and Hallak 2020;
Majić, Schmidt, and Gallinat 2015). However, Angus Bancroft exemplifes the problem of
capturing experiences of intoxication with conventional scientifc methods; ‘It is fundamen-
tally an experience of the individual, and although mechanisms of this experience can be
described through pharmacology and neurology they cannot capture what it is, only why it
is’ (Bancroft 2009:73; see also Langlitz 2012:257).
In this chapter, we show how experiences of intoxication may be studied by analyzing trip
reports – written and oral accounts of intoxication – from online drug information forums and
libraries. We focus on trip reports of psychedelic drugs, including lysergic acid diethylamide
(LSD), dimethyltryptamine (DMT) and psilocybin. These drugs, when ingested in high doses,
‘have the potential to alter consciousness and to evoke phenomena such as hallucinations’ (Blom
2010:249). We will analyze these trip reports as ethnographic texts, focusing on subjective expe-
riences of intoxication induced from psychedelic drugs. By studying trip reports, we thus analyze
experiences of intoxication as emic knowledge, i.e., placing the psychedelic drug user’s knowl-
edge and experiences at the forefront (Atkinson and Morriss 2017; Barratt and Maddox 2016).
In general, trip reports can be seen as a specifc genre of drug writing containing
personal written and oral reports of the experiences of drug use. Psychedelic drug users
and authors of trip reports are often referred to as ‘psychonauts’ (cf. Blom 2010). Some
of the most famous psychedelic trip reports are Aldous Huxley’s The doors of perception
(1954/2010), reporting on his experience of mescaline, Gordon Wasson’s 1957 report on
Mazatec ‘magic mushrooms’ (see Ceraso 2008) and Albert Hofmann’s original report
on LSD (2013). However, while white, Western and academically educated men have

328 DOI: 10.4324/9780429058141-26

 Trip reports

authored the most well-known trip reports ( Jay 2019:19), psychonauts include people
of diverse genders, ethnicities, classes and faiths (Knight 2013; Palmer and Horowitz
2000). Today, psychonauts share trip reports in online forums and repositories where
one of several possible aims is to assist other users to experience safe and informed trips
(Barratt 2017; Kjellgren and Soussan 2011; Soussan and Kjellgren 2014). The act of
sharing integrates the psychonaut within a community of experienced recreational drug
users, distancing themselves from ‘the reckless and uninformed manner in which inex-
perienced users take drugs’ (Söderberg 2016:301).
In the chapter, we will argue that intoxication is best analyzed as structured experiences (see
also Kjellgren and Soussan 2011; Preller and Vollenweider 2018), in other words that intoxi-
cation experiences are not random, but instead follow observable patterns. We emphasize two
aspects of intoxication experiences that illustrate these patterns: the context of intoxication
and the inner experience of intoxication. Regarding the context of intoxication, our point of
departure is based on Zinberg’s conceptual triad ‘drug, set and setting’ (1984). He argued
that the context of drug use is imperative for understanding why and how someone uses a
drug, and that the experienced efects of drugs do not solely arise from ‘the pharmacologic
action of the substance itself ’ (Zinberg 1984:5). Instead, it is the combination of drug(s) and
the mindset of the drug user, or ‘the attitude of the person at the time of use, including
personality structure’ (Zinberg 1984:5), which fosters the experiences. To understand expe-
riences of intoxication, we thus need to take the social and material contexts into account,
the drug user’s mindset, including personality, expectations, attitudes and knowledge of the
drug, as well as the drug of choice. By applying the ‘drug, set and setting’ perspective to trip
reports, we will show how it is possible to identify specifc patterns of intoxication expe-
riences. The other aspect we focus on is the inner experience of intoxication, which includes
thoughts, emotions and perceptions (Majić et al. 2015; Preller and Vollenweider 2018). Inner
experiences of psychedelic drugs, such as LSD and psilocybin, have been studied in clinical
settings by using the ‘Mystical Experience Questionnaire’ (MEQ). The MEQ evaluates what
religious, or ‘mystical’, experiences the respondents recognize while intoxicated (Barrett et
al. 2015; see also Majić et al. 2015). While MEQ certainly has its uses, we will show that
drugs might foster inner experiences of intoxication which do not lend themselves solely to a
religious or mystic vocabulary when analyzing trip reports from online sources. The follow-
ing section outlines our methodological considerations for studying trip reports.

Methodological considerations
Our data for this chapter stems from voluntarily supplied trip reports from publicly accessible
online sources. This kind of material can be studied as ethnographic text (see Atkinson and
Cofey 2010; Barratt and Maddox 2016; Page and Singer 2010) and lends itself to ethno-
graphic text analysis. In ethnographic text analysis, the researcher uses ‘native’ texts to study
the participants’ constructions, conventions and practices in a given (sub)culture (Hammer-
sley and Atkinson 2007:121–141). In our case, psychonauts are local experts who produce
texts as documentary constructions of reality. These constructions, in turn, produce facts,
records, diagnoses, decisions and rules that are crucial for social activities (Atkinson and Cof-
fey 2010; cf. Atkinson and Morriss 2017; for studies of other cultures, see e.g. Gamst 1980;
Gunnarsson and Elam 2012). Using an ethnographic text analysis approach, we consider the
trip reports’ language and content in relation to the texts’ uses and functions in ‘psychonaut
culture’, placing narratives within a cultural context while also scrutinizing their construc-
tion (Atkinson and Delamont 2006).

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Empirical material
The trip reports used in this chapter come from three diferent drug information libraries
and forums: Bluelight, Erowid and Shroomery. We chose these three libraries because they
ofer a vast number of trip reports gathered for diferent and distinct purposes. Bluelight is ‘an
international, online, harm reduction community committed to reducing the harms associ-
ated with drug use’ (Bluelight.org 2019), and hosts a forum that covers topics related to drug
use, including a sub-forum called ‘Trip Reports’ with over 10,000 threads (see also Barratt
2017). While only members can post, the discussions are accessible to the public without
being a registered member. Erowid.org, or ‘The vaults of Erowid’ as its title suggests, is an
online library hosted by Erowid, ‘a member-supported organization providing access to re-
liable, non-judgmental information about psychoactive plants, chemicals, and related issues’
(Erowid 2017). Erowid.org is a vast website, supplying resources on everything from cul-
tural and religious practices to a library of published works on psychedelics. In this chapter,
we refer to Erowid’s ‘Experience Vaults’, which is the organization’s library of experiences,
including but not limited to trip reports (Erowid 2019). The trip reports in this vault are
publicly accessible and contain information on how to cite them in journalistic or scientifc
works. Finally, Shroomery is an initiative to ‘help spread accurate information about magic
mushrooms so [that] people can make informed decisions about what they put in their bod-
ies’ (Shroomery 2019a). One of Shroomery’s sub-forums is dedicated to ‘trip reports’, cate-
gorized according to the quantity or potency of the ingested mushroom, starting at micro
dosing followed by levels 1–5, where 5 is the most potent dosage (Shroomery 2019b).
In general, drug information libraries are an important part of internet drug culture
(Andersson and Kjellgren 2017; Barratt 2017; Bogenschutz 2000). In their posts, the library
users both challenge and reproduce conventional narratives of drug use (Kataja et al. 2018),
and the data that trip reports consist of can be called ‘naturally occurring’, i.e., unsolicited
data supplied for intra-cultural communication (Enghof and Aldridge 2019). They are ‘nat-
urally occurring’ because frst, the subject was not part of a scientifcally designed study,
and second, because the report was written with the aim of giving a personal account of the
experience (Enghof and Aldridge 2019). We selected individual trip reports by focusing on
two criteria: frst, reports of the ‘classic hallucinogens’, i.e., the most archetypical serotonin-
ergic psychedelics: LSD, DMT and psilocybin (dos Santos and Hallak 2020); and second, rich
and detailed descriptions and narratives of the trip. Using these criteria, we identifed and
studied approximately 100 reports from the three libraries. After reviewing these reports,
we concluded that the sample had reached saturation due to recurring patterns and narra-
tives of intoxication. While there are many more reports of this kind, this study sought to
explore the reports as a means of studying intoxication experiences. A conclusive analysis
of all available reports would thus be premature because the large quantity of data would
demand a systematized framework, which is yet to be developed. This chapter might be
regarded as a frst step in that direction. To highlight the value of ethnographic text analysis
for understanding intoxication, we focus on nine reports: four reports from Bluelight, three
from Erowid and two from Shroomery. We selected these nine reports because they display
an internal variety of intoxication experience while supplying clear, rich and useful examples
for our thematization and analysis.
Trip reports generally share information about types of drug used, dosage and means of
administration. On Erowid, several users have uploaded a table as part of their trip report
accounts that includes substance(s) and dosage, but often also timing, mode of administration
(e.g. smoke or liquid) and the psychonaut’s body weight, that can help new psychonauts to

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administer their trip (see, for example, trip reports from Chris 2006; Lucy 2018; Reverse
Pingpong 2017). Supplying information in this manner is common in psychonaut culture,
where psychonauts often compare diferent drugs, dosages and means of consumption (An-
dersson and Kjellgren 2017; Duxbury 2018). In the following, we will quote the original trip
reports and explain specifc expressions or metaphors after the quotations if needed. Some
quotes include parentheses which are part of the original quotes.

Ethical implications of studying online trip reports

When studying online trip reports, we also considered the following ethical issues. Online
drug libraries and online forums are particularly well-suited sources of data for ethnographic
text analyses since they ofer frst-hand accounts of intoxication. Such accounts reduce the
risk of (re)producing dominant scholarly (or popular) narratives, and highlight those ‘native’
to the studied intoxication culture (cf. Barratt and Maddox 2016; Duxbury 2018). Since
the reports are public and freely contributed, we chose to quote them in a rich and liberal
manner, thus highlighting the authorship and contribution of the informants. Moreover,
we followed the ‘fair use’ clauses on the respective online library or forum’s homepage to
ensure the ethical reproduction of trip report quotations. Such clauses ofer important ethical
guidelines since online, public posts by anonymous users often fall within a gray zone of aca-
demic ethics’ guidelines. Moreover, the individual report’s sensitivity and the potential risks
that quoting it poses for the author might deviate drastically between diferent cases (Rob-
erts 2015). We therefore sought to quote excerpts which lent themselves to anonymization
without losing their analytical value, and excerpts which included little to no incriminating
details beyond psychedelics use.

Te experience of psychedelic intoxication

The language used in trip reports is both flled with metaphors and with particular ex-
pressions well known within the psychonaut culture. For example, when a Bluelight user
writes: ‘…I fnd my self [sic] with two hits of 225 ug SpongeBob blotter’ (User145667),1 it means
that s/he holds 2 × 225 micrograms of LSD infused into a small, stamp-like piece of paper, a
‘blotter’, with a picture of the children’s cartoon character ‘SpongeBob SquarePants’ printed
on it. As well as ‘LSD’, psychonauts may refer to this substance as ‘acid’. ‘Blotter’ is the spe-
cifc mode of administration. While blotter is the conventional mode of administration, LSD
can be distributed as a liquid, either dropped directly on the tongue using a pipette or mixed
into a beverage and drunk. When another Bluelight user writes: ‘Yesterday I gave myself a
fair good wallop in the head with 4HO-DMT, at 30 mg’ (PippUK), s/he refers to experienc-
ing a metaphorical sudden and surreal blow to the head following the use of 30 mg of a syn-
thesized drug similar to psilocybin, indicated by the expression ‘4HO-DMT’. Psychonauts
generally refer to (naturally occurring) psilocybin from a mushroom or the peyote cactus
in terms of these modes of administration. In the following sections, we frst explore the
psychonauts’ context of intoxication and then turn to the inner experience of intoxication.

Context of psychedelic intoxication

As argued above, contexts of intoxication can help us to understand observable patterns
of intoxication. In the following, we will examine how trip reports reveal psychonauts’
experience of intoxication and how it is shaped by and related to the psychonauts’ setting:

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psychosocial factors, including personality, attitudes, expectations and knowledge (Zinberg

1984). We will explore two important contextual factors that are discussed in the trip re-
ports: planning a trip and the role of the setting.

Planning the trip

The importance of organized preparations before ‘embarking’ on a trip is widely discussed
in the trip reports. Caution and preparation are integral to a proper trip, often contrasted
with amateurish ‘party’ intoxication, and well known within a Western psychonaut culture
(Söderberg 2016; see also Power 2014). Trip reports discuss the psychonaut’s knowledge
of diferent drugs’ intoxication-efects – individually and in concert – as instrumental for
achieving the best possible experience.
Two examples will highlight how previous experiences of a certain drug (or lack thereof )
infuence the psychonaut’s knowledge and expectations of intoxication.
If the trip report outlines a psychonaut’s frst experience of a substance, it is often empha-
sized in the report’s headline, such as ‘My frst DMT – can I have passed out?’ (Bluelight user 3).
In this example, before going into the details of the trip, Bluelight user 3 describes the psycho-
social context as: ‘This night, I was extremely tired. Before 12 hours of work, I only got four
hours of sleep’. This context contrasts with the psychonaut’s plan, namely to try DMT when
‘rested and fed, on a relaxed day’. This psychonaut deviates from these plans due to his or her
high expectations of DMT, ‘… the substance I’ve been obsessed with and investigated since I
saw the documentary DMT: The Spirit Molecule. So, I decided to take the DMT right then and
there around midnight’ (Bluelight user 3). However, while deviating from the plan, Bluelight
user 3 shows the dedication and planning that goes into embarking on a frst experience of a
hallucinogenic drug. Similarly, Erowid user Reverse Pingpong reports:

I had been planning this for a long time. About six years to be precise. Actually it was
the time that I frst got the idea of trying psychedelics. As the moment passed I never got
around to it until years later, when I happened to read a book by Albert Hofman [sic],
the father of LSD. Instantly hooked again I started looking for LSD in order to exper-
iment with it. I’ve never been a drug user. A few hits of cannabis is [sic] the most I’ve
ever done. I’m a fairly heavy drinker though, so I certainly don’t patronize myself on
that front. /…/ I spent a lot of time reading other peoples [sic] trip reports and gathering
information about the drug I was about to take.
(Reverse Pingpong 2017)

Both Reverse Pingpong and Bluelight user 3 show that they prepared themselves for a long
time with a defnitive goal in mind: to experience a drug-induced hallucination. These
preparations are, to an extent, part of their ‘set’, meaning that the psychonaut seeks to acquire
a certain mindset or mood to appreciate the trip. Moreover, Reverse Pingpong details his
or her experiences of other intoxicating substances and moral disposition toward intoxica-
tion in general. Both of these psychonauts show that they do not seek to be surprised by the
experience of intoxication, but rather to mimic others’ experiences of psychedelic drugs as
portrayed in popular media, such as the documentary mentioned. However, at the end of
Bluelight user 3’s report, s/he ponders whether the lack of the desired mental state could
have caused the seemingly negative experience of passing out: ‘I mean, I wonder if sleep
deprivation, and the sudden and intense experience took me of guard, might have knocked
me out?’ (Bluelight user 3).

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The seemingly more experienced psychonaut ‘PippUK’ outlines considerable practical

preparations for his trip on the psilocybin-like hallucinogen 4HO-DMT. First, he had ‘a
light breakfast of cereal so that the little packet [4HO-DMT] would not open on an empty
stomach’ and prepared additional drugs to counteract eventual negative efects of the hallu-
cinogen, such as ‘a lightbulb vaporizer containing about 50mg of spice [synthetic cannabi-
noid]’. However, he did not prepare the ‘set’ in the same minute manner:

…in retrospect I hadn’t really prepared emotionally so well. I knew that the trip was
intended as a bit of DIY [Do It Yourself ] therapy, because this is what I had been con-
sidering for my trip during my week of. However, that morning I had set everything up
for the session but had not had the useful quiet time of contemplation about what might
transpire, and I ploughed in rather hurriedly.
(PippUK)

These trip reports suggest a belief that mental preparations are key to achieving the
sought-after experience from hallucinogenic drugs, and that bad experiences might be
the result of poor preparation. The reports do however deviate in one signifcant way.
Bluelight user 3 is a novice psychonaut and thus asks the Bluelight community if the
negative experience could have been caused by bad mental preparation. PippUK, how-
ever, concludes from experience that the negative experience must have been caused by
bad mental or emotional preparation. Nevertheless, these psychonauts describe planned
uses of psychedelics, including explicit considerations of the psychosocial context. In
this way, both the reports engage with the community of psychonauts by, respectively,
asking for and giving advice on the procedure of preparing one’s set (cf. Andersson and
Kjellgren 2017; Duxbury 2018).

Te role of the setting

Beyond the drug and the set, Zinberg (1984) distinguishes the importance of setting for expe-
riences of intoxication, referring to the psychonaut’s material environment and, occasionally,
also his/her social environment (i.e., other people, social positions and relational structures).
In the following example, Bluelight user 4 reports on the setting in which s/he took ‘two
hits of Albert 3000 (some nice potent acid)’ and remarks on the importance of the setting
for the trip experience:

I was staying in a friend’s beach house together with X. Her friend Y was also there.
The place is enormous (well, big for me anyway) with long hallways and a great many
rooms. It was obviously built and decorated during the 1960s and was unchanged since.
The foors have a fufy bright red carpet and the curtains are bright purple. To me, the
house has very 1960s furniture in matching colours /…/ The interior shows that the
owners have travelled a lot, and artifacts from their travels are placed in interesting ways
throughout the house. One room even has big black and white tiles.
(Bluelight user 4)

In this report, Bluelight user 4 intersperses the experience of intoxication with a description
of the setting. Both the material and social settings are described: the interior of the house,
and the user’s relationship with the people present and those who own and who have dec-
orated the house. Moreover, s/he emphasizes that the setting is important for the reader to

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 Jonas Bååth and Johan Nordgren

understand the experience of intoxication. The material environment is important in psy-

chedelic culture, and some psychonauts alter the interior to control and enhance their expe-
riences (Parley 2016). The social environment becomes especially vivid when Bluelight user
4 comments on his or her own social position; the house is described as lavish and foreign,
and the label ‘beach house’ suggests that the owners have multiple properties. Moreover, the
psychonaut’s impression is that ‘the owners have travelled a lot’. This example shows that the
social environment infuences his/her experience of intoxication. The social environment
shows in the experienced distance between the psychonaut’s social position (i.e., class) and
the position s/he fnds that the property owners inhabit, provoking thoughts about difer-
ences of socioeconomic status.
An important aspect of the social environment can also be people ‘sitting’ with the user,
for example, a trusted companion who aids the psychonaut in diferent practices, which
has been developed specifcally within the psychedelic culture as a way of minimizing
unwanted experiences, such as bad trips. Trusted companions have assisted users both in
clinical and non-clinical settings (Parley 2016; Pollan 2018). Other people, close to the
psychonauts, can also be important for the experience of intoxication. The following
quote from Shroomery user 1 exemplifes the role of other people during the trip, here
the psychonaut’s wife (‘wifey’), who has also ingested a psychoactive substance (thus is not
functioning as a sitter):

Then I kept coming out somewhat clear and thinking ‘Oh, this must be the end of the
trip’ but it wasn’t. I had these little ‘awakenings’ over and over again. I looked at my wife
in bed next to me, and I saw her hair looked like a wave for [sic] ocean fowing of of her
head and out into space … I did fnd myself a little too preoccupied with her comfort
though. I must have asked her 200 times if she was ok. Next time, I’ll write it on paper
‘wifey is just fne, focus on yourself.’
(Shroomery user 1 2019)

The report indicates a relationship of trust and afection, strongly related to positive expe-
riences and the ability to experience the trip in a positive manner. The social environment,
encompassing both the immediate, personal relations of the reporting subject, and his or her
position in society, is thus explicitly framed as an important infuence on this psychonaut’s
experience of intoxication. The social environment thus becomes an integral part of the in-
toxication experience. So far, we have focused on the context of experiences of intoxication
in trip reports; in the following section, we focus on the inner experience of intoxication and
how psychonauts report on these inner experiences.

Inner experiences of intoxication

‘We were somewhere around Barstow on the edge of the desert when the drugs began to
take hold’ (Thompson 1971/2014:3). So began Hunter S. Thompson’s Fear and Loathing in
Las Vegas. By ‘taking hold’, the sentence implies what we seek to capture with the notion
‘inner’ experiences of intoxication: the arguably psychologically internal reactions and ex-
periences of intoxicating efects taking hold, and how the reporting psychonaut understands
and addresses them. In the following sections, we discuss the inner experience as a series of
diferent stages. However, it should be noted that not all psychonauts necessarily experience
all these stages in every trip.

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 Trip reports

Initial inner experiences

Examining how psychonauts report their inner experiences means analyzing how they nar-
rate the sensations caused by the drug, along with the psychonauts’ expectations of and as-
sumptions about such trips, often using a metaphor-heavy language. We begin by exploring
how psychonauts experience the initial efects of psychedelics. The following excerpt exem-
plifes how Erowid user Lucy narrates her initial reactions to LSD.

When the efects started [to] kick in, my boyfriend was playing video games and I was
internet surfng. Gradually I started noticing some changes in the lights, it was as if
someone had been messing with the the [sic] brightness, turning it up higher. My head
felt warm, as if I was sick (I wasn’t) and my heart was racing. I also felt very nauseous,
but I didn’t throw up. Then, I got up from the sofa and started browsing around the
house. [My body] … felt heavy and visually I could see light trails, but no distance or
size distortion, as in, objects did not seem further, longer etc. from what I originally
perceived them to be.
(Lucy 2018)

Lucy’s initial reaction to LSD is clearly framed in terms of sensory experiences: changing
and trailing lights, heat, heart racing and nausea. She thus relies on a specifc set of sensations
to narrate her intoxication: perception-based cues which Lucy assumes the LSD has caused.
These sensations tie the inner experience of intoxication to the context in which she expe-
riences it, emphasizing how her perceptions and inner experiences change in tandem with
her activities. However, Lucy also relates the intoxication experience to her expectations of
LSD, pointing out that she did not experience any of the expected ‘distance or size distor-
tion’. Instead, the experience of intoxication from LSD is presented as primarily afecting
her perceptions of the setting:

Colours seemed more vibrant, and looking outside the world had an ‘electric’ feel to it,
sometimes my vision would get blurry by all the objects’ trails, but in general every-
thing was visually crisper, like my vision jumped to high defnition.
(Lucy 2018)

In this quote, Lucy’s narrative changes from the previous one in which she used perception-based
sensations to evaluate whether or not she had begun to experience intoxication. In contrast to the
previous quote, she has moved beyond evaluation and describes the experience of intoxication
itself. At this point, she allows for a more metaphorical framing. Using metaphors like ‘“electric”
feel’ and ‘like my vision jumped into high defnition’, she implies that it becomes harder to give
concrete accounts of the intoxication and thus she relies on metaphors.
As hitherto exemplifed, we fnd that when the psychonaut’s experience of intoxication
is established, the reports focus on the contents of the experience, and how the psychonaut
engages with it. Lucy’s report of an LSD experience suggests, moreover, that psychedelic
intoxication demands active management of emotions and sensory interpretation:

The frst hours of the trip weren’t all that great, nothing ‘interesting’ was happening and
the visuals were just mild; also, I had a constant feeling of uneasiness and fear. I was hav-
ing illogical thoughts, mainly that my trip would go bad like all the other times and that

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 Jonas Bååth and Johan Nordgren

my neighbours could hear everything I was doing/saying. But as I was moving closer
toward the peak of the experience, I tried to calm myself and abolish such thoughts by
using reasoning, although that last thought that everyone inside a certain km radius
could hear us sadly accompanied me all throughout the trip.
(Lucy 2018)

In this quote, Lucy gives a general account of the experience in an almost dramaturgical
manner, indicating that the experience of intoxication is an ongoing process, in which she
explicitly seeks to manage her psychosocial context. Similar to the earlier examples of failed
psychosocial preparations, Lucy posits that negative and illogical thoughts threaten the ex-
perience of intoxication. Moreover, Lucy points out that she was ‘moving closer to the peak
of the experience’. Taken together, Lucy’s reports suggest that she is an experienced psy-
chonaut, at least in using LSD. Moreover, she suggests that there is a pattern to the intoxica-
tion, approaching a ‘peak experience’, while negative thoughts might jeopardize that pattern
(cf. Majić et al. 2015; Preller and Vollenweider 2018). In the next section, we examine how
the movement toward the peak reaches its goal: peak experience.

Peaking in psychedelic experiences

The peak of the psychedelic experience is a recurring part of trip reports. The ‘peak’ re-
fers to ‘a highly intense component of the [psychedelic] experience which only occurs on
occasion’, that scholars have compared to mystical experiences (Majić et al. 2015, quote on
p. 243). Shroomery user 2 details this kind of experience, accounting for a ‘Level 5’ trip, i.e.,
the most potent kind:

I died. My ego dissolved and was washed away quickly. My physical body was contort-
ing uncontrollably on my bed. I died and then I awoke again as pure energy/ conscious-
ness/ God. I began speaking out loud, uncontrollably. In fact I think for the duration
of this section of the trip I was speaking out loud continuously and without control.
At frst I just kept chanting and declaring ‘I have awoken. I have awoken. I am awake.’
It felt as if pure energy was speaking through me. I had no control over this. I began
changing ‘I AM I AM I AM I AM I AM’ over and over again. My physical body was
striking and holding poses. Some times [sic] my body was uncomfortably twisted and
contorted on my bed.
(Shroomery user 2 2019)

In this quote, the psychonaut refers to the notion ‘ego death’, which is a common way of
describing the peak experience of a potent psychedelic intoxication ( Jansen 2004; Preller
and Vollenweider 2018:226). The psychonaut reports that the ego death is not only an inner
experience, but also a corporeal one: taking on uncomfortable bodily poses (cf. Kjellgren
and Soussan 2011). As is implied in the previous quote, this experience is reported by some as
overwhelming and thus intensely negative. However, psychonauts occasionally re-interpret
ego death as a positive experience on a later occasion, which might foster continued psy-
chedelics use despite previous negative experiences (Gashi, Sandberg, and Pedersen 2021).
Taken together, the reports of reaching the peak of intoxication suggest two things: frst,
that trip reports frame intoxication as a narrative process, with a dramatic peak, rather than
a homogenous state of intoxication. Second, that intoxication is not a passive experience but
that the psychonaut actively engages with it both bodily and psychosocially.

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 Trip reports

Experiences of subsiding intoxication

As the peak experience begins to wane, some psychonauts report diferent after efects.
Erowid user Chris refects upon her LSD trip which contained elements that she describes
as ‘hard hitting’, including the thought that she was dead (not necessarily equated with ‘ego
death’):

By now, 6 months after the trip, I have experienced a few ‘fashback’-like states, where
I experienced the extreme paranoia and terror that I had sometimes experienced while
on LSD. I am sure they were from the experience, because I had never experienced this
sort of thing before. I had always been relatively mentally healthy, if a little bit depressed
at times. Despite this, I think my experience changed me for the better. I don’t know
what it is, but reality seems slightly diferent. I have learned to be more accommodating
of other people, friendlier, and more accepting to diferent viewpoints.
(Chris 2006)

Refections such as these suggest that the user seeks to cope with a profound personal expe-
rience derived from the intoxication, which might be both positive and negative. Similarly,
early research on the potential therapeutic efects of psychedelic drugs noted a period of
‘afterglow’ following relatively high dosing, which refers to a highly positive emotional and
psychological state (Majić et al. 2015). Having now explored both the context of and inner
experience of intoxication, we will draw the paper to a close by discussing the fndings and
their implications.

Discussion and conclusion: toward understanding experiences

of psychedelic intoxication
This chapter set out to explore trip reports as ethnographic texts. We have examined trip
reports of LSD, DMT and psilocybin as a means of understanding psychedelic intoxication as
structured experiences. That is, experiences which follow observable, non-random patterns.
These patterns, we have shown, emerge both in the context of intoxication – the drug, set
and setting – and in the psychonauts’ inner experiences of intoxication – initial, peak and
subsiding efects. We have thus analyzed how trip reports bear witness not only to the direct
changes in the initial experiences that drugs provoke. We have also shown how preparations,
and social and material settings infuence the experience and become an integral part of it.
Moreover, we fnd that the trip reports suggest that psychedelic intoxication is a structured
process with a beginning, a peak and an end, and that the psychonaut actively engages with
this process (rather than merely passively experiencing it). Our analysis shows how the psy-
chonaut experiencing such psychedelic intoxication actively infuences the experience both
by preparing the context of intoxication and by actively engaging with their thoughts, emo-
tions and bodily reactions during the experience. In line with Zinberg’s argument (1984),
the trip reports discussed in this chapter highlight the importance of organizing the contex-
tual aspects of intoxication to control the experience, but also that controlled intoxication
includes active bodily and psychological engagement with the inner experience itself (cf.
Kjellgren and Soussan 2011). These fndings are certainly exploratory. Moreover, they are
limited as psychonauts who author trip reports may not be representative of, or have the same
experiences, as those who do not. Nevertheless, they illustrate the ways in which psychedelic
intoxication can be analyzed as a structured experience.

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 Jonas Bååth and Johan Nordgren

Our analysis is consistent with earlier studies of psychonauts’ online trip reporting (Dux-
bury 2018; Söderberg 2016; Soussan and Kjellgren 2014). Overall, trip reports can be un-
derstood as a contribution to a community of psychonauts who share particular experiences
and knowledge about psychedelic trips. In line with existing studies, we fnd that online
psychonaut culture is a form of ‘citizen science’, and the trip reports partly mimic scientifc
reports, which may aid other psychonauts in planning their intoxication experiences (An-
dersson and Kjellgren 2017; Duxbury 2018; Söderberg 2016; Soussan and Kjellgren 2014). In
addition, the trip reports also show the problems and mistakes of psychonauts, which both
inform others of the diferent types of risks and seek to identify causes of imperfect trips
(Andersson and Kjellgren 2017; Soussan and Kjellgren 2014).
Analyzing trip reports as ethnographic texts, we question the validity of analyzing psy-
chedelic intoxication (i.e., hallucinations) as a solely mystical, religious or existential expe-
rience, as in the case of MEQs (cf. Barrett et al. 2015; Majić et al. 2015). Our analysis shows
that the inner experiences of intoxication might involve existential aspects, such as ego
death, but that psychonauts do not necessarily interpret such experiences in mystic, religious
or existential terms. They are rather described as their own type or category of experience.
We thus argue that trip reports ofer a means of studying intoxication on its own terms (see
e.g. Preller and Vollenweider 2018), before assuming any similarity to other types of experi-
ences, such as a religious experience.
In concluding this chapter, we propose that focusing on the psychedelic experiences
themselves ofers new and relevant methodologies for studying the recent ‘psychedelic
renaissance’. Unlike religious or recreational psychedelic intoxication, this renaissance
is fostered by groups of psychonauts and researchers who seek to establish ‘psychoactive
substances as a legitimate feld of research’, not only for therapeutic uses but also for
uses which have both therapeutic and recreational functions, including experiences of
intoxication (Söderberg 2016:303). Another issue, for which trip reports ofer important
insights, is that popular constructions of psychedelic drugs paint them as highly unpre-
dictable, perception-altering and controlling of the psychonaut, which fosters stigma
and fear that obstruct an impartial approach to such drugs (Barratt and Maddox 2016;
Langlitz 2013). Beyond challenging the stigma of psychedelic intoxication, the trip re-
ports analyzed here give detailed information about how psychonauts use drugs, and
what kinds of usage are considered wise or reckless (see also Young 1971). Consequently,
we agree with Enghof and Aldridge (2019) that trip reports authored by psychonauts
for a psychonaut community ofer important insights for the development of drug policy
(contrasting with those authored as part of a scientifc study). Mapping out and analyzing
the psychonauts’ reported practical strategies suggest new paths for efcient harm reduc-
tion, including advice for safe usage and the debunking of myths (see also Bilgrei 2016;
Soussan and Kjellgren 2014).

Acknowledgments
We wish to thank the psychonauts whose trip reports contributed to this study. This study
is partially based on data sets obtained from Bluelight.org. Bluelight.org is a non-proft on-
line community dedicated to reducing drug-related harm. This work was conducted with
authorization from Bluelight.org. The content is solely the responsibility of the authors and
does not necessarily represent the ofcial views of Bluelight.org.

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 Trip reports

Note
1 Due to diferent fair use clauses, the names and attributions of authorship for trip reports difer be-
tween the sources used. In line with Bluelight’s attribution policy, we asked the quoted Bluelight
users if they approved our use of their trip reports in this chapter. PippUK and User145667 replied
afrmatively and preferred that we use their Bluelight.org usernames, while Bluelight users 3 and 4
did not reply. We have thus included the latter two trip reports, but have altered the quotations in
order to ensure their anonymity while keeping the important parts for the analysis. Moreover, we
have cited the trip reports from Erowid and Shroomery as references, according to the demands of
their respective fair use clauses.

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 21
PASSION, REASON AND THE
POLITICS OF INTOXICATION
Ontopolitically-oriented approaches to alcohol
and other drug intoxication

Suzanne Fraser, David Moore, Adrian Farrugia and Renae Fomiatti

Introduction
‘Intoxication’ is a multivalent term that invokes a range of experiences – from joy and plea-
sure to chaos and impairment – and applies diferently across diferent drugs and diferent
settings of drug consumption. More broadly, it operates culturally as both elevating (the aria
was ‘intoxicating’) and harmful (he collapsed while ‘intoxicated’). When conceived in con-
ventional neo-liberal terms (that is, the privileging of market forces, cost/beneft rationality
and the self-managing individual (Petersen, 1997), intoxication sets up binaries between rea-
son and emotion, sense and irrationality, legitimacy and illegitimacy, chaos and order (Ayres
and Taylor, 2020). As such, its application can carry highly variable political implications and
efects, entailing varying governance measures and practices. Directly modifed by questions
of class and cultural capital, it is also freighted with diferentially raced and gendered mean-
ings. In this chapter, we examine some of the political implications and efects of the notion
of intoxication using two large-scale qualitative Australian research projects as case studies. In
one project, the place of intoxication is examined in accounts of accidental opioid overdose
and the use of the opioid antagonist naloxone; in the other, it is examined in accounts of the
use of performance and image-enhancing drugs (PIEDs). In relation to naloxone, intoxication
often fgures as perilous: it is a liminal state adjacent to death, seductively dangerous, in need
of direct biomedical intervention. While the naloxone distribution programmes created in line
with this approach are an undoubted good, they tend to downplay the contexts of overdose
in which risky intoxication is for many an efect of legal conditions that render drug strength
opaque and dosage unmanageable. They also raise questions about what counts as intoxication
and why. In relation to PIEDs, intoxication can be understood less as an immediate efect of
drug consumption and more as the product of carefully managed treatment regimes, such as in
the case of steroids, where men describe an intensely heightened sense of confdence, energy,
power, resilience and competitiveness. Here, intoxication complicates the neo-liberal demands
for productivity visible in some engagements with PIEDs, as well as the traditional polarisation
of drug use and discipline and order.
In conducting our analysis, we adopt what has elsewhere been called an ‘ontopolitically-
oriented’ approach to research (Fraser, 2020) in which bodies, corporeal changes and other

342 DOI: 10.4324/9780429058141-27

 Passion, reason and the politics of intoxication

material phenomena are understood to be the efect of complex processes, including meaning
making and social practices. Based on science and technology studies (STS) and new mate-
rialism, this approach sees realities, including the realities of drug consumption, as emergent
rather than predictable and guaranteed by biochemistry or prior states. As we will argue,
this allows recognition of the ways in which diferent contexts and discourses of intoxication
(including those operating in research itself ) co-produce culturally and politically specifc
intoxication experiences and efects. In turn, we raise new questions about the conditions of
intoxication, the assumptions made about drug efects, the meaning of intoxication and how
best to respond to it. As the chapter will show, intoxication is a political designation reliant
on a range of assumptions about drug-consuming subjects and practices. In making this case,
the chapter will set out theoretical resources for new approaches to researching politically
multiple concepts such as intoxication.

Literature review
The social science literature on intoxication is extensive. It covers broad discussions of
intoxication as it relates to a range of practices and issues, including emotions, physical
sensations, religious perceptions, responses to the arts and of course drugs. Researchers
have sought to identify diferent kinds of intoxication, diferent ways of accounting for it,
diferent social and cultural purposes it fulfls, and diferent global political dynamics and
histories relating to it.
In relation to alcohol and other drugs, intoxication has often been positioned as neces-
sarily harmful and self-evidently problematic: it threatens health and the moral order, and
needs to be managed and reduced (Bancroft, 2009; Homel, Tomsen and Thommeny, 1992;
McClelland and Teplin, 2001; McCreanor et al., 2008; Orcutt, 1978; Room, 2001). Anthro-
pological and sociological research suggests however that, like alcohol and other drug con-
sumption more generally, experiences and meanings of intoxication are shaped by cultural
practices, social relations and power dynamics (Herbert and McCreanor, 2020; MacAndrew
and Edgerton, 1969; Sande, 2002). Researchers have also pointed to the ways the perceived
individual and social harms associated with specifc forms of intoxication lead to stigmatisa-
tion and criminalisation (Yardley, 2012), and have noted that the pursuit of intoxication must
be understood in the context of contemporary injunctions to rationality and moderation
(Zajdow, 2010). Experiences of and responses to intoxication have further been identifed as
gendered (Bogren, 2008; Hunt and Antin, 2019; Moore, 2020; Moore et al., 2017). Other
work has renewed attention to Durkheim’s nascent theory of intoxication (Shilling and
Mellor, 2011) and drawn on Plato’s ‘ironic intoxication’ as a philosophical method (Bonner,
2013). Recent edited collections on intoxication (Hutton, 2020; Withington, 2014) em-
phasise two key points: (1) forms of intoxication have been part of many diferent human
societies for millennia, and (2) practices of intoxication and their implications require social,
political and cultural analyses.
Within this burgeoning literature, several key works on intoxication published over the
last two decades draw specifcally on the advances in alcohol and other drug studies pro-
vided by STS and its emphasis on ontological politics. The attention STS pays to the role
of research in constituting, rather than merely measuring or refecting, realities has fostered
fruitful refection on research methods, but has also ofered new ways of looking at reality
itself, ofering a particular framework through which to understand reality: as multiple and
emergent rather than singular and anterior to research or other kinds of observation. This
approach has been of value to the feld of drug social sciences because it helps theorise the

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lack of coherence and consistency long noted in drug efects, such as intoxication, and the
political opportunities aforded by recognition of this inconsistency. This work is not alone
in raising questions about the stability and predictability of drug efects, of course. As we
noted above, anthropology, a signifcant contributor to STS, has long argued that drugs
perform diferent functions in diferent societies, carry diferent meanings and even have
diferent subjective efects, such as those relating to intoxication. MacAndrew and Edger-
ton’s classic work, Drunken comportment (1969), for example, argued that, ‘The way people
comport themselves when they are drunk is determined […] by what their society makes
of and imparts to them concerning the state of drunkenness’ (p. 165). Contrary to received
wisdom, they observed, alcohol does not produce the same efects cross-culturally, and in-
toxication (or ‘drunkenness’) too varies by culture. This framing was consistent with other
contemporary anthropological, sociological and historical accounts of alcohol intoxication
as shaped by the historical, social and political contexts of consumption (Douglas, 1987;
Gefou-Madianou, 1992; Heath, 1958; Levine, 1978; Mandelbaum, 1965; Marshall, 1979a,
1979b; Orcutt, 1978; Room, 2001), and with work on other drugs (Zinberg, 1984). While
MacAndrew and Edgerton’s analysis, and that of related work, is amenable in some ways
to the ontological politics animating our analysis here (more on which below), it does not
necessarily conform to its account of reality. It bases its analysis on the idea that all drunk-
enness causes ‘clumsiness’, but that the meanings attached to this clumsiness are not fxed.
In this way, the diferences it identifes could be interpreted as the result of a superstructure
of meaning laid over a stable biological reality. Overall, these works do not ask direct ques-
tions about the ontological nature of drunkenness, and by extension all drug intoxication,
although their social constructionist orientations (articulated in diferent ways) undoubtedly
paved the way for later work that takes a more searching approach to the nature of reality as
it pertains to drugs and their efects.
Among the earliest work to bring explicitly ontological questions and approaches to
bear on issues of drug use and intoxication is Gomart and Hennion’s 1999 article on
agency and subjectivity, explored through a discussion of ‘passionate attachment’ and STS,
in particular actor-network theory. The authors explore two passions – drug consumption
and classical music – usually considered very distinct in terms of the status of their efects.
In doing so, they argue that engagement with either is a means of constituting the self,
and that such a process of constitution is an efect of a dispositif (an assemblage or appara-
tus composed of a complex range of ideas and practices (Deleuze, 1992)), rather than the
achievement of an individual agent or the direct causal efect of the drug or music itself.
In making their argument, their aim is to ‘ofer an alternative account of the ways in
which subjects may be seized, impassioned and swept away’ (1999, p. 221), one that avoids
ascribing causal force to either the subject (such as the music connoisseur) or the object
(such as a drug). As they go on to explain, ‘This version of actor-network theory switches
focus from the (albeit decentred) subject to what one might think of as the socio-technical
“dispositifs” of passion’ (1999, p. 221).
While Gomart and Hennion do not use the word ‘intoxication’ in their article, they do
say this about music and drugs:

Both have to do with entering into a world of strong sensations; of accepting that ‘ex-
ternal’ forces take possession of the self; of being ‘under the infuence’ of something
else; of bracketing away one’s own control and will in order to be expelled or rendered
‘beside oneself ’.
(1999, p. 221)

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 Passion, reason and the politics of intoxication

It is via this interest in processes by which the self is taken over by external forces, rendered
beside itself, that their work speaks to issues of intoxication. To make their argument, they
illuminate the points of commonality between intoxication through music and through
drugs despite their cultural and political diferences, raising questions that are otherwise
invisible in considering one or the other in isolation. In this chapter, we too bring together
two distinct areas of practice to illuminate notions of intoxication in new ways, to consider
the possibility that the constraint of intoxication is not only limiting but productive and to
think about the political implications of this reading.
Also working in STS, Sulkunen (2002) draws on its ontological concerns to discuss the
attempts made to generate cultural theories of intoxication. Using the work of Latour, he
argues that, ‘[i]ntoxication is a proto-semiotic fact between culture and nature, not being
completely meaningful but not possible without meaning either’ (2002, p. 253). Pointing to
the need to consider the social and symbolic dimensions of intoxication as well as chemical
efects, he tries to ofer an approach that exceeds commonplace dualistic models of intoxi-
cation as either the straightforward result of the drug or of socially produced meaning. His
closing observation that ‘the cultural study of intoxication as a signifer therefore always
reaches toward other realities beyond drug use itself ’ (Sulkunen, 2002, p. 272) is directly rel-
evant to the analysis to be conducted here, in its location of intoxication as indivisible from
the broader realities with which it is made and understood.
A recent addition to this body of literature is Pienaar et al.’s (2020) analysis of intoxication in
LGBTQ communities. Drawing on two mainstays of approaches that attend to ontological poli-
tics – Karen Barad and Judith Butler – the authors remind us of the instability of drug efects and
their emergence within social contexts, to argue that drug use and intoxication should be seen
as productive, not just as risky and harmful. In making their argument, they also point out ‘the
proximity of pleasure, risk, care and intimate experimentation as prominent concerns within
LGBTQ cultures ofer new ways of thinking about the place of drugs and intoxication in social
life’ (Pienaar et al., 2020, p. 157). In this latter point can be found connections with other work
written from one of the studies analysed here – Farrugia et al.’s (2019) article on the politics of
care, which elucidates the intimacies produced and relied upon in couples who consume opioids
together and must manage the possibility of overdose.
In sum, the literature informed by STS and related ontological theorisations of drug use
and drug efects remind us of several key points for our analysis to follow:

• Drug efects such as intoxication are not determined by the pharmacological properties
of substances but are made in social practices;
• In this instability, we can see that intoxication is not reifable as a state but is better un-
derstood as a shift in relations with the self and the world;
• As such, intoxication can refer to any number of practices, including practices axiomat-
ically positioned as antithetical to it, such as work on the self, agency and reason;
• Once intoxication is understood in this way, the political implications of labelling some
phenomena ‘intoxication’ and declining to do so for others can be considered more
clearly.

Approach
Our theoretical approach in this chapter begins with some observations made in a recent
book chapter by leading social scientist of drug issues, Helen Keane (2020). In this piece, she
analyses intoxication and nicotine by drawing on the work of Bancroft (2009) and Hunt and

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Frank (2017). Keane sets out to depathologise intoxication and, at the same time, to ofer a
more subtle understanding of it that allows recognition of experiences and efects not usually
recognised within defnitions of intoxication. As she (Keane, 2020, p. 47) observes:

Drunkenness is the iconic state of pathological intoxication, marked by disinhibition,

mood lability, impaired judgement, inappropriate behaviour and other signs of dimin-
ished physical or mental control (American Psychiatric Association, 2013, pp. 485, 497).

Keane’s aim is to consider intoxication through the substance of nicotine, identifying ways in
which it invites an expansion in the meaning of intoxication, and raises questions about our
tendency to treat intoxication as pathological, that is, as evidence of a diseased mind, body
or lifestyle. In this context, she argues for ‘a broader understanding of intoxication which
incorporates less forid changes in consciousness than drunkenness’ (Keane, 2020, p. 47). She
quotes Bancroft on the topic, who notes that, ‘Whether smoking cigarettes, drinking alcohol
and cofee, or taking illicit drugs, for the majority of society’s members, some kind of intox-
ication is a regular, often daily practice’ (Bancroft, 2009, p. 5, cited in Keane, 2020, p. 47).
Why does Keane seek to incorporate the efects of nicotine into accounts of intoxication? As
she explains, in describing Bancroft’s contribution:

By expanding the category to include substance-induced changes in the relationship

between the self and the world, whatever their intensity, Bancroft (2009) normalises the
experience of and the desire for intoxication, broadening out the concept of intoxication
as something that can be more subtle than ostentatious and visible alcohol and other
drug intoxication.
(2020, p. 47)

Keane draws on practice theory (which focuses specifcally on the role of practices in making
events and other phenomena) to conduct her analysis, identifying its ability to resist ‘explana-
tions based on universal drug properties and individual psychology’ (2020, p. 50).
A related expansive defnition of intoxication found in the literature and relevant to our
analytical approach is simply the use of substances to alter consciousness (Hunt and Frank, 2017,
p. 323). Keane is explicitly interested in this defnition, arguing that it can encompass relatively
mild changes in perception, such as daydreaming. Returning to nicotine, she explains that:

The notion of a ‘slight’ euphoria seems oxymoronic at frst glance, but it captures the
particular capacity of cigarettes to create a brief opening in the smoker’s day which is a
minor but sustaining enhancement of routine.

More broadly, Keane’s aim is to draw our attention to the ways in which ‘intoxication’ can
be seen as a ‘shift in one’s relationship to the world, with no fxed meaning or inevitable
consequences, either negative or positive’ (2020, p. 51), and in this way, not necessarily other
to the normal.
In taking up Keane’s suggestion that intoxication be redefned, we are able to recognise
in our data experiences of intoxication that would otherwise be neglected in research and
public discourse. Doing so helps depathologise intoxication, allowing us to ask new ques-
tions about it and about the politics that shape its meaning and status. In particular, it helps
identify the proximity of intoxication to the attributes and practices usually positioned as its
opposite: reason, productivity and agency.

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In Keane’s piece and the orientation she takes to the efects of drugs and the status
of intoxication, we can see connections with STS approaches that refuse conventional
assumptions about the anteriority of reality and the stability of drug efects. Indeed, in
setting of from her piece, we also draw on an approach that has recently been termed
‘ontopolitically-oriented research’ (Fraser, 2020). In an article aiming to bring together
key aspects of this approach, Fraser outlines fve features, also noting that further features
may remain to be identifed:

1 The methodological performativity of naming

Fraser refers here to the terminology of ‘addiction’, considering its role in shaping
research recruitment and analysis for a project about regular heavy drug consumption,
but the same issues apply to the language of ‘intoxication’. When we call something
intoxication, that is, we must decide what it means and recognise that particular uses of
the label have particular political efects. In this chapter, we draw on Keane, Bancroft
and Hunt and Frank to consider where a more expansive defnition of intoxication
might take us.
2 The ontological politics of data generation
Fraser also notes the ways in which specifc approaches to collecting data in research
shape the realities it materialises. As she observes, convenience recruitment has histor-
ically dominated drugs research, thereby foregrounding the experiences and circum-
stances of the most marginalised and disadvantaged. In turn, this approach materialises
a reality of drug use as fundamentally about marginalisation, vulnerability and depri-
vation. By taking a diferent approach to recruitment, our projects reached participants
rarely included in research, illuminating the nuances of intoxication and its relationship
to apparently anomalous facilities such as titration, reason and balance.
3 The liabilities and limits of representation
Also important for our analysis is Fraser’s third point, which relates to the role of
‘representation’. The data we use in this chapter are not to be treated as a simple win-
dow onto true events. In attending to the accounts of drug efects (such as overdose or
euphoria and so on) evident in the interviews we analyse, it is necessary to recognise
the discursive constitution of these experiences and terms, and equally, to try to notice
relevant dynamics and efects that might be obscured or erased by the discursive con-
ventions of intoxication.
4 The contingency of units of study
As Fraser notes in her outline of ontopolitically-oriented research, the unit of study
on which we base any analysis warrants scrutiny as a choice. Our analysis sees intox-
ication as a collective efect of a network or dispositif, and therefore as unstable and
emergent. Seen this way, intoxication cannot be taken for granted as an efect of certain
patterns of drug consumption, or of the ‘behaviour’ of individuals and their individual
‘agency’, nor assumed to be absent from other such patterns. This approach necessarily
shifts focus from the individual as origin and embodiment of action to the network or
dispositif, and therefore to dispersed and various actions and contributing agencies.
5 Researching partial worlds
In Fraser’s approach, and in our mobilisation of it here, there are only partial, con-
tingent worlds, only unstable emergent subjects and objects whose perspectives and
priorities cannot be taken for granted. This chapter forms part of a body of work, in
other words, that seeks to illuminate a partial world of intoxication, raising questions as
it does so about which partial worlds we wish to materialise.

347
 Suzanne Fraser et al.

Methods
This chapter draws on two Australian qualitative research projects: (1) an investigation into
the meanings and experiences of take-home naloxone for opioid consumers and health pro-
fessionals, and (2) an exploration of PIED injecting among men, with a particular emphasis
on hepatitis C transmission.1 The methodological design of both projects was informed by
the ontopolitically-oriented research approach described above. Both projects were framed
by new materialist theory, which emphasises the mutually constitutive relationship between
knowledge practices, material objects, subjectivity and social relations. In what follows, we
briefy describe some of the ontopolitical considerations that informed our research, the
projects’ methods and their implementation.
Commenced in 2017, the frst project on impediments to scaling up take-home nalox-
one provision aimed to look beyond questions of whether take-home naloxone ‘worked’ by
drawing attention to the social and political dimensions of naloxone (Farrugia, Fraser and
Dwyer, 2017). The project used a purposive recruitment strategy to reach a wide variety of
participants with diferent experiences with take-home naloxone, as well as diferences in
gender, age, ethnicity, socioeconomic background and types of opioid consumed. As such, a
recruitment fyer with intentionally broad language (‘Would you like to share your views on
opioid overdose and naloxone?’) was circulated through drug health services, drug consumer
organisations, chronic pain peak bodies and support groups, and generalist social media. Using
this approach, we recruited 28 people who consume illicit drugs and 18 who consume pre-
scribed opioids for health issues such as chronic pain (most of the latter were not engaged in
alcohol and other drug services and had hitherto rarely been included or addressed in research
on take-home naloxone). In this way, the recruitment method contributed to an ontopolitical
intervention that broadened understandings of the problem of overdose, and therefore the
subjects of take-home naloxone, beyond people who inject drugs. The project team con-
ducted in-depth, semi-structured interviews exploring experiences of opioid consumption
and overdose; awareness of, and experiences with, take-home naloxone; access to take-home
naloxone; experiences with, and perspectives on, overdose response and take-home naloxone
training; and preferred modes of administering take-home naloxone. This approach elicited
detailed accounts of opioid consumption, overdose events, stigma and take-home naloxone
administration. Importantly, the concept of ‘overdose’ was broadened too. Usually positioned
as a pharmacological phenomenon caused by drug consumption, our interview schedule and
data analysis took a social approach to drug efects. In this way, we were able to draw out how
media representations of overdose deaths, stigma and material inequalities shaped the politics
of overdose and take-home naloxone responses (Fraser, Farrugia and Dwyer 2017; Farrugia,
Fraser and Dwyer, 2017; Fomiatti et al. 2022). The generation of such rich detail is uncommon
in research on take-home naloxone, as it is ordinarily focused on straightforwardly conceived
questions of efectiveness and utility. Our interests in the social dimensions and capacities of
take-home naloxone, and in re-imagining the enhancement of take-home naloxone uptake,
were integral to data collection and the generation of the dataset.
The project on PIED consumption and hepatitis C transmission was funded at the same
time as the take-home naloxone project, and adopted a similar ontopolitically-oriented qual-
itative approach. When the research team began developing research tools, such as the inter-
view schedule, we actively sought to elaborate diference, variation and complexity within
the phenomenon of PIED injecting, trying to avoid simplistic generalisations and binary
comparisons with psychoactive drug injecting. With this in mind, we avoided importing
taken-for-granted concepts from research into psychoactive drug consumption and eating

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 Passion, reason and the politics of intoxication

disorders (see Fraser’s (2020) remarks on the methodological performativity of ‘naming’),

such as dependence, addiction, body image concerns and body dysmorphia. Instead, we
asked open-ended question about recent experiences and social settings of injecting, the
feelings and concerns associated with injecting PIEDs, perceptions of hepatitis C, and em-
bodiment and physical training practices, to generate accounts rich in detail and diversity
and to illuminate novel matters of concern.
Connected with these issues of language, power and knowledge, the research team paid
close attention to the ontopolitics of participant recruitment. As with the previous project,
this project aimed to generate a wide range of experiences on the basis of location, age,
ethnicity, occupational background and socioeconomic status. This meant recruiting partic-
ipants (n = 60) from varied sources, including harm reduction services, primary health ser-
vices, sexual health services, bars and clubs, supplement stores and sex-on-premises venues,
as well as various social media platforms, such as Facebook, Twitter, Gumtree, Craig’s List
and Scruf, steroid and bodybuilding online forums, and Men’s Health magazine. By working
hard to recruit consumers from sites other than needle and syringe programmes, we were
able to recruit men with a wide range of perspectives and experiences, some of whom were
not readily visible in conventional research approaches.
In these ways, and in others we do not have the space to address here, these projects ac-
tively sought to suspend the pathologising narratives that render the complex phenomena of
opioid and PIED consumption in singular and narrow ways, for example, as issues of addic-
tion and disorder. In analysing the data from these two projects together for the frst time,
we aimed to allow new insights to emerge.

Analysis
Our analysis begins by exploring data collected for our project on overdose and the use of
take-home naloxone. It examines the experiences recounted in the interviews to consider
the role of intoxication in making sense of these experiences, and to ask which aspects of
these experiences could be reconsidered in light of the politics of intoxication noted at the
outset. The analysis then examines intoxication in a very diferent context, PIED consump-
tion, one in which the efects of drugs are generally considered less pronounced than those
relating to opioids and overdose, but may also be considered intoxication depending on
our purposes. In both cases, we fnd a range of intoxication experiences, including familiar
changes in bodily sensations, mood and consciousness, often in ways that indicate their indi-
visibility, as well as less familiar instances and sources of intoxication.

Overdose, revival and intoxication

Opioid overdose and the use of naloxone to prevent death would seem to map neatly onto
both intoxication and its putative opposite: the rational application of a life-saving drug. Yet,
as we will see below, it is possible to identify the ways in which the pursuit and experience
of intoxication are not so readily dismissible as excessive, chaotic and intemperate, as the
efect of questionable individual agency or behaviour. Equally, the use of naloxone is not so
simply understood as the erasure of intoxication and the imposition of order and coherence.
We begin with Valentina’s account of opioid overdose. As she explains:

R: We went just of to school one day, scored, had a shot in my car and we both passed out.
She [Valentina’s friend] woke up frst and I was still out, and so she moved me over, got

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into the driver’s seat and drove me to hospital, and I got a Narcan [naloxone] and I just
came to.
I: Okay, so yeah.
R: Yeah, and then that was pretty good of her, pretty impressive of her.
I: Yeah, yeah, to get it together to get someone to hospital.
R: Yeah, totally ruined her buzz, I’m sure.

In Valentina’s account of overdose, the story begins with a familiar series of events: drugs are
bought illicitly, injected in a relatively isolated location, and overdose occurs, leading to un-
consciousness. Here, intoxication is this loss of consciousness: the absence of conscious thought
and rational action. However, immediately following these events, we are told, a series of other
events occurs. Valentina’s companion wakes up, identifes Valentina’s overdose risk, moves
her in the vehicle and then drives the vehicle to hospital. While this course of action could no
doubt be criticised in that it may have involved driving while under the infuence of a drug
(the timeframe for the events is not available in the account, and it is worth noting that the
events described occurred before the popularisation of mobile phones), it is also a strikingly
organised and decisive one. Not only does Valentina’s account present a (young) companion
possibly saving her life, the companion seems to show a signifcant amount of competence and
resourcefulness. In this account, we see intoxication not as the opposite of sense, order, co-
herence and agency, but adjacent it, aforded by other elements such as the action of stigma in
shaping injecting location, and the availability of a car for transportation purposes. We are also
able to identify in the overdose dispositif a key element often ignored in overdose accounts and
ofcial responses: the legal status of drugs and the role of prohibition in governing the location
of consumption and constraining knowledge of dose.
While Valentina and her companion did not have access to naloxone while injecting, the
medication emerges in other accounts of overdose and revival. Jamie describes, for example,
an experience in which she was injected with naloxone by a close friend, and the adminis-
tration resulted in a less intense opioid experience but one that would nevertheless qualify
as intoxication:

I: I wanted to ask you a bit about the efects of the naloxone: what it felt like after it had been
administered and how long the efects lasted.
R: It was good, I still felt a bit smashed but yeah.
[…]
I: So physically it didn’t feel too bad, but you still felt a bit …
R: Yeah, I still felt a bit stoned.
I: Which maybe is good, I guess.
R: Yeah it is, because you don’t want to completely miss out.

While this account is rather less dramatic than that ofered by Valentina, it nevertheless
includes similar elements not usually associated with intoxication: moderation and sense.
For Jamie, the naloxone was ‘good’ because it was efective, possibly saving her life, but was
also not so intense as to eradicate the experience of intoxication altogether, perhaps due to
thoughtful and cautious administration. In both Valentina and Jamie’s accounts, Keane’s call
to depathologise intoxication resonates clearly, reminding us that it can coexist with, rather
than simply contradict, reason, control, agency and sense.
Ghassan’s account of intoxication and naloxone administration is signifcantly diferent
from Jamie’s. Instead of a relatively benign experience in which a degree of intoxication is

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preserved, Ghassan experiences a signifcant wrench on revival, including cold shakes, diar-
rhoea and vomiting. It was, he says, ‘ugly’:

R: So I was locked up [in gaol] for a period of time and then I got out and I never knew about
tolerance levels and stuf. So I went out and used the exact same amount that I was using
prior to being locked up and I was at a friend’s place luckily, and his sister was there and
she was an addict too, yeah, so I’ve had it [naloxone], and then the next thing I know,
I’m waking up in […] hospital throwing up all over, like the instant withdrawal and all
that kind of stuf. Just didn’t know how I got there. That was the frst time.
[…]
I: Yeah, and how did you like, I guess, what view of Narcan did it give you sort of, having
that experience?
R: It was ugly. It was the feeling, but it saved my life at the same time, so like I’m not the
type to start jumping up and going, ‘Oh yeah’. No, they did save my life [but] I didn’t
like it, it didn’t feel good because of the instant, you know, like the vomiting and the
cold shakes and the diarrhoea and all that kind of stuf.

Here, Ghassan wakes up in a hospital – a relatively controlled environment – yet, it seems

that the naloxone had been administered in such a way as to induce serious negative physical
efects. The impact of naloxone, and the thought and agency entailed in it, difer markedly
here from descriptions in the previous examples. Rather than imposing order and coher-
ence, the naloxone in Ghassan’s account substitutes one kind of intoxication with another.
Conventionally, experiences of this kind have been framed as examples of ‘over-antagonism’
in which too much naloxone is administered, leading to acute withdrawal symptoms or
‘opioid withdrawal syndrome’ (see, for example, Kim and Nelson, 2015; Neale and Strang,
2015; for a discussion of infuence on post-revival actions, see Elliot, Bennett and Wolfson-
Stof ko, 2019). Importantly, the notion of over-antagonism suggests that there is a specifc
dose of naloxone that returns the recipient to ‘normality’. This point goes to our inter-
est in defnitions of intoxication and their political valencies: while the symptoms induced
by high doses of naloxone are rarely if ever labelled intoxication (given the implications
of excess, impulsiveness and disorder the term implies), it is difcult to avoid the conclu-
sion that the biomedically induced sensations Ghassan describes are indeed ones of (highly
unpleasurable – and avoidable) intoxication. The volume of naloxone used in producing
such efects might, further, be considered excessive and even intemperate. Interestingly,
the concept of over-antagonism medicalises the efects of naloxone, apparently precluding
the designation of intoxication, an efect primarily attributed to non-medically sanctioned
drug consumption. At the same time, as Ghassan woke, he says, he recognised the logic in
the use of naloxone, and despite new and unpleasant symptoms of intoxication, responded
in a reasoned way. Looked at closely, then, an account like Ghassan’s does much to disrupt
standard understandings of intoxication, which tend to foreground poor consumer choices
and conduct and the polarisation of intoxication and reason.
Other work conducted by the authors of this chapter also bears on the issues raised here.
In an article stemming from the same project, we analysed the role of take-home naloxone
in a caring relationship between a couple, Gabrielle (whom we interviewed) and Jeremy (her
partner) (Farrugia et al., 2019). As we described, Gabrielle explains that Jeremy is terminally
ill with cancer, and the intoxicating efects of his heroin consumption and risk of overdose
are especially acute. Importantly, Jeremy continues to enjoy heroin consumption and Gabri-
elle actively supports this practice. Unlike her use of naloxone in other contexts, she does not

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use it to revive Jeremy from overdose. By agreement with Jeremy, Gabrielle monitors him
and administers only small amounts of naloxone when she feels he is close to overdosing or
appears to be ‘forgetting to breathe’. This is because she wants to ‘take the edge of’ rather
than counter his intoxication altogether. In this way, Gabrielle uses naloxone to help Jeremy
maintain a pleasurable and safe experience of intoxication. Importantly for this chapter, this
account also disrupts assumptions that reason and intoxication are contradictory. Such as-
sumptions constitute two states: overdose (intoxicated) and revival (unintoxicated). Instead,
Gabrielle describes modulating intoxication in ways that allow for the considered mediation
of intoxicating and analgesic efects (Farrugia et al., 2019, pp. 435–436).
In summary, the project from which these accounts have been drawn identifed many
complexities that disrupt common assumptions about intoxication, how it happens, what
it means and who is culpable. In the next section, we consider another research project in
which the results also invite us to rethink received wisdom about intoxication.

PIEDs and intoxication

In this project, the role ascribable to intoxication difers signifcantly from that in the opioid
overdose project described above. Here, we again turn to Keane’s observations about the
importance of including less intense efects in defnitions of intoxication and unfamiliar
substances (hers is nicotine) to allow us to see it at work in our participants’ accounts. As we
will show, the efects of PIED consumption are rarely as extreme as those described above,
and are, to our knowledge, never described as intoxication in the literature, yet they nev-
ertheless constitute important changes in bodily sensations, mood and perception, and in
relations with the self. They are both positive and negative, and, as in the material presented
above, can be seen to trouble the standard binaries usually applied to intoxication discourse:
impulse and reason, risky illicit consumption and safe, biomedical moderation. Indeed, as
has been noted elsewhere (Fraser, Fomiatti, Moore, Seear and Aitken, 2020), the PIED use
in the project discussed here raises particularly stark issues for the conventional binary drawn
between biomedical reason and illicit irrationality in that health professionals, especially
doctors, are commonly described by participants as responding in unhelpful ways, lacking
knowledge and giving inaccurate advice.
In many of the interviews we conducted, the efects of PIEDs, especially steroids, were
often described in ways that linked them to anger and aggression. As Reece, for example,
explains:

When I’m on [PIEDs], like, I can be sitting there, like even now I feel like my chest is
tight because I’m just … I’ve got high test[osterone]. But I can just be sitting there and
I’ll just get angry for no reason. Like, the smallest thing will set me of and the next
person who says something – I could hit someone, and then you kind of can’t control
it, I just click, and then after you look at yourself and say, like, ‘You’re an idiot’, like,
‘Why’d you do that’?

Explaining his experience further, Reece goes on to give an example:

We [were] in class, because I’m doing training, [and] a guy said something [while] I was,
like, trying to listen to the teacher, and he kept talking, and then I turned around and I
swore at him. And I was like ‘Just shut the you know up, I am trying to listen’ you know
[…] But he had only been interrupting the teacher once or twice in that instance, and I

352
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just clicked. Everyone was like ‘Ooohh, a bit angry’ and everyone is staring at you and
then you start shaking and stuff.

In his interview, Tibor also described important changes in perception and in relations with
the self in the form of increased sensations of rising anger and impulsiveness. Importantly,
however, he also talked about positive experiences that we might consider as forms of mild
intoxication related to his PIED consumption:

I: And were there any other feelings or effects aside from anger that came up?
R: I was way more confident.
I: Can you give me an example?
R: Just in general, so like every day when I stand in front of the mirror I looked better and
every day I felt better and this gave [me] a very good feeling, that if you are not using
steroids you’re not going to have, because you are not going to see any change even if
you train for like two month[s]. And in this two months’ time, I achieved way more
and better things than what I did any time before, and my strength was like way better,
so I had much more power, I could lift much more weights, I was getting bigger much
faster, so it was like, yeah … so this is why I was more confident and I felt good from it.

In Tibor’s account, the consumption of a substance or group of substances elicits new and
different emotions, creating a new relation with the self, even if temporarily. Tibor combines
labour, planning and discipline with drugs to create ‘a very good feeling’.
Henry’s comments about the changes in emotions and in relations with the self connected
with PIED consumption echo Tibor’s, except that in the intensity he describes they are more
akin to conventional formulations of intoxication. When asked about whether consuming
PIEDs affected his emotions, he says:

R: Yeah, absolutely. The intensity and the rate at which emotion can rise, or the frequency
within which you are in a high emotion, increases sometimes, and part of that’s desirable
because really it helps you getting into [a gym] workout, you know. Sometimes you hit
it and sometimes you don’t without gear [PIEDs], but with the right stuff, it’s like you’ve
got your finger on the fucking switch.
I: So that feeling of being emotionally heightened…
R: Energised, engaged.
I: That can help you push your training session. What else?
R: Just intensity, that intensity, and the ability to access that intensity.

Henry’s words communicate a particular kind of intoxication here: there is a ‘switch’ at hand
that may be flipped – usually in the presence of PIEDs but also occasionally without. What
happens in this moment? He experiences significant emotional changes and related physical
effects such that his relation with himself becomes characterised by energy, engagement and
the ability to ‘access’ ‘intensity’.
Like Henry, Ryan refers to heightened physical and emotional sensations, returning to
issues of aggression and edginess:

[PIEDs] were augmenting my levels of testosterone and giving me more testosterone, so

therefore it’s just making me more…it’s taking me away from, I guess in my language,
it’s taking me away from the present moment and from being myself and like pushing

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me into somewhere else, like into the future. You know, you’re more aggressive, you’re
more edgy, you’re more, I don’t know, you’re more vigilant about stuf, like all those
diferent things, it’s like you become more of a soldier than a peaceful human being, so
to speak, you know.

Here, Ryan describes an extremely signifcant change in perspective from ‘peaceful human
being’ to ‘soldier’. In his account, the extra testosterone in his system is associated with
changes in his relation with himself: it takes him away from the present moment and from
‘being myself ’, pushing him ‘into the future’. Ryan’s highly vivid account of intoxication
in his subjective experience of PIED consumption is striking. This group of substances and
context are rarely if ever associated with intoxication, yet these remarks indicate that for
some (including others quoted above as well), intoxication is undoubtedly involved.2
Alongside these accounts of anger, edginess and aggression are many of excitement and
euphoria, where the efects of PIED consumption are rendered in far more positive terms.
For Grant, Nathan and Alex, for example, life on PIEDs (steroids or human growth hor-
mone) creates an enormous positive change in subjective experience of confdence, strength
and power:

So there would be … your muscles look fuller, you look bigger. It’s more of a … what’s
the best way to put it, you feel supernatural basically. […] Like you can basically conquer
the world.
(Grant)

You know, you feel amazing, you feel confdent, you feel like you can take on the world.
You feel like nothing can hurt you, you know.
(Nathan)

And just a phenomenal feeling in the body, like I just felt unstoppable, and I was training
twice a day. I just felt really good because in general I sufer from pretty major anxiety
and when I was on that stuf, I had no anxiety, no fear at all.
(Alex)

In all these descriptions, very vividly articulated experiences of intoxication emerge.

Some participants could be described as intoxicated with their own growing powers
of confdence, discipline, strength and agency. They are supernatural, unstoppable and
invulnerable. Others are intoxicated with aggression, anger and vigilance. Efects are
strikingly aligned with widely promulgated clichés of masculine agency and efcacy, in-
dicating the ways in which, as past researchers have argued, these efects are socially and
culturally constituted (Fomiatti et al., 2019). Importantly, these accounts also remind
us of the ways in which intoxication, historically aligned with alcohol and with loss of
consciousness, or at best compromised consciousness, may also be linked to heightened
consciousness and awareness of changes in relations with the self. Of course, the eu-
phoria conventionally associated with stimulant consumption could also be described
in these terms, yet a signifcant diference remains in the accounts we have examined
above. Here, intoxication, confdence and euphoria align with self-discipline, labour and
self-improvement. Elsewhere, we have argued that PIED consumers indicate a strong
desire to have informed, reasoned interactions with health professionals about their con-
sumption and about ways of managing risks and avoiding ill-efects (Fraser et al., 2020).

354
 Passion, reason and the politics of intoxication

In these ways too, we can see the alignment of some kinds of intoxication, experienced
in certain conditions and induced through particular practices, with their putative op-
posites: rationality, moderation, control and productivity.

Conclusion
The two research projects analysed in this chapter ofer a great deal for new understand-
ings of intoxication, especially when considered together. As explained at the outset, our
analysis was informed by Keane’s (2020) expanded defnition of intoxication – as a ‘shift
in one’s relationship to the world, with no fxed meaning or inevitable consequences,
either negative or positive’ – and by Fraser’s ontopolitically-oriented research approach.
This work allowed us to recognise experiences of intoxication that would otherwise be
neglected in research and public discourse. The accounts of opioid overdose and revival
with naloxone showed how intoxication may coexist with, rather than simply contradict,
reason, control, agency and sense; and conversely, that actions to restore sobriety may
themselves induce or align with notions of intoxication. The accounts of the heightened
emotion and changed relations with the self associated with PIED use highlighted the
alignment of some kinds of intoxication with their putative neo-liberal opposites: ratio-
nality, moderation, control and productivity.
Taken together, the case studies demonstrate that common assumptions about intoxi-
cation, how it happens, what it means and who is culpable are thoroughly political. When
conceived conventionally, intoxication sets up unhelpful binaries between reason and emo-
tion, sense and irrationality, legitimacy and illegitimacy, chaos and order. As our analysis
suggests, these distinctions do not hold up to scrutiny. Illicit drug consumers, possibly while
still intoxicated themselves, can and do act decisively and save lives. The administration of
naloxone can itself cause negative intoxication experiences, even in hospitals (Neale and
Strang, 2015). In short, illicit drugs are as legible through notions of moderation as through
notions of excess, and naloxone is as legible through excess as moderation. PIED consumers
can feel angry or phenomenal, use legal and illegal drugs to do so, and incorporate labour,
discipline, knowledge and care into their consumption (disrupting the conventional polari-
sation of drug use and productivity and discipline).
This chapter and the projects on which it is based have attended carefully to language and
naming, collected stories from a wide range of participants, noticed relevant experiences,
dynamics and efects that might be obscured or erased by the discursive conventions of ‘in-
toxication’, and shifted the unit of analysis so bodies, corporeal changes and other material
phenomena are understood to emerge from complex processes. It has done so as an exercise
in ontopolitically-oriented research, one that allows us to begin to identify other partial
worlds that disrupt conventions about intoxication, moderation, reason and the self. Con-
trary to widely held assumptions, drug consumers work hard to calibrate intoxication care-
fully for a variety of reasons. Responses that ignore or dismiss such work (perhaps because of
lingering neo-liberal suspicions about intoxication) are likely to impede attempts to support
health and well-being, or miss opportunities to do so. Furthermore, following Keane, if we
understand intoxication as a practice or relationship with the self, rather than as a state, we
also need to recognise that it cannot be eradicated with simplistic measures, such as policies
that ignore the contexts of overdose in which risky intoxication is often an efect of legal
conditions that render drug strength opaque and dosage unmanageable (see also Fomiatti
et al., 2020), or medical responses that ofer PIED consumers inaccurate or unhelpful infor-
mation (Fraser et al., 2020). Future research and responses need to acknowledge the many

355
 Suzanne Fraser et al.

ways and degrees of being ‘beside oneself ’ (Gomart and Hennion, 1999), the potential for
measures considered antithetical to intoxication to overlap with it, as well as the productive
relationship with the self sometimes aforded by intoxication.

Notes
1 Full details of the methods used in these studies – including analytical approach, coding and
transcription processes, deidentifcation procedures and ethics approval – are available in other
publications (for the take-home naloxone study, see Farrugia et al. (2020); for the PIED study, see
Fomiatti et al. (2020)).
2 Also of note is the direct association Ryan draws between testosterone and clichés of male ag-
gression. In a 2019 article (Fomiatti et al., 2019) also written from this project, this linking of
masculinity and testosterone is examined, pointing to ways in which context and discourse shape
subjective experiences of drug use and intoxication.

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 PART VI

Scapegoated Substances
 22
ALCOHOL, SLAVERY AND RACE
IN BRAZIL DURING THE LONG
NINETEENTH CENTURY
Lucas Brunozi Avelar and Deborah Toner

In the 1830s, shortly after achieving independence as a nation, Brazilian authorities launched
a series of measures to tackle drunkenness, which they considered to be a major social prob-
lem. In this chapter, we examine how and why drunkenness emerged as a signifcant concern
for the Brazilian state in the frst half of the nineteenth century, focusing on the longer-term
process of racializing drinking behaviors from colonial Brazil to the twentieth century.
We argue that the stigmatization of certain types of drinks, drinking places and drinking
practices has been a central component of the history of racial discrimination in Brazil. In
the early nineteenth century, the expansion of the slave trade led to increasingly restrictive
and violent measures to control the enslaved population. For the enslaved themselves, alco-
hol was integrated into their culture and consumed for a variety of reasons, including as a
means of resisting slavery. For slave owners, alcohol had been used as a form of currency and
to increase labor productivity, but its use was also considered a threat to their control. The
escalation in anti-drunkenness legislation in the early nineteenth century contributed to po-
litical and social eforts to justify and prolong the slave system as well as to build the Brazilian
state. When slavery was abolished in 1888 and a republic established in 1889, the political
and economic elite put forward new plans to change drinking practices that continued to
racialize drinking behaviors but in diferent ways. Distilled spirits were described as causing
alcoholism and racial degeneration, while beer was promoted as part of eforts to modernize,
de-Africanize and ultimately “whiten” Brazil as it moved into the twentieth century.

Alcohol in Colonial Brazil

Alcohol was central to the development of colonial Brazil and particularly its system of
slavery. Cachaça (Brazilian rum), as a major by-product of the sugar plantations that fueled
the Portuguese trans-Atlantic slave trade in the late sixteenth and seventeenth centuries,
helped to expand the colonial economy. Belief in the dietary and medicinal benefts of
alcohol consumption was widespread, although colonial ofcials were concerned about its
potential role in causing social disorder and unrest, especially among the growing enslaved
population, during the eighteenth century. The gold mining and cofee industries continued
to stimulate Brazil’s importation of African slaves in the run-up to and aftermath of its inde-
pendence from Portugal in 1822, and the drinking habits of enslaved people became subject

DOI: 10.4324/9780429058141-29 361

 Lucas Brunozi Avelar and Deborah Toner

to increasing scrutiny and coercive control. While racialized justifcations for such discrim-
inatory controls were made more explicit during the nineteenth century, their origins lay
in the interplay of colonial directives to maximize proft while controlling the people who
produced it.
The large-scale production and export of sugar formed the bedrock of the early colonial
economy in Brazil, with agricultural plantations concentrated in the northeastern coastal
Captaincies of Bahia and Pernambuco. Captaincies were the main administrative units of
the Portuguese colonial system in Brazil, initially led by private individuals with the means
to establish colonies, and later taken under Crown control. Most plantation labor was con-
ducted by Indigenous slaves until the late sixteenth century, when the Portuguese expanded
the trans-Atlantic slave trade. As many as 15,000 enslaved Africans were transported to work
in Brazil’s sugar, tobacco and other plantations every year by 1600 (Bakewell 1997: 310).
After a series of gold mine discoveries in the southeastern region around São Paulo – today
Brazil’s most populous city – the Portuguese Crown established a new administrative unit of
São Paulo and Minas do Ouro (Gold Mines) in 1709, before dividing this in 1720 to give the
gold mines region its own administrative status as Minas Gerais (General Mines). Later in the
eighteenth century, gold deposits were discovered in the interior Brazilian regions of Goiás
and Mato Grosso. The distribution of Brazil’s population into southern and interior regions
that the mining industry spurred was further solidifed in the frst half of the nineteenth
century, with the rise of cofee plantations and cattle ranching. Throughout this time, the
transportation of enslaved Africans to Brazil expanded enormously: of the approximately 5.8
million slaves that were transported to Brazil from 1501 to 1878, roughly 2.4 million arrived
between 1800 and 1850 (SlaveVoyages 2019a) (Figure 22.1).
Historically, cachaça was a distilled spirit made from either fermented sugarcane juice or
molasses (a by-product from the process of refning sugar), and was the main drug traded and
consumed in colonial Brazil (Mintz 1985). In his study of alcohol and slavery in Brazil, José
Curto described the period from 1700 to 1830 as the “século da geribita” – the “century of
geribita”, another historical term for cachaça (2002: 151–199). It was produced by slave labor
on sugar plantations and used as a currency in the American inland and by slave traders at the
African shore, so that this form of alcohol spread on both sides of the Atlantic. Tobacco pro-
duced in the northeastern Brazilian plantations of Bahia and Pernambuco was also included
in the slave trade. Together, cachaça and tobacco were used to pay for 48% of the slaves who
were brought to Brazil between 1701 and 1810 (Alencastro 2000: 324). Cachaça and tobacco
to Africa, enslaved Africans to Brazil, sugar to Europe: the colonial economy depended on
these drugs (Azevedo Fernandes 2014; Carneiro 2021).
The historical lexicon of Brazilian cachaça shows how deeply intertwined with slavery
this commodity was. Between the seventeenth and nineteenth centuries, the most com-
monly used names for sugarcane spirit in Brazil were malungo, cachaça and geribita, as well
as aguardente de cana. Malungo, as well as describing the drink, was used to name central
aspects of the experience of bondage. Malungo (sometimes spelled mulunga or malongo)
was the name given to the iron chains in which Africans were bound, and the name for the
relationship formed between slaves who crossed the Atlantic Ocean in the same slave ship, or
who belonged to the same slave owner or plantation (Alencastro 2000: 313–314). Cachaça,
geribita and aguardente de cana were less symbolically loaded terms, referring to diferences
in production of the spirit. Cachaça meant “honey spirit, or molasses dregs”, describing the
thick scum that comes out from the frst boiling of the sugarcane juice (Moraes Silva & Blu-
teau 1789: 315; Pinto 1832: 178), whereas gerebita meant “sugarcane made from sugar dregs”
(Moraes Silva & Bluteau 1789: 896; Pinto 1832: 555). Aguardente (literally, burning water)

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Figure 22.1 Carte du Brésil

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was a generic Portuguese word for distilled spirits, and meant distilled “from sugarcane”
when “de cana” was added. While the denomination of origin legislation that applies to
cachaça today distinguishes it from rum – cachaça can only be made from fermented sug-
arcane juice, whereas rum can also be made from molasses, or a combination or both – this
distinction was not observed historically (Azevedo Fernandes 2014: 46–47).
Across the colonial period, cachaça had important social roles and in many respects was
understood to provide the same kinds of benefts as other “drugs”. According to Antônio de
Moraes da Silva’s dictionary of 1813, the term drug (droga in Portuguese) had an expansive
defnition, encompassing all “exotic resources, luxury products destined to consumption,
to medical use, and also as food supplies” (642). The defnition included, therefore, an in-
fnity of plants, vegetables, dyes, oils, roots, wool and/or silk goods. Consumption of these
“drugs”, none more so than cachaça, marked special occasions in enslaved people’s lives, like
parties and weddings, but also more routine daily activities. In the sugarcane mill, on hot
summer days, the cachaça, served by the plantation owner, was mixed with water, sugar and
lemon or orange. This mixture was the foundation of what we know today as “caipirinha”,
a famous Brazilian cocktail. Among Bahia’s African people, cachaça was also exchanged for
beans and potatoes. In the northern interior state of Pará, Indigenous laborers who worked
on ginger plantations received payment in cocoa, which was the current currency in Am-
azonia. Mixed with tobacco and urine, it was used against fevers. It was also used to wash
smallpox pustules, and along with fowers, leaves, resins and seeds, cachaça served for magi-
cal, medical, religious and empirical purposes (Priore 2005: 67).
However, alcohol was simultaneously considered problematic for both economic and so-
cial reasons. In the middle of the seventeenth century, the Portuguese Crown issued laws
forbidding the production and sale of cachaça. The goal was to avoid economic competition
with Portuguese wine in the Atlantic trade. But because an illegal market soon developed
and cachaça production became more crucial to the proftability of sugar plantations in the
face of increased competition from Caribbean sugar producers, the law was overturned in
1695, so that the colonial authorities could retrieve tax income from the legalized trade (Aze-
vedo Fernandes 2014: 49–52; Ricardo 2014).
Colonial approaches to regulating alcohol were also shaped by social concerns about the
drinking behaviors of Indigenous and Black people, both enslaved and free. As in other parts
of colonial Latin America and North America, missionaries and colonial ofcials in Brazil
frequently wrote in alarmed tones about Indigenous consumption of distilled spirits. Despite
the trade and exchange of alcohol often being vital to the establishment and maintenance of
Indigenous-colonial relationships, Indigenous practices of ritual intoxication and drunken-
ness were regarded with fear, suspicion, misunderstanding and even disgust, and became part
of wider set of categories employed in colonial discourse to construct Indigenous people as
“other” to the European colonizers. The so-called “drunken Indian” stereotype which de-
veloped in diferent ways across the Americas became an “essential element in the formation
of this colonial narrative” of Indigenous inferiority and barbarism (Azevedo Fernandes 2014:
58; see also Mancall 1995; Quintero 2001; Earle 2008; Earle 2014; Córdova 2015).
More than elsewhere, likely due to Brazil’s greater and longer-lasting use of the trans-At-
lantic slave trade, such racialized ideas about drinking behaviors were also extended to the
Black population during the colonial period. During the eighteenth century, the Portuguese
Crown vacillated between accepting or prohibiting alcohol use by the Black population. On
the one hand, there was a belief that cachaça stimulated enslaved Africans to work harder
both on agricultural plantations and in the mines. This was consistent with broader under-
standing of drugs as both medicine and food at the time. On the other hand, slave owners

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and colonial ofcials feared that the cachaça trade and consumption allowed enslaved Afri-
cans to conduct secret gatherings, and exchange goods and information which could lead
to social unrest or even rebellions. In the southeastern Captaincy of Minas Gerais, enslaved
people forced to work in the gold mines were caught and punished for hiding gold under
their fngernails in order to buy cachaça sold by “Negras de tabuleiro” (selling women).
Likewise, the Portuguese Crown was concerned about cachaça production and consump-
tion because they worried that it distracted enslaved people from their work and that the
drinking and drunkenness of enslaved people threatened the “public tranquility”. But in the
last decades of the eighteenth century, when gold mining declined, opinions about cachaça
changed to a more tolerant posture (Figueiredo & Venâncio 2005: 36–41).
Racial ideas underpinned some of these concerns. According to Jorge Benci, an Italian
Jesuit who lived in Brazil from 1683 to 1700 and developed a set of precepts to regulate
relations between slave owners and slaves, drunkenness was a sin to which Africans were
inclined because they were considered the “sons of Ham”. This refers to a biblical episode in-
volving drunkenness in which a curse of perpetual servitude was placed on one line of Ham’s
descendants, and some Christian thinkers used this “curse” to explain why Africans had dark
skin and to justify their enslavement, as well as depicting them as inclined to drunkenness.
Some slave owners agreed that enslaved Africans should be made to work even on Holy Days
because it was a way to prevent them from indulging in wine and dances or fghts (Benci
1977: 192–193). Benci considered Black people to be “more skillful for all kinds of evils” and
given over to impudence (Lotierzo 2011: 79).
Therefore, in the colonial period, both positive and negative ideas circulated about alco-
hol. On the one hand, alcohol was recognized as bringing medical, dietary and economic
benefts, including tax income and improved productivity. On the other hand, particularly
regarding the enslaved populations’ drinking, there were concerns about alcohol consump-
tion leading to social unrest and/or resistance. Some slaves did use alcohol in ways sus-
pected by slave owners, and there existed some punishments for slave drunkenness. But the
temporary prohibition against the production of cachaça was driven mainly by economic
concerns – protecting Portuguese-produced wines in trade – rather than social concerns.
Ultimately, the interests of the slave trade and slave economy were too strong to maintain
the prohibition of alcohol. However, in the wake of Brazilian independence in 1822, and
the establishment of an “imperial” constitution in 1824, alcohol and concerns about drunk-
enness became entangled in Brazilian elites’ attempts to square the contradictions inherent
in promoting liberal ideology in an expanding slave society. While liberalism was strongly
contested in nineteenth-century Brazil, as it was elsewhere in Latin America, it was very
infuential in shaping the political culture of Rio de Janeiro, the capital city of the Brazilian
Empire after independence from Portugal in 1822. Yet by the mid-nineteenth century, Rio
de Janeiro was also the city with the largest number of slaves in the world. The increasingly
explicit racialization of the problem of drunkenness, and the increasing concentration of
criminal punishments for public drunkenness on the bodies of enslaved people, was con-
nected to attempts to reconcile liberalism and slavery.

Alcohol and the Paradoxes of Liberalism in Post-Independence Brazil

The city of Rio de Janeiro underwent profound changes in the early nineteenth century,
which led to attacks on established drinking practices. Napoleon’s invasion of the Iberian
Peninsula in 1808 sparked political transformations across the Spanish and Portuguese em-
pires in the Americas. The Portuguese Court moved to Rio de Janeiro to escape Napoleon,

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stimulating growth of the urban population and deepening changes in the political culture of
the city. In 1822, Brazilian independence was achieved. The expanded white population of
the capital, infuenced by Enlightenment ideas, political ideologies of liberalism, seculariza-
tion and constitutionalism, sought to remake the city into an exemplar of a “civilized” soci-
ety, and its population into rational, moral citizens for the success of the new nation. At the
same time, the enslaved population of Brazil and of Rio de Janeiro expanded greatly. Among
the 2.4 million Africans estimated to have been transported to Brazil as slaves between 1801
and 1850, at least 880,447 are known to have disembarked at Rio de Janeiro (SlaveVoyages
2019b). Consequently, by 1849, Rio was the city with the highest number of enslaved people
in the modern world (Karasch 2000; Chalhoub 2012; Marquese & Salles 2016).
Liberalism meant free trade and political rights, but not for the enslaved and the ever-ex-
panding slave system. Land and property rights – including the right to own slaves – were pro-
tected to maximize the economic opportunities involved in ending the colonial monopoly on
trade with the Portuguese metropolis (Bosi 1992; Franco 1993; Parron 2009: 28–87; Marquese
& Parron 2011). These circumstances produced a clash of forces that led to new justifcations
for slavery based on ideas of African racial inferiority and to the criminalization of public
drunkenness, developments that were intertwined. Ideals of liberal citizenship within the new
constitutional monarchy promoted sobriety and social order for the whole population.
The Viscount of Cairu, José da Silva Lisboa (1756–1835), a Brazilian politician and eco-
nomic advisor to D. João, prince regent of Brazil from 1816 to 1822, published a moral man-
ual in 1824 that denounced intoxication as inimical to the proper behavior of responsible,
productive citizens in the new nation and empire. His Moral Constitution and Obligation of the
Citizens proclaimed that:

this law condemns drunkenness, as the most vile and pernicious vice. The drunkard,
depriving himself of the right use of the senses, and of the reason that God has given
him, desecrates the beneft of the Godhead; he is reduced to the condition of the brutes;
is unable to guide his steps; falls as an epileptic; his weakness makes him an object of
derision and contempt of all around him: if in this state he contracts, he ruins and loses
his business: being out of himself, he says injurious words, provokes enemies, and cause
regrets: he flls his home with disturbances and displeasures, and ends his life by an un-
timely death or a sickly old age.
(Lisboa 1824: 92)

For the Viscount, alcohol intoxication, a “pernicious vice”, would block appropriate so-
cial and economic behavior for a citizen of the Brazilian Empire: the drunkard disrespects
God, has mental and physical health problems – including self-destructive behaviors – he
is frowned upon and even socially ridiculed; he acts in a uneconomical way; breaks social
peace; compromises family life and dies early or ages poorly. Drunkenness was thus an ob-
stacle to fulflling the ideals of family, religion, work, social order and a healthy body. In the
liberal view, drunkenness was irrational, immoral, unhealthy, anti-social and unproductive:
anathema to good citizenship.
Since impoverished, non-white and enslaved sectors of the population were already con-
sidered less well-equipped for the responsibilities of liberal citizenship, their drinking be-
haviors became entangled in elite rationalizations that excluded them from the rights of
citizenship. In the case of enslaved and free Africans and Afro-Brazilians, their use and
perceived abuse of alcohol were increasingly understood in racialized terms, as something to
which they were innately inclined. Ernst Ebel, a German traveler visiting Rio de Janeiro in

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1824, registered in his diary that cachaça was a “harmful drink” consumed only by the poor
and especially the Black population. For the Black population, Ebel wrote that such was their
lack of self-control in the use of alcohol that such control would need to be strictly imposed:

With regard to the nature of the negro in general, opinion is one: it is useless to treat it
well. We must keep it under severe control: the men are too inclined to drink, to steal,
and to laziness; the women […] it is so difcult to moderate their instinct, that they
practice their acts with greater shamelessness
(Ebel 1972: 45)

The use of words such as “nature” and “instinct” to describe Black men as drunken, lazy
thieves and Black women as sexually uncontrollable suggests that these characteristics were
innate, contributing to the development of a racial stereotype. This discourse, recorded by
Ebel, was widespread, not only in the works of foreign observers but also among Brazilian
authors. According to this racist ideology, the lack of self-control possessed by Black people
meant that stricter regulations around alcohol were needed to control their behavior.
Consequently, while governing authorities identifed urban taverns – public drinking
places – as potential sites of popular dissent and unrest, the measures they applied to the
whole population during periods of socio-political crisis were retained to control enslaved
people for a much longer time. During the struggles for separation from Portugal in 1822, for
instance, the State Council proposed a series of measures for the country’s security, which in-
cluded controls on the operation of taverns and surveillance of tavern-goers’ activities. These
proposals sought to put spies in the taverns and gambling houses of Rio de Janeiro where
people “usually speak with more freedom” (Atas 1822: 87–93; see also Bretas and Rosemberg
2013). These general measures did not outlast the political crisis of the early 1820s; however,
legal proscriptions forbidding the “gathering of slaves” in drinking houses lasted throughout
the nineteenth century (Santana 2020: 13. See also Avelar 2021).
Similarly, punishments for violating the new 1830 law against public drunkenness were
more severe and violent for the enslaved. Article 60 of the 1830 Criminal Code, which re-
mained in efect until the end of the Imperial State in 1889, provided for torture to be used
against enslaved people who violated this and other laws:

If the defendant is a slave... he will be condemned in the case of lashes and after sufer-
ing them, will be delivered to his master, who will be obligated to bring him with an
iron for the time and the period established by the judge, the lashes will be fxed in the
sentence, and the slave shall not receive more than ffty lashes per day
(Alencastro 2007: np)

In addition to whipping, slave owners were entitled to punish enslaved people for drunken-
ness by imposing physical restraints such as the tinplate mask (see Figure 22.2). Imprisonment
was another common punishment for the crime of public drunkenness. Rio de Janeiro’s mu-
nicipal government published the Posture Code in 1830, laws designed to “modernize” daily
life in the capital city and to restrain cultural practices deemed “backward”. This included
provision for Justices of the Peace to temporarily confne “all those who are found on the
street in a state of drunkenness” to protect them from being injured or killed in accidents
such as being run over or stepped on by horses. The law applied to all residents of the city,
but was overwhelmingly used against Africans, both enslaved and free. The Posture Code
also introduced regulations for street cleanliness, dress and behavioral comportment, and the

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Figure 22.2 HARRO-HARING, Paul. Scene at a tavern: sailors trade with black women. Tropical
sketches of Brazil, 1840. Available in: Paul Harro-Harring - Instituto Moreira Salles (ims.com.br)

operation of commercial establishments, including taverns, that amounted to a crackdown,

even criminalization, of African culture. The 1830 Code was the frst to prohibit the sale
and use of the “pito do pango” (marijuana joints, also known as maconha), the consumption
of which was particularly associated with the enslaved and free Black population. Paragraph
7º of Title 2 in the 1830 Code provided that

the sale and use of the pango pito is prohibited, as well as the conservation of it in public
houses. The ofenders will be fned, namely: the seller in 20$000, and the slaves and
more people, who use it, in three days in jail.
(Código de Posturas 1830, Title 2, § 7º)

Gatherings of the enslaved to drink, sing and dance were also defned as obstructions to
public space that promoted disorders (Santana 2020: 13).
In 1838, another Posture Code transferred the responsibility of dealing with public
drunkenness to the Policía da Corte (Court Police), marking an escalation of the repression
against drunkenness (Rodrigues 1981; Lopes 2004). To the existing prohibition of mari-
juana consumption, the 1838 Code added prohibitions against other components of enslaved
people’s cultural practice in Rio de Janeiro, including entrudo (a religious dance) and the casa
de zungu, popular eating places for a type of soup. These measures were part of an efort to
achieve what Gilberto Freyre called the “desafricanization” of Brazil (2003: 458). As Sidney
Chalhoub has highlighted, daily life in Rio de Janeiro continued to defy the de-African-
ization ideology of the Posture Codes, not least through the resistance of the enslaved, for

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whom taverns and public houses were important spaces for sociability and clandestine ac-
tivities, including the consumption of alcohol and marijuana (Chalhoub 1990). In 1854, the
Posture Code was republished and the article sustained:

it is prohibited in drinking houses, taverns or other public places, gatherings of people

with tocatas, dances or voices: the house owner will be fned 30$000 rs; and being a
public place, each of the ofenders will be fned in 6$000 rs and put in prison until the
fne is paid; those who don’t have the money, pay with 4 days in jail.
(Código de Posturas 1854: 55–56)1

For comparison, an enslaved craftsman aged 20–29 years was valued at an average of 324 réis
in the frst half of the nineteenth century.
In rural areas, paternalistic slave owners portrayed slavery as a way of protecting the en-
slaved from their alleged impulses toward drunkenness. As part of the measures to control
consumption of alcohol on plantations, a handbook for slave owners recommended provid-
ing a piece of land for the enslaved to produce their own food such as cofee, corn, beans
and bananas. To prevent enslaved people from going to roadside taverns to sell or exchange
their surplus, as had been customary, they were prohibited from exchanging these goods of
the plantation. Slave owners were, moreover, exhorted to pay a “reasonable price” for these
products to reduce the incentive for the enslaved to risk breaking the rules anyway. Taverns
were places where Africans went to exchange products for alcohol, tobacco and tools with
tavern-keepers. Small but regular allowances of tobacco and cachaça were distributed as part
of this paternalistic efort for maintaining “peace in senzalas” (the slave quarters), but there
were also violent punishments for drunkenness or excess in consumption. In cases of intoxi-
cation, the enslaved were punished by fogging of “20 to 50 lashes” (Werneck 1847: 24–25).
The recommendations of slave owners about alcohol and taverns didn’t change substan-
tially after 1850 when the transatlantic slave trade was prohibited and interrupted in Brazil.
In 1861, a group of landowners described taverns as their “greatest enemies”, due to the
clandestine trade of cofee, which enslaved laborers produced and took from the plantations
for sale within taverns (Stein 1990: 208). Despite prohibitions against and punishments for
such actions, it is clear that the enslaved continued to resist the system of slavery through
conducting such commerce in taverns. In 1878, only ten years before the abolition of slavery,
plantation owners complained that it seemed taverns’ “exclusive purpose is to trade with
slaves during the night, [the slaves are] incited by thieves to steal from their masters, who are
thus obliged to infict punishments on them” (Congresso Agrícola 1878: 32). The authors
of this 1878 report fnished by arguing that “there are so many evils, losses and disturbances
that these small establishments of illicit trade bring to farmers, they can rightly be considered
the greatest scourge of farming” (Congresso Agrícola 1878: 32).
Frequenting taverns to sell produce raised on their own land allocations or taken from
the plantation’s main crop was only one way in which alcohol featured in enslaved people’s
resistance to slavery. In the frst half of the nineteenth century in Rio de Janeiro, historian
Mary Karasch argues that “to alleviate the burden of slavery, many slaves indulged in drink
and smoking diamba (maconha, marijuana)”. While, from “the landlord’s view, drink, after
laziness and robbery, was the great defect of the Black population”, from the perspective of
the enslaved, drug consumption was part of their “nonviolent resistance” to slavery. Acts
of resistance included conducting spiritual rituals to cast spells over slave owners, harming
plantation productivity by working deliberately slowly and feigning illness, and engaging
in self-harm. Within these experiences, the use of alcoholic beverages was common among

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enslaved women and men for diferent reasons: cachaça was cheap and it was essential to their
diet; it featured in religious rituals; and, importantly “drinking was also an important part of
the social life of the slaves” (Karasch 2000: 437).
Alcohol and tavern-going also became embedded within cultural expressions, such as
folklore, religion and dance, of West Central African peoples in the Brazilian Empire’s slave
system. These cultural expressions contested the racial stereotype of Black drunkenness con-
structed as part of the liberal rationalization of slavery. Jongo, for instance, was (and is) a
group dance formed by a large circular group of men and women singing together, clapping
hands at the same time, shaking their bodies without moving place, and in the center one or
two dancers demonstrate the steps. The singer improvises stanzas, the group answers back
and to the side musicians play instruments loudly. The ritual goes on day and night once
cachaça circulates. Alcohol had a strong spiritual and communal component in these meet-
ings, which were part of enslaved people’s culture in nineteenth-century Brazil (Gallet 1934:
62; see also Dias 2001; Agostini 2007; Slenes 2007).
The following stanzas from jongo expressions and folklore illustrate how alcohol and tav-
ern-going could ofer space for the resistance and critique of slavery, as well as highlight
the hypocrisy of racist discourse that attributed inequality and oppression to Black people’s
alleged tendency toward drunkenness.

Quando Baranco vai na venda|Logo dizi tá sequentario,|Nosso preto vai na venda,|A-

cha copo ta viraro [When white man goes to tavern | it is because he is restless | our
black man goes to tavern|look for alcohol because he is furious].
(Lopes 1988: 171)

Branco dize quando more|Jesucrisso que o levou,|E o pretinho quando more,|Foi

cachaça que o matou [When white man dies|Jesus Christ took him|and when black
man dies|it was cachaça (rum) that killed him].
(Goulart 1971: 71)

Operating within these stanzas is what Michael Pollak has described as “underground mem-
ory” as opposed to “ofcial memory”. Underground memory is transmitted inside family,
associations and networks of social and/or political sociability, “forbidden, unspeakable or
shameful memories that are jealously guarded into structures of informal communications
and go unnoticed by encompassing society” (Pollak 1989: 3–15). The majority of Africans
who were forcibly transported to Brazil and the Caribbean as slaves shared beliefs about the
spiritual importance of alcohol that were incorporated and adapted into slave culture. For
many West Central African peoples, alcohol was especially important to ceremonial occa-
sions in which ancestors were honored, and in funerary rites, both to help the passage of
the deceased to the spiritual world and to keep channels of communication open between
the deceased, the living and the wider community of ancestors (Smith 2005: 101–102). In
the context of slavery, such rituals were adapted to deal with transitions and dislocations in
general (not just funerals and deaths), as a means of bringing a sense of order, continuity and
social cohesion to the inherently traumatizing and destabilizing experience of slavery. The
consciousness of racialized double standards in the “ofcial memory” of drinking practices
expressed in the jongo stanzas above, together with their palpable anger, simultaneously ex-
poses the exploitation to which enslaved peoples were subject and lay claim to tavern-going
and drinking as legitimate means of dealing with trauma that political and economic elites
sought to deny them in the nineteenth century.

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The criminalization of public drunkenness in the 1830s was driven by the growing con-
cerns of Brazilian elites to control and suppress marginalized groups, especially the enslaved,
who were seen as troublesome or socially disruptive. This was justifed by an ideology in
which drunkenness, already understood as a sin associated with Africans because of their
supposed biblical descent from Ham, was viewed as an immoral, irrational behavioral vice
to which Africans and Afro-Brazilians were innately susceptible. Paternalistic measures on
slave plantations and legal punishments for public drunkenness in cities like Rio de Janeiro
were designed to increase control over the enslaved population by minimizing their oppor-
tunities for resistance through cultural expressions, solidarity-building sociability and access
to clandestine gatherings and trade in taverns. In the following decades, as the abolition of
slavery was increasingly debated, especially after the closure of the transatlantic slave trade in
1851, the Black population’s relationship with alcohol was used to justify the perpetuation of
slavery. After the abolition of slavery in 1888 and the establishment of a republican political
system in 1889, new pseudo-scientifc racial theories and medicalized understandings of al-
cohol abuse were added to this longer-term racial discourse about drunkenness to justify and
rationalize racial inequality in republican Brazil.
In 1837, a slave owner somewhat sympathetic to the cause of abolition expressed con-
cerns that freeing the enslaved Black population could lead to the further spread of the vice
of drunkenness throughout the population. Frederico Leopoldo Cezar Burlamarqui, in his
Analytic Memory about the Slave Trade, stated that while the system of slavery worked to “de-
moralize the customs” of the country, abolition posed two major problems. First, the lack
of a substantial alternative workforce to substitute for the labor of the enslaved and, second,
the behavioral infuence of a large unemployed Black population on the rest of society. His
position was predicated on the view that without the compelling force of slavery, Black peo-
ple would not work productively because “they vegetate in a state closest to the most brutal”
and, being given over to the “vice of drunkenness”, the formerly enslaved would spread this
vice throughout the lower classes and even “going to classes ‘higher’”. Indeed, he argued that
the vice of drunkenness had already “been communicated to them [the lower classes] by the
slaves”. But, because he viewed drunkenness as an inclination innate only to the enslaved,
abolition would accelerate the transmission of the vice throughout society by increasing
social contact between the formerly enslaved and the rest of the population (Burlamarqui
1837: vi, 43, 134).
More than a decade after the closure of the trans-Atlantic slave trade made the abolition
of Brazil’s slave system an increasing inevitability, the stereotype of Black drunkenness was
used to decry proposals for immediate, rather than gradual abolition. In 1866, the magistrate
Luiz Francisco da Câmara Leal described the proposal for immediate abolition as

an inexcusable political imprudence to put thousands of men exalted by drunkenness,

real or deriving from delirious imagination, the acquisition of the ever aspired and never
forgotten gift of freedom - without the slightest corrective, without giving them proper
occupation, without directing them to the love of order, respect for institutions, recog-
nition of the rights of all, social freedom, which is born of observance of the laws, and
obedience to their enforcers.
(Leal 1866: 32)

Expressing many of the same fears as Burlamarqui had, about the limited capacity of the
enslaved to live as productive, orderly liberal citizens after emancipation, he suggested that
the proposal for immediate abolition was the result of a real or imagined drunkenness on

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 Lucas Brunozi Avelar and Deborah Toner

the part of those fghting for freedom. In other words, for Leal, the demand for an imme-
diate end to slavery was a mere nonsense of drunks, to be disregarded as totally irrational.
Instead, he argued that a more gradual emancipation would not only allow for the payment
of compensation to slave owners for their lost property, but also to prepare the enslaved for
the rights and responsibilities of their freedom (Leal 1866: 17–29).
By the 1880s, when steps toward abolition had been taken – most notably, the Law of the
Free Womb in 1871, which meant that enslaved women’s children would be born free – the
idea that without the controlling force of slavery, Black Brazilians would languish in drunken
ruin that had become widespread, even among some of those who supported abolition. Such
ideas helped to perpetuate stark economic and political inequalities in post-emancipation
Brazil by providing a rationalization for the continued economic exploitation and political
disenfranchisement of Black people. Louis Couty, a French physiologist and Professor at the
National Museum in Rio de Janeiro, argued that while the abolition of slavery was neces-
sary, the newly emancipated Black person “becomes for some time useless or less useful”
(Couty 1881: 7). He suggested that enslaved Black people in Brazil’s cities were good porters,
carpenters or masons, but when “they are set free and, shortly thereafter, having become
drunkards or lazy, they only work when compelled by very limited needs” (Couty 1881: 29).
Beliefs in the redemptive virtues of slavery had already appeared in the early nineteenth
century, and they remained powerful even among those who agreed that abolition was nec-
essary. Couty, for instance, believed that Brazil needed to abolish slavery so that the country
could exploit all its natural potential, populate the territory and make savings: “It is therefore
necessary to suppress this work, not because it is harmful to a class of men, but because it is
detrimental to an entire social evolution” (Couty 1881: 42). The combination of economic
liberalism and racism allowed Couty to defend the use of violence in dealing with the en-
slaved population:

It is quite true that if a serious misconduct, such as theft, complete drunkenness, or

prolonged absence – and these faults are far from rare – is incurred, the black is liable to
corporal punishment. But after taking ffty lashes, the unfortunate will not be changed,
and his force of inertia will remain unchanged.
(Couty 1881: 45)

Couty’s pessimism that even violent punishment would not deter the enslaved from drunk-
enness was informed by the premise that Black people were unsuited to driving efciencies
and improvements in cofee production, one of Brazil’s largest export industries by the late
nineteenth century. He described the “social characteristics” of “negros” as lazy and child-
like, making them vulnerable to the “low” attractions of alcohol consumption:

Most black adults have many of the characteristics of children in our civilized societies.
Like children, they have relatively developed lower senses, especially taste and hearing.
The black man likes tobacco, rice, and well roasted corn, loves sweets, rapadura, but,
above all, he likes cachaça or impure sugarcane brandy made in the country. During
the night, and by sacrifcing himself more for this passion than for freedom itself, he
may even work on Sundays. In this way a slave whose particular feld is cultivated can
simply be a more determined drunkard. Despite all the vigilance, all the prohibitions,
all the punishments, you often see drunken slaves on the farms, and according to general
consensus, drunkenness is their greatest defect.
(Couty 1881: 77) 2

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 Alcohol, slavery and race in Brazil

Couty concluded his racist yet anti-slavery book stressing that even “the best treated slave
can be, like others, thieves and drunkards” and, when freed, “they will become disobedi-
ent, arrogant, drunks and drunkards, and it will be necessary to get rid of them”. While he
viewed slavery as incompatible with Brazil’s economic modernization, the institution had, he
argued, protected the enslaved and, in the absence of such protection, he was convinced that
“because of their laziness or drunkenness” emancipated slaves would be “unable to support
themselves” (Couty 1881: 97). This dilemma was, for elites like Couty, the Brazilian white
man’s burden. According to Frantz Fanon, “it is not possible to subjugate man without log-
ically making them inferior from one side to another. And racism is nothing more than the
afective, emotional and sometimes intellectual explanation of this inferiorization” (Fanon
2014; see also Avelar 2020). The long-term process of racializing the drinking practices of
enslaved and free Black people in Brazil had developed in tandem with colonialism and the
institution of slavery. After the abolition of slavery in 1888, the creation of republican Brazil
in 1889 and the promotion of European immigration to “whiten” and “modernize” Brazil
in the following decades, new intellectual dimensions were added to the longer-term racial
discourse about drunkenness to explain ongoing racial inequalities in Brazilian society.

Modernity and the Racialization of Drinking Behaviors in

Post-Abolition Brazil
Brazil’s new republican government responded to the abolition of slavery by encourag-
ing mass immigration from Europe, with policies that were envisioned as efecting eco-
nomic modernization and national progress. The new federal republic was dominated by
the economic powerhouse states of São Paulo and Minas Gerais, in a largely oligarchical
system that was nicknamed the “café com leite” (cofee with milk) alliance because these
states were dominated by cofee production and cattle ranching, respectively. These political
and economic elites exerted strong infuence on Brazil’s immigration policies, which were
predicated on racist assumptions about the greater industriousness of European workers,
compared to newly emancipated slaves and the Black population in general, and were ani-
mated by the goal of “whitening” Brazilian society demographically, socially and culturally
(Skidmore 1999: 69–79; see also Meade 1997). Cofee producers set up recruitment agencies
in European port cities, the state subsidized transportation fares for European migrants and
other incentives were ofered to encourage the migration of whole families, as a means of
promoting a moral social order based on family stability and as a means of keeping wages
low. At the same time, with Decree Law 528, Brazil prohibited the migration of Asians and
Africans (Lesser 2013: 69–73).
Scientifc racism formed part of the intellectual and ideological justifcation of this im-
migration policy and other aspects of the modernizing agenda of Brazilian elites in this era.
As in other parts of Latin America, scientifc racism, especially in the form of degeneration
theory, shaped medical, psychiatric and criminological studies of alcoholism, marking a new
stage in the racialization of drinking behaviors in Brazil. Degeneration theory, emerging
from the infuential work of French psychiatrists Valentin Magnan and Benedict Morel, pro-
vided a hereditary framework for interpreting social problems such as poverty, mental illness
and crime as advancing progressively from one generation to the next. Within this frame-
work, alcoholism was “thought to be both a major cause and consequence of this process of
degeneration, with implications for public health, national productivity, and social order”
(Toner 2021: 181). While these ideas were infuential in many national contexts during the
late nineteenth and early twentieth centuries, they were used to pathologize the drinking

373
 Lucas Brunozi Avelar and Deborah Toner

behaviors of diferent demographic groups in diferent places. In France, Spain and Chile, for
instance, where the majority of the population was considered ethnically white, fears about
degeneration were concentrated on the urban working classes (Bynam 1984: 69–70; Sournia
1990: 98–108; Rebolledo 2013: 145–162). In Latin American nations where the “drunken
Indian” stereotype had taken powerful hold as part of colonial discourse that “othered” and
“inferiorized” Indigenous peoples – such as Mexico, Guatemala and Bolivia – alcoholic de-
generation combined concerns about race and social class, in connection with their largely
Indigenous and mestizo (mixed Hispanic-Indigenous heritage) lower classes (Toner 2015:
212–216). In Brazil, such discourse was concentrated on Africans, Afro-Brazilians and their
descendants.
In 1894, Nina Rodrigues, a Brazilian doctor (1862–1906) infuenced by social Darwinists
like Cesare Lombroso, Herbert Spencer and Francis Galton, published “As raças humanas” (The
human races), on criminal psychology in Brazil. Rodrigues argued for a diferentiated criminal
treatment of Afro-Brazilians, Indigenous and mixed-race groups, all of whom he described as
“inferior races”. He asserted that the causes of racial degeneration were miscegenation, alco-
holism and “miasmatical emanations” (Rodrigues 1894: 151). In line with the racial hygienists
and social Darwinists he cited, Rodrigues viewed alcoholism as one of the “abnormalities” that
threatened national progress and social disorder because of its degenerating efects on subsequent
generations, especially among the Afro-Brazilian population. He stated that

the black creole [a term meaning born in Brazil] kept the brutal instincts of the African
alive: he is bitter, violent in his sexual impulses, much given to drunkenness and this
background of character impresses his stamp on the current colonial criminality.
(Rodrigues 1894: 124)

The author therefore believed that drunkenness was a “brutal instinct” of Afro-Brazilians
inherited, in turn, from Africans, and that tendencies to alcohol abuse, sexual aggression and
criminality were hereditary characteristics that these groups transmitted to their descendants.
The republican government tried to lower alcohol consumption with laws and campaigns
based on ideas of racial hygiene that connected alcoholism to problems of mental illness,
crime and disease. The Penal Code in its twelfth chapter, “of beggars and drunks”, made
both habitual drunkenness and public drunkenness crimes punishable by 15 days imprison-
ment (article 396), and the same penalty applied to anyone who would “provide to someone,
in a public space, drinks to get him drunk, or to increase drunkenness” (article 397). Article
238, moreover, stipulated that public employees would lose their jobs for habitual drunken-
ness, with no possibility of getting another job until they could demonstrate their reformed
ways. Citizenship rights, already extremely restricted in republican Brazil, were also re-
moved for ofenses related to drunkenness (Santos 2018: 330). The great majority of patients
admitted to the National Hospice for the Insane in Rio de Janeiro in the early 1900s were
classifed as alcoholics with “toxic psychoses” (Moreira 2015: 54). In 1912, a total of 19,950
people in Rio de Janeiro were recorded as having been arrested or prosecuted, as having died
from tuberculosis or by suicide, or as registered patients of the Hospice (asylum). Of this total
14,750 were deemed to be alcoholics (Souza 2004: 68).
Distilled spirits, especially cachaça consumption which had long been associated with
Afro-Brazilians, were linked to this medicalized framework of alcoholism and degeneration.
A biographer of a slave owner commented that “the cachaça was the frst and most import-
ant freedom which the freed slaves used and abused” and cachaça “ruined the poor people
who still continue to wander without knowing how to enjoy the freedom that was so much

374
 Alcohol, slavery and race in Brazil

touted” (Viotti 1992: 510). The memoirs of Luis Edmundo, an infuential journalist, poet
and historian, praised the eforts to modernize and de-Africanize Rio de Janeiro around the
turn of the twentieth century, and identifed taverns as particular sites of African sociability
and culture that tarnished the city. Edmundo described taverns as dirty, inhospitable and
abject, frequented by drunken Black women and men, who play African instruments, dance,
drink and laugh while the “cachaça drips” (Edmundo 2003, vol. I: 76). For Edmundo, such
spaces meant that “the city was still a village of Africans”, and the customs of mainly Black
tavern-goers harmed the image of the capital city Brazilian elites wanted to project as mod-
ern and civilized (Edmundo 2003, vol. 1: 120).
While distilled spirits, and especially cachaça, were associated with Afro-Brazilian sociability,
backwardness, disease, mental illness and crime, at the same time beer drinking was actively pro-
moted as modern and healthy and featured signifcantly in plans to Europeanize – and thereby
“civilize” – the capital city Rio de Janeiro. Fluminense Park, established in 1902, was emblem-
atic of this process. In addition to its elegant gardens, carousel, theater, orchestral performances,
flm projection and electric lighting, all “symbols of modernity”, Fluminense Park had a “huge
space for beer consumption, especially draft beer and Bock Ale from Brahma”. The Park quickly
became an important leisure center and “the best beer advertising center, greatly helping the
increase of beer consumption” (Marques 2014: 307). Urban modernization reforms were both
helped by international investment and designed to attract more foreign capital and to support
the eforts to attract European migration. Beer advertisements alluded to its medieval European
origins of production (see Figure 22.3), as well as its nutritional, even medicinal, value (see Figure
22.4), to shape new consumption habits in the city.
By centering elegantly dressed white women as domestic consumers (Figure 22.4), ad-
vertisements dissociated beer from the wider medical and social concerns about alcohol that
targeted Afro-Brazilian consumption habits by focusing on distilled spirits such as cachaça
and the space of the tavern. Beer halls, such as the one in Fluminense Park, were promoted
as mixed-gender and socially elite spaces (see Figures 22.5 and 22.6), alluding to romance,
refnement and modern forms of recreation (Marques 2014: 307). These advertisements,
published in magazines like Fon Fon that set out to publicize “symbols of modernity”, con-
tributed to an idealized whitening of Brazil’s drinking culture and society as a whole.

Figure 22.3 Brahma Bull-Bock Advertisement

375
 Lucas Brunozi Avelar and Deborah Toner

Figure 22.4 Brahma-Porter Advertisement

Figure 22.5 Companhia Cervejaria Brahma Advertisement

376
 Alcohol, slavery and race in Brazil

Figure 22.6 Bock-Ale Teutonia Advertisement

Beer became a symbol of modernity in other parts of Latin America at the same time, in
opposition to traditional drinks associated with Indigeneity, such as pulque in Mexico and
chicha in Colombia, while wine served a similar symbolic function in attracting European
migrants to Argentina (Hibino 1992; Bunker 1997: 231–233; Hanway 2014: 91; Stein 2014:
210–215). Beer consumption in Brazil fuctuated in the subsequent decades, but steadily
became the most widely consumed alcoholic drink from about the middle of the twentieth
century up to the present day (Flacso 2021: 81).

Conclusion
The promotion of beer drinking as modern, healthy, civilized and, ultimately, “white”, stood
in stark contrast to the public campaigns against distilled spirits and the laws against drunk-
enness dating back to the early nineteenth century. These alcohol regulations were framed

377
 Lucas Brunozi Avelar and Deborah Toner

by racial assumptions and fears about the drinking behaviors of non-white people, especially
enslaved and free Africans, that had been formed under colonialism. Distilled spirits, espe-
cially cachaça, were the main alcoholic drinks consumed by Africans and non-Africans alike
on a wide range of occasions in colonial life. But the drinking practices of enslaved groups
were increasingly associated with religious and social disorders and resistance to slavery by
the end of the colonial period and afterward. In the early nineteenth century, the newly
independent Imperial State used legislation and police powers to control drinking practices.
In the countryside, slave owners tried to prevent slaves from tavern-going and drunkenness
by providing pieces of land, permitting dances and music on plantations, providing rations
of alcohol and tobacco, and threatening and exercising violent punishments. Despite these
measures, enslaved and free Africans continued to engage in alcohol consumption and tav-
ern-going, shaping both rural and urban forms and spaces of sociability. After abolition in
the late nineteenth century, ideas about the racial degeneration of the Black population and
non-whites as a whole became infuential, and alcoholism was considered evidence of their
inferiority. This contributed to the broader modernization agenda of the political and eco-
nomic elite in republican Brazil, under the motto “order and progress”, where order meant
urbane beer consumption instead of cachaça-based drunkenness and progress meant de-Af-
ricanization of society and culture.

Notes
1 The quotation mentions “rs” referring to “réis” that was the currency of that period.
2 Rapadura is a sweet and solid bar made from molasses of sugarcane.

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 23
STREET-LEVEL POLICING,
STRUCTURAL VIOLENCE
AND HABITUS
Accounts of street-involved cannabis
users in Nigeria

Ediomo-Ubong E. Nelson

Introduction
Consumption of cannabis among street-involved youths has been fairly well documented in
the existing literature (Adlaf, Zdanowicz & Smart, 1996; Thompson, Barczyk, Gomez et al.,
2010; Bender, Thompson, Ferguson et al., 2012; Bozinof, Small, Long et al., 2017), but few
studies have explored their experiences of policing in relation to cannabis use (Ti, Wood,
Shannon et al., 2013; Nelson, 2018; 2021b). There is a dearth of studies that explore the direct
perspectives of street-involved youths on cannabis use and street policing, which involves
surveillance, street patrols, crackdowns and arrests. The possession and use of cannabis are
legally prohibited under the 1961 United Nations Single Convention on Narcotic Drugs. In-
fuenced by this convention, national drug laws (including Nigeria’s) have mainly focused on
strengthening law enforcement, including policing of drug markets and arrest of dealers and
users. A disproportionate burden of drug policing is borne by the most visible and vulnerable
populations, including young people who use drugs, live on the streets and experience social
exclusion (Werb, Kerr, Li et al., 2008; Ti, Wood, Shannon et al., 2013; Nelson, 2018; 2021b).
In this study, I explore the accounts of street-involved youths on cannabis use and street-
level policing; highlighting the negative efects it has on their health and well-being. The
study is based on primary data collected through qualitative interviews with street-involved
youths in the city of Uyo, Akwa Ibom State in Nigeria. Apart from providing information
on a relatively under-researched subject, the study seeks to echo voices from the streets on
the harms of zero-tolerance policies in order to challenge dominant narratives used to justify
the continuation of a “war on drugs” at a time when this approach is losing support in other
countries of the world (Csete & Sanchez, 2013; Nelson & Obot, 2020). Specifcally, I pose
three key questions: What is the broader social and structural context in which cannabis use
by street youths takes place? What are their encounters with the police and what efects do
these have on their health and well-being? How do they respond to policing and how do
such responses contribute to their structural vulnerability (i.e. reinforces their subordinated
positions in society’s power hierarchy)? Answers are expected to broaden understanding of

382 DOI: 10.4324/9780429058141-30

 Street-level policing, structural violence and habitus

the social and structural context of drug-related harms as well as support the development
and implementation of public health-centered and human rights-based policies.

Cannabis, drug laws and enforcement practices in Nigeria

Cannabis is the most commonly used illicit drug in Nigeria. A nation-wide survey of drug
use conducted in 2018 indicated that an estimated 10.8% of persons aged 15–65 years (10.6
million people) had used cannabis in the past year, which is far more than the proportion of
opioids users (4.7% or 4.6 million people) in the same population (United Nations Ofce on
Drugs and Crime [UNODC], 2019 Cannabis accounts for 47.9% of people seeking treatment
for substance abuse in Nigeria (Economic Community of West African States [ECOWAS],
2018). Although cannabis has been cultivated and distributed along the West African coast
since the 1920s (Akyeampong, 2005), it is reported that trade and consumption of the drug
did not grow signifcantly until after World War II when soldiers returning from the middle
east and elsewhere brought the plant to Nigeria and other West African countries (Asuni,
1964). The plant found a habitat and grew easily in Nigeria’s tropical climate so that large-
scale cultivation and exportation to Western markets were reported by the 1960s (Obot,
2004).
Until the late 1950s, cannabis smoking was regarded as the fringe habit of a small group
of urban laborers, ex-soldiers and seamen, who consumed it mostly to enable them to under-
take physical labor (Klantschnig, 2014). Beginning from the 1960s, with media reports of a
“hemp boom” in Lagos, increased seizures of cannabis and discovery of farms were recorded.
Increased cultivation of cannabis has been attributed to decline in the market price of cocoa
and the lucrativeness of cannabis when compared with other cash crops (Klantschnig, 2014).
Similarly, the low cost of cannabis spurred local consumption so that by the late 1960s, “can-
nabis spread from the fringe habits of ex-soldiers and port workers…to other social classes
who used it for diverse reasons, including recreation, as a marker of modernity and social
identities” (Klantschnig, 2014, p. 75). Cannabis use has entered the cultural mainstream.
It is consumed by diverse groups, including transport workers, students and bar patrons.
Street-involved youths (homeless, out-of-school young people, who live on the streets, en-
gage in street-based income-generating activities and experience social exclusion) are the
most visible group of cannabis consumers in Nigeria (Klein, 1999; Nelson, 2018; Dirisu,
Shickle, & Elsey, 2019; Nelson, 2021a).
Cannabis use, though increasingly common, remains highly moralized and users are stig-
matized and marginalized by other members of the community (Dirisu, Shickle, & Elsey,
2019; Nelson, 2021c). Media portrayals that associate cannabis use with mental illness and
criminality (Nelson & Obot, 2020) reinforce stigma and social discrimination of cannabis
users, particularly street-involved users who consume cannabis in hotspots (places where
young people hang out to sell and consume cannabis) and other semi-pubic settings (Nelson,
2018; 2021b). As Sandberg (2012) argued, the discrepancy between young people’s interest
in cannabis and (proscriptive) social norms leads to the development of subcultures as fgu-
rative representations of use and shared identity. Cannabis is often used by street-involved
youths as a way of coping with the traumatic efects of social exclusion (Klein, 1999; Dirisu,
Shickle, & Elsey, 2019; Nelson, 2021a, 2021b), but the risk of dependence and adverse health
and psychological efects increases when it is consumed over a long period of time (Hall &
Pacula, 2003). Punitive drug policies, including police harassments, incarceration and other
criminal sanctions for cannabis use, however, cause more harms to these youths than those
caused by the drug.

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Concerns about the over-publicized health and social harms of cannabis use (e.g. crime
and mental illness) have reinforced preference for punitive drug laws, which may be traced
back to the earliest drug ordinances introduced by the colonial government in Nigeria (Obot,
2004; Nelson & Pates, 2017). Cannabis is classifed as a dangerous drug along with cocaine
and heroin in domestic drug laws, which are applicable in all states of the Nigerian feder-
ation (Klein, 2001). Cannabis is the main focus of domestic drug laws, which is driven by
concern over state power rather than fndings from scientifc research (Klantschnig, 2016).
Klantschnig (2009) has shown that Nigeria’s drug control system operates on the basis of
a discourse that emphasizes “crises, correction and success”. In this discourse, illicit drug
trafcking and consumption are portrayed as a social crisis afecting social order and invit-
ing a military-style campaign of social correction. Law enforcement outcomes, particularly
seizure and arrest (see information in Table 23.1), are displayed as measures of performance,
which reinforces the notion of a drug crisis as well as a targeted and successful response.
Nigeria’s drug laws have contained some of the most punitive sanctions imposed on can-
nabis trafcking and use (Obot, 2004). The current drug law has been described as almost a
verbatim duplication of the 1988 UN Convention, covering every aspect of drug trafcking
and related ofenses (Kavanagh, 2013). One of the aims of the law is to “eliminate” cannabis
production, trafcking and consumption. The Indian Hemp Decree of 1966 included death
penalty or 21 years imprisonment for the cultivation of cannabis, 10 years imprisonment
for trafcking in cannabis and another 10 years for possession and/or smoking of cannabis.
The Indian Hemp Act of 1975 removed the death penalty and reduced sanction for cannabis
smoking to six months and/or a fne. The Special Tribunal (Miscellaneous Ofences) Decree
of 1984 reinstated death penalty for the use of cannabis, which was later replaced with life
imprisonment in the amended Decree of 1986.
Decree 48 of 1989, which is now an act of parliament CAP N30 Laws of the Federation of
Nigeria, established the National Drug Law Enforcement Agency (NDLEA) to coordinate
drug control activities in the country. The NDLEA combines supply and demand reduction
activities, which were previously discharged by diferent agencies. The agency has been
criticized for targeting cannabis users and retail-level dealers, while trafckers who accumu-
late millions of dollars in proft from drug trade operate with impunity (Williams, 2014).
Most arrests for drug-related ofenses are on charges of cannabis peddling and use, resulting
in many “casualties, including hundreds of people convicted on several years’ sentences for
smoking cannabis inside a joint” (Klein, 1999, p. 68). A review of arrest data for 2006, for

Table 23.1 Cannabis seizure and arrest of traf-

fckers by the NDLEA (2010–2015)

Year Seizure Arrest

2010 174,661.59 6,788

2011 191,847.91 8,639
2012 228,794.13 8,052
2013 205,373 8,843
2014 53,878,194.52 8,826
2015 871,480.32 8,778
2016 187,394 8,257
2017 191,084.2 10,009

Source: NDLEA, 2016/ECOWAS, 2018.

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 Street-level policing, structural violence and habitus

instance, indicated that over 80% of those detained for drug-related offenses were cannabis
users and retailers (Gyong, 2009).
The NDLEA, which operates as a specialized police agency, enforces drug laws in con-
junction with the Nigerian Police Force (NPF). Law enforcement is aimed at drug inter-
diction and crime prevention (Nelson, 2018). Common law enforcement practices include
surveillance and street patrols, crackdowns on drug markets as well as arrest and prosecution
of offenders (e.g. dealers and users). Extra-legal practices such as planting of evidence, ex-
tortion of money from drug users, sexual harassment, physical violence, threats and other
human rights abuses are telling features of everyday street-level drug policing (Nelson &
Brown, 2019; Nelson, 2018; 2021c). Physical violence contravenes prohibition of the use
of excessive force under the Nigeria Police Force Order No. 237 (Lawyers Committee for
Human Rights, 1992), while extortion violates Article 324 of the Police Act, which requires
that a police officer “offer prompt obedience to lawful order” and “be determined and in-
corruptible in the exercise of his duties” (Omotola, 2007, p. 627).
Poor remuneration and widespread impoverishment among police personnel fuel cor-
ruption and extra-legal practices. Extortion is a common means through which lower cadre
officers attempt to supplement their meager incomes (Ibeanu, 2007). As Klein (1999) argued,
the policing of cannabis users is governed by the revenue imperative of the under-paid
police personnel who needs to make up for unrealistic wages. Poor and socially disadvan-
taged populations bear the brunt of police abuses, which suggests a social class bias in police
corruption (Agbiboa, 2015). Street-involved youths who use cannabis are the most affected
group (Klein, 1999; Dirisu, Shickle, & Elsey, 2019; Nelson, 2018; 2021b). Their inability to
afford bail fee or legal representation exacerbates their vulnerability to predation by police
officers, resulting in untold suffering and harms, including dispossession, imprisonment,
health harms and loss of employment prospects (Nelson, 2018).

Structural violence and habitus – theoretical framing

Drawing on conceptual tools such as “risk environment” (Rhodes, 2002), “structural vi-
olence” (Farmer, 1996), “structural vulnerability” (Quesada, Hart, & Bourgois, 2011) and
“everyday violence” (Scheper-Hughes & Bourgois, 2004), drug use researchers have gone
beyond individual/micro-level explanations and emphasized the wider structural and in-
ter-personal contexts in which drug use and harms occur. This development reflects the
recognition that drug harms are “virtually meaningless outside their socio-cultural as well as
political economic contexts” (Bourgeois, 2003, p. 32), and that drug use is “a symptom – and
a vivid symbol – of deeper dynamics of social marginalization and alienation” (Bourgeois,
1995, p. 2). These concepts capture the different ways vulnerability to drug-related harms
are shaped by structural and systemic factors. The structural production of harms is mediated
by “enforcement-based policies that disproportionately affect those using drugs as well as
those already suffering intense and systematic discrimination” (Rhodes, Wagner, Strathdee
et al., 2012, p. 4).

Structural violence and vulnerability

In an attempt to “resocialize” drug-related harms by showing its social-structural and political
economic antecedents, researchers have used the concept of “structural violence” to show how
these harms are reproduced within wider social relations of structural inequality. Structural
violence describes social arrangements that contribute to inequality in a manner that constrains

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human agency and increases harm for vulnerable populations (Farmer, 1996; Kleinman, 2000).
It references large-scale forces such as poverty and gender inequality that structure unequal ac-
cess to goods and services and create conditions that reproduce the risk of drug-related harms.
Put simply, structural violence shows how social institutions (e.g. criminal justice system) may
harm people by preventing them from meeting basic needs. The concept of “structural vul-
nerability” sharpens understanding of structural violence by accounting for how mutually
reinforcing economic, political, cultural and psychodynamic insults that dispose individuals
and groups toward harms are embodied (Quesada, Hart, & Bourgois, 2011). It emphasizes
how individuals and groups internalize their depreciated status in ways that shape behavior and
self-concept (Holmes, 2011). An individual is structurally vulnerable when the acceptance of
her or his location in society’s hierarchy prevents him from attaining optimum well-being. The
institutionalization and everyday internalization of structural violence through punitive po-
licing practices render it invisible as a feature of lived experience (Rhodes, Wagner, Stradthee
et al., 2012). This has both “symbolic” and “embodied” efects. Symbolic violence describes a
process whereby social practices legitimate the existing hierarchies so that those who are dom-
inated accept and contribute to their structural subordination (Bourdieu & Wacquant, 1992).
However, structural violence is embodied as “oppression illness”, which is the chronic efects
of social mistreatment and discrimination (Singer, 2004). Drug use, particularly high-risk drug
use, may be seen as a response to “oppression illness” and social stress in high-risk environ-
ments (Gee, Delva & Takeuchi, 2007).

Habitus
The disadvantage of macro-structural perspectives on drug-related harms is that they tend
to be “over-deterministic”, and do not account for the role of agency, subjectifcation and
non-material forces in the dynamic and mutually constitutive relationship between individ-
uals and society (Rhodes, Wagner, Strathdee et al., 2012). In response, researchers have ex-
plored drug users’ creativity and inventiveness in relation to macro-structural forces. Some
have found the concept of “habitus” (Bourdieu, 1990) useful in analyzing the reciprocity of
structure and agency in the feld of illicit drug use. Defned as “systems of dispositions that
are shaped by the experiences of actors in particular positions in social structure” (Calhoun,
Gerteis, Moody et al., 2007, p. 261), habitus draws attention to how individuals internalize,
and take for granted specifc ways of acting and being which correspond with social struc-
tures. In simple terms, habitus refers to the set of beliefs, attitudes and practices, acquired
by reason of an individual’s social location, which shapes how she or he responds to the
environment. It is not an ensemble of relatively fxed and unaltered dispositions, but is fex-
ible and capable of improvisation and adaptation to diferent situations. Habitus is acquired
through repetition as individuals interact within specifc “felds” or domains of social life.
Grundetjern and Sandberg (2012) have used the concept of habitus to analyze women’s sur-
vival strategies in a gendered drug economy that favors men. Haritavorn (2014) has explored
how gendered habitus enabled women to position themselves in relation to structural and
gendered violence, and the choices and strategies they adopted to lessen the efects of social
discrimination and inter-personal violence. In this study, I use “structural violence” and
“habitus” to explain the interplay of structural inequality, social discrimination and puni-
tive policing in the production of drug-related harms among street-involved youths who
use cannabis, and to highlight the situated strategies they adopt in response to street-level
policing, which suggests internalized social practices that resist, just as they reinforce, social
structures.

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Data and methods

The study was conducted in Uyo, Akwa Ibom State in Nigeria. The city’s population is estimated
at 1,143,689 people, including migrants from other ethnic groups. Basic social amenities such as
healthcare, housing, electricity, water and transportation are inadequate. Commerce, services and
a variety of low-level ofce, administrative or salaried positions in the civil service are the foci
of the economy. An estimated 51% of the population lives in absolute poverty (National Bureau
Statistics, 2010). Most earn a precarious living toiling in a poorly regulated informal sector, where
the boundary between what is legal and illegal is blurred. There is a signifcant level of illicit drug
use in the city, and cannabis is the most commonly used drug (United Nations Ofce on Drugs
and Crime [UNODC], 2019). Ninety-seven (n = 97) street-involved young persons who use
cannabis were recruited for the study through venue-based sampling from eleven (11) “hotspots”
(popularly known as “bunks”) identifed through ethnographic mapping. Cannabis hotspots are
informal socio-spatial contexts where young people hang out to sell and/or consume cannabis.
Examples are nightlife environments, abandoned buildings, market stalls, school compounds
(used during non-school hours) and abattoirs.
For the purpose of this study, a “street-involved youth” is a young person (21–35 years) who
engages in street-based income-generating activities and spends most of her/his time among
street-involved peers. The inclusion criteria were being a current cannabis user, defned as hav-
ing used cannabis in the last 30 days, and having experienced police crackdown on a cannabis
hotspot. Participants were mostly males (78/80%). They were between the age of 21 and 34 years.
The highest level of education attained by any participant was secondary education; the majority
had only primary education. They were from poor households and earned a precarious living
from informal income-generating activities such as commercial transportation, manual labor,
touting, hair weaving, and food vending and (casual) sex work. Some participants were homeless
or unstably housed, alienated from relations, orphaned or had a single parent whose earnings
could not meet the basic needs of the household (e.g. accommodation and feeding) (Table 23.2).
Data were collected through in-depth, individual interviews facilitated by a topic guide,
which was revised in the course of data collection and analysis. Interviews were conducted
by trained male and female feld assistants, who were recovering cannabis users trained on
how to build rapport with participants and conduct interviews on sensitive subjects without
causing tension. The use of peers as interviewers fostered trust, enhanced co-operation and
facilitated elicitation of sensitive information that would evade conventional self-report in-
terviews (Elliot, Watson, & Harris, 2002). Interviews took place at ofce spaces leased for
the purpose of interviews, which provided privacy and safety for the participants. Interview
questions of focal interest concerned factors infuencing cannabis use, preferred physical
settings for using cannabis and reasons for preferring these settings, perceptions of street-
level policing, experience of police crackdowns on cannabis hotspots, efects of crackdowns
and strategies adopted to detect and evade police arrest. Interview questions were worded
in ways that would enable the discovery of key themes relevant for exploring cannabis use
and experiences of street-level policing among the study population. Interviews generally
lasted between 45 minutes and 1 hour, and were tape-recorded with the (verbal) consent of
each participant. Recorded interviews were transcribed verbatim and checked for accuracy.
A thematic approach was adopted in the analysis to identify patterns of meaning in the data
(for details of the data analysis process, see Nelson, 2018). Selected verbatim comments
(identifed by interviewee’s sex) are used to illustrate important analytic themes. Participants
received two bars of toilet soap in appreciation of their participation. The study was approved
by the Institutional Review Board of the University of Uyo, Nigeria.

387
 Ediomo-Ubong E. Nelson

Table 23.2 Socio-demographic characteristics of the participants

(n = 97)

Number of
participants (#) Percentages (%)

Sex
Male 78 80
Female 19 20
Age 31 32
21–25 38 39
26–30 28 29
31–34 57 59
Educational attainment 40 41
Primary 24 25
Secondary 73 75
Relationship status 37 38
Regular 18 19
Others 21 22
Housing 21 22
Living with parent/relation
Living with partner
Living with friend
Homeless

Source: Data collection.

Social exclusion and cannabis use among street-involved youths

The participants’ accounts emphasized how the realities of marginalization and social in-
equality contributed to initiation of cannabis use. Although difering on many points, the
key themes in the accounts were constraints on opportunities for gainful employment owing
to a lack of formal education leading to “hustling on the streets” (i.e. engaging in street-
based income-generating activities). This, in turn, facilitated contact with other street-in-
volved youths who used cannabis leading to acceptance and adoption of cannabis use. This
trajectory is captured in the following comment:

I started smoking because things were very tough. Then I used to hang around with
some friends and they encouraged me to try it (cannabis). They told me that I should
take it that it will help me forget some of my worries.
(Male participant)

For most participants (74/76%), a social learning process which involved continuous in-
teractions with peers within cannabis subcultures undermined social control on behaviors
(Becker, 1968). This led to cannabis being seen as “normal” within these subcultures, while
being stigmatized in the wider community. For example, a male participant commented:

There is nothing to worry about… Before I used to fear that people will judge me for
smoking weed, but now I am not afraid anymore. I see my guys taking it all the times…
now I know that there is nothing wrong with it. It is just a plant.

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 Street-level policing, structural violence and habitus

Most female participants (13/68%) were introduced to cannabis use by their male sexual
partners (Nelson, 2021c). As Klein (2001) observed almost two decades ago among cannabis
users in southwest Nigeria, many women are introduced to the drug by their boyfriends and
cannabis smoking may accompany the frst sexual experience of young women. A female
participant noted:

I didn’t use to smoke weed. I use to take only alcohol in parties. It was my former boy-
friend who made me take it. He used to bring it home to smoke in the house we were
living together. I started smoking weed when we were together.

Most participants denied the adverse efects of cannabis on their health (“They say weed
has made you sick, but I don’t believe”; “I know Igbo can cause problems for people, but
not someone like me”), but extolled the positive efects of consumption (Hathaway, 2004).
Beliefs about the positive efects of cannabis consumption are an important part of youth
subcultures, and are important for understanding initiation and maintenance of cannabis use
(Holm, Sandberg, Kolind et al., 2014). While other illicit drugs were available and consumed
in the hotspots, cannabis was lauded for fostering a sense of belonging and community for
street-involved youths (81/83%) (“Weed is not like other drugs… It makes people feel like
family, you know”).
Cannabis consumption ofered most street-involved youths (79/81%) a means of cop-
ing with the traumatizing efects of social exclusion. “Forget all the worries”, “freeing
my mind” and “helps me get through the day” were common reasons given for smoking
cannabis. This supports the view that cannabis is valued by youths because it eases anxiety
and enables daily functioning (Dirisu, Shickle, & Elsey, 2019). The anxiety-easing efect
of cannabis needs little elaboration in Nigeria where living conditions are so precarious
that any substance that alleviates anxiety could be seen as serving a social function (Klein,
2001; 2009). Ironically, the intoxicating properties of cannabis, which is positively valued
by users for easing anxiety, account for the moralization of the substance and stigmatiza-
tion of its users (Room, 2005).
Cannabis hotspots provided most male participants (69/71%) a social context to develop
“street masculinity”, which is characterized by public consumption of cannabis and a pro-
pensity for violence. A similar association between cannabis smoking and violent masculin-
ity was reported by Klein, where a participant noted that “some people take it (cannabis) and
start fghting to let people know they are hard…” (2001, p. 115). A participant in the present
study stated:

People will take it just to show that they are tough, that they can make trouble... If you
can smoke many wraps and still “hold your side” (maintain comportment), others will
hail you.
(Male participant)

Most participants (77/79%) used cannabis in “hotspots”, which provided a space where users
could “socialize” (i.e. meet with friends). Hotspots also provided a social context for social
recognition achieved by conveying the latest news in local politics, sports and entertainment,
and bragging about one’s sexual adventures. While consuming cannabis in hotspots signifed
that participants belonged to street subcultures, it also amplifed their exclusion from main-
stream society and fostered stigma and marginalization (see Hammersley, Jenkins, & Reid,
2001; Room, 2005).

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 Ediomo-Ubong E. Nelson

Consumption of cannabis reproduced negative social categorizations and “stigmatizing

conficts” with community and the police (Hathaway, 2004). Accounts emphasized the la-
beling of cannabis users as criminals regardless of their actual criminal status (“People call
us criminals because we smoke weed”). Societal perceptions associating cannabis use with
mental illness also contributed to the view that cannabis users are unstable and potentially
dangerous. Hotspots were seen as nuisances and law enforcement activities targeting can-
nabis hotspots enjoyed community support (“Nobody wants to see people smoking weed
around… They will call police”).

Cannabis use, social deviance and policing

Cannabis is an illegal substance, and its trade and use are subject to sanctions by the state (Room,
2005). Law enforcement, as an expression of state sanction for cannabis use, was a recurrent
theme in the participants’ accounts. For example, participants emphasized that cannabis hotspots
were the target of frequent crackdowns by police patrol teams and this made visiting hotspots
a risky venture. Cannabis is the primary target of street-level policing in Nigeria (Klein, 1994;
Klantschnig, 2014). Most participants (67/69%) had experienced multiple police crackdowns on
cannabis hotspots, which they variously described as a “terrible experience” and a “nightmare”
(see Erickson, van der Maas, & Hathaway, 2013). A male participant narrated:

One day I went to the spot and bought some weed. Before I could even light the stuf, I
heard people shouting “police” and everybody started running. I threw it away and ran.
I’ve had that experience several times.

According to the participants, the key reason for the policing of cannabis hotspots is the
illegal status of the drug. Cannabis consumption, therefore, becomes “primary deviance”,
and its disapproval leads to the marginalization of its users (Knuttila, 2002). Since most users
are from socially marginalized households, street-level policing may be seen as exacerbating
their marginality (Nelson, 2018). Policing also contributed to the normalization of violence
in the day-to-day life of street cannabis users. According to a female participant:

Police arrests people who use drugs because they have committed a crime. Cannabis is
an illegal drug. Those who smoke cannabis are treated like criminals. When you are
caught taking it, you will be taken to police cell.

Cannabis hotspots were also targeted because of the widespread view that cannabis users are
criminals, regardless of their actual criminal status. Hotspots were, therefore, seen as hideouts
of criminals and crackdowns are considered part of the crime prevention mandate of the police.
Some participants (47/48%) acknowledged that some cannabis users engage in criminal activities
such as cultism, armed robbery, shoplifting, pick-pocketing and swindling. They, however, felt
that characterizing all cannabis users as criminals was an unfounded generalization1 (Dirisu,
Shickle, & Elsey, 2019). Such generalization refects a negative categorization of cannabis users,
which contributed to stigma and discrimination. A female participant explained:

People think that those who smoke weed are criminals, and that hotspots are places
where cultists and criminals hide. If you smoke weed people will see you as a criminal,
and they will suspect you. It is very bad.

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Societal stigma related to cannabis use tended to drive the behavior underground and fa-
cilitated the development of subcultures of cannabis use situated in hotspots (“I don’t want
trouble with anybody. I smoke at the bunk with people who can understand”). This corrob-
orates Sandberg’s (2012) view that subcultural use of cannabis is usually the result of negative
societal attitudes that force young people to hide their use to avoid the efect of stigma.
Participants also hide to use cannabis for fear of police harassment and extortion, as seen in
the following comment:

Police come to the hotspots frequently. They behave as if they have nothing else to
do than to harass people. When they come, they arrest many people in order to make
money. Police is our major problem.
(Male participant)

Street-level policing did not deter cannabis consumption. Participants (64/66%) attributed
their persistent use of cannabis, even in the face of repressive policing, to dependence on
the substance as well as its usefulness for daily functioning and for coping with personal
and social problems (see also Dirisu, Shickle, & Elsey, 2019; Nelson, 2021b, 2021c). The
discrepancy between young people’s motivations for cannabis use and the legal assumptions
underlying criminalization partly accounts for the failure of zero-tolerance policies to deter
young people from using cannabis (Klantschnig, 2014).

Policing, structural violence and well-being

Policing practices targeting street-involved cannabis users show how state sanctions for sub-
stance use could include deprivation of liberty (Room, 2005). The “coercive authority” of
the police (Terrill, Paoline, & Manning, 2003) may translate into brutality, including threat-
ened and enacted physical violence. Physical violence meted to people who use drugs by
police ofcers is common (Sarang, Rhodes, Sheon et al., 2010). Most participants (61/63%)
narrated being beaten by police ofcers. They explained that beatings violate their human
rights, and portend negative consequences for their health and well-being. A male partici-
pant stated:

The police can be very brutal and heartless. I have experienced it. I was once caught by
the police when I went to buy some weed. They pointed a gun at me. I was so scared
that I almost fainted. They punched me and threw me into the van… They treated me
as if I am not a human being like them.

Street-level policing generated fear among participants (“You are afraid all the time because
of the police”). Fear of police beatings, arrest and extortion was so palpable that the majority
of participants (64/66%) were willing to do anything within their powers to escape from
the police. The internalization of structural violence through fear had negative health efects
(“It (fear) can drive you crazy… You just get sick”). A female participant (7/37%) described
maltreatment of female cannabis users by police ofcers:

Police ofcers will not say because you are a woman we will not beat you. Of course,
they will not treat women the way they treat men. They will be less violent with
women. But they will still push you around.

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 Ediomo-Ubong E. Nelson

Arrested cannabis users (43/44%) could be extorted by police ofcers. Dealer-users who are
arrested could have their drugs impounded along with fnancial proceeds. Accounts indi-
cated that confscated items were usually not submitted at the police station, but were appro-
priated by the police ofcers. This was seen as theft perpetrated by ofcers (“They treat us
as criminals but they are the ones who steal from us”). Extortion and other corrupt practices
by police ofcers are forms of structural violence that negatively impacted the well-being of
street-involved youths.
Incarceration was seen as a severe form of structural violence toward street-involved
youths. Accounts highlighted a pervasive fear of incarceration among participants due to
the signifcant fnancial cost of obtaining bail. Nigerian anti-drug laws deny bail for persons
arrested for drug-related ofenses, including personal drug use (Klein, 1999). Apart from the
inherent injustice, this practice encourages extortion of ofenders by police ofcers. Police
ofcers easily escape the adverse consequences of their misdeeds since cannabis users deem
it more expedient to ofer money than to be arrested and charged for drug-related ofenses
(“Once they tell you that you cannot be bailed, you will ofer anything to be free”). A male
participant explained:

Nobody wants to be locked up in police cell. They will not release you unless you pay
a huge sum of money. Those who are arrested because of drugs cannot be bailed. Police
will use this to collect so much money from you.

Social marginality and estrangement from family and other sources of social support mean
that some cannabis users cannot aford bail and may therefore languish in detention. Incar-
ceration combines with poverty and lack of social support to further marginalize street-in-
volved youths. Incarcerated users experience dehumanizing prison conditions, which
includes overcrowding, poor sanitation and health risks (Osasona & Koleoso, 2015). A male
participant stated:

The cell is a terrible place. I have spent four days in the police cell before so I know what
I am talking about. It is very dirty and stinking. The odour can kill you. You can’t sleep
or eat in that place. I felt sick inside the cell.

Incarceration also confers a criminal record, which further compromises the life-chances
of street-involved youth. Accounts showed how a criminal record creates barriers to em-
ployment and other opportunities for street-involved youths. Crucially, a criminal record
fostered stigma and hampered employment prospects for participants who had served prison
terms (39/40%) (“You cannot get good job to do because you have been in prison… you are
like a criminal”). Unemployment, in turn, creates risk for involvement in criminal activities
as a means of survival, and this constitutes “secondary deviance” (Room, 2005). Criminal-
ization does not reduce the use of cannabis; it may even foster it by exacerbating the condi-
tions that made young people initiate cannabis use in the frst place.

Street habitus and responses to policing

Street-involved youths are not passive victims of structural violence in the forms of repressive
policing practices. They adopt diferent safety strategies based on their understanding of po-
lice tactics and the street environments (“street habitus”) to avoid police detection and arrest.
Street habitus has been described by Sandberg and Fleetwood (2016) as the “internalization

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 Street-level policing, structural violence and habitus

of social marginalization and structural violence entrenched through experience and social-
ization”. For street-involved youths, habitus involved heightened vigilance to detect police
presence at the hotspot and to escape from the scene. As an expression of “group habitus”,
or shared internalized dispositions (Bourdieu, 1990), some users would alert others about
the police so that everyone could escape. Accounts indicated that it is a “street code” to run
when others are running. A male participant commented:

Once police ofcers enter the place you will see everybody running. It is only a fool
that will not run. It is better to be caught trying to escape than to be picked up like a
piece of wood.

Running is a key escape strategy for street cannabis users. Accounts emphasized that this was
so common that it was said to be used by some users as a ruse to fool the others (“They will
start running and when you join, they will laugh at you”). This did not stop people from
running when they saw others doing so. A male participant stated:

If you don’t run because you feel someone is trying to fool you, you may fnd that police
men were actually around and you are caught. It is better to run than to be caught. So,
you just run, whether it is true or not.

Most participants (54/55%) threw away the wraps of cannabis in their possession as they took
of for safety. This was a common practice because in the event of being caught, it is the pos-
session of drugs and related paraphernalia that justifes arrest. Accounts indicated that some
cannabis users (21/22%) would swallow wraps of cannabis so that no incriminating evidence
could be found on them. A female participant commented:

Police ofcers must not see you holding weed. You have to put it away. You may have
to swallow your weed so they don’t see it on you. If police fnd weed on you, you are
in big trouble.

Accounts showed how street-involved youths were selectively targeted by police ofcers
during crackdowns. Those who ft the “junkie” stereotype (looking unkempt) are often
apprehended by police ofcers. Street habitus therefore meant beating the junkie stereo-
type through “impression management” (Gofman, 1959). Improving personal appearance
to avoid police detection and arrest was a common escape strategy. A male participant stated:

The police are looking for a young man who has not had a bath for many days. One who
is dressed in a dirty jean and torn T-shirt, and whose lips are burnt by cannabis smoke.
Then you walk pass well dressed, with your smart phone in your hand. You don’t look
at them. They will not suspect that you are a user.

As cannabis users engaged with street policing, they adopted new attitudes and practices,
which overtime became part of street habitus. This habitus is often demonstrated in situa-
tions where policing did not follow familiar patterns. For example, police ofcers occasion-
ally stopped all “suspects” for search regardless of their appearance. This involves frisking
and stripping suspects, and ransacking purses, wallets and pockets (Dixon & Maher, 2002),
which could be seen as sexual harassment of female users by mostly male police ofcers. Par-
ticipants generally counted on “luck” in such circumstances. A male participant commented:

393
 Ediomo-Ubong E. Nelson

Everything depends on your luck. You escape because you are lucky. That’s all. Some-
times you can pretend that you are not a drug user and go free. But other times the
ofcers will stop everybody for search, even if you don’t look like a drug user.

Others articulated a more empirically based understanding of changing street policing strat-
egies, suggesting that street habitus may be updated the hard way, including through wit-
nessing or experiencing arrest. A male participant narrated:

One time police came to the hotspot and we took of, not knowing that there were
police ofcers running with us. They pretended to be “customers” (i.e. cannabis users).
Before we knew it they turned and arrested people... I learnt a lesson that day… You
have to watch your back when you escape. Know who is with you.

Accounts indicated that arrested cannabis users could beg for pardon or ofer money to police
ofcers to be freed on-the-spot. Bribing police ofcers was seen as a smart thing to do since
suspects on drug charges have no right to bail (Klein, 1999).

Discussion
The fndings show that limited opportunities for gainful employment in the formal sector,
owing to low educational attainment, and street involvement facilitated contact with street
youths who use cannabis and infuenced initiation of cannabis use by participants. At the
inter-personal level, contact with other street-involved youths who use cannabis normalized
the behavior and made it possible for participants to start using. This shows that canna-
bis use initiation is not solely the consequence of an individual’s decision or action, but is
also infuenced by negotiated actions between individuals (Holland, Ramazanoglu, Sharope
et al., 1992) and macro-structural factors (Rhodes, Wagner, Shannon et al., 2012). Structural
antecedents of cannabis use included poor educational attainment and lack of employment
opportunities. However, inter-personal relationships and shared beliefs about the positive
efects of cannabis undermined social control mechanisms and facilitated the development of
cannabis subcultures (Becker, 1968; Holm, Sandberg, Kolind et al., 2014).
Conventional explanations of drug use behavior view it as the outcome of individual
decisions and actions. The data presented in this study shows that cannabis use by street-in-
volved youths is infuenced by social and structural factors, not only individual decisions.
Following Buchanan, Khoshnood, Stopka et al. (2002, p. 40), I emphasize that drug use
behaviors are “largely symptom(s) of deeper social structural inequalities and… eforts to
eliminate illegal narcotics use are, and will continue to be, futile until (the) society ad-
dress(es) these fundamental antecedent political-economic problems”. Drug use and related
harms are “features of the political economy of social sufering” (Rhodes, 2009, p. 196). For
marginalized street-involved youths, cannabis use serves as self-medication for “oppression
illness”, which is the “product of the impact of sufering from ‘social mistreatment’; a type of
stress disorder where the source of the stress is being the object of widespread and enduring
discrimination, degradation, structural violence and abusive derision” (Singer, 2004, p. 17).
Against this background, social policies that seek to improve access to social services, includ-
ing education, healthcare, housing and employment, for street youths may do more to reduce
drug-related harms than enforcement-based policies that often exacerbate these problems.
In Nigeria, studies have consistently associated cannabis use among young people
with lived experiences of structural inequality (Klein, 1999; 2001; Nelson, 2018; Dirisu,

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Shickle, & Elsey, 2019, Nelson, 2021a, 2021b, 2021c). Cannabis use provides street-involved
young people with the benefts they are excluded from, including coping with personal and
social problems, relieving anxiety and stress, access to income-generating opportunities and
social bonds. However, inclusion and exclusion go hand in hand (Dixon & Maher, 2002).
Cannabis is an illicit drug and its use is subject to state sanction. Although it fosters social
bonds among users, it also attracts stigma and discrimination which reinforce their exclusion
from mainstream society (Hammersley, Jenkins, & Reid, 2001; Room, 2005). Stigma is not
only attached to cannabis use, but also to the physical environment where it is used so that
these environments become the material symbolism of social marginalization and exclusion
or a form of symbolic violence against these youths (Bourdieu & Wacquant, 1992).
As the participants’ accounts highlighted, street-involved youths lived day to day in a
context of violence and fear. They were subjected to beatings and harassments by police of-
cers. They were frisked, stripped and searched for “incriminating evidence” and extorted in
ways that they saw as unfair, inhumane and violating fundamental human rights. Accounts
also revealed unlawful practices by police, including sexual harassments, confscation and
dispossession of drugs, money and other valuables. The zenith was incarceration for posses-
sion of cannabis for personal use, which exposed these young people to health risks in prison
environments. I found that violence was ubiquitous in the lives of street-involved youths,
and there was an inevitability of emotional and psychological harms alongside the physical
ones. Violence, exercised through police authority, was internalized and embodied as inhu-
man conditions of life that dehumanizes, depersonalizes and discredits (Shotter, 1993).
I argue that punitive policing that facilitates dispossession and impoverishment, health
risks, stigma and criminal record in the absence of social services can amplify drug-related
harms for an already marginalized population. As Elliot, Golub and Dunlap (2012, p. 218)
pointed out, punitive policing “establishes a context in which the risks of deleterious forms
of psychosocial exposure may trump those involved with the actual marijuana use”. Apart
from a restrictive deterrence, including modifcations of cannabis use practices to avoid
detection and sanction, street-level policing did not reduce cannabis use but displaced it
to neighborhoods where it was previously unknown (see Nelson, 2018). Similarly, street-
level policing, partly implemented as a crime control measure, may unintentionally increase
crime as street youths released from police detention without means of livelihoods turn to
criminal activities to generate income for survival.
The fndings document diferent situational strategies adopted by street-involved youths
to detect and evade police arrest, which indicates that these youths are not passive toward
structural violence mediated by punitive policing practices. Social theorists have emphasized
the capacity of human agents for invention and creativity. In drug use research, “habitus”
(Bourdieu, 1990) is widely used as a conceptual tool to explore internalized capacity for re-
sistance and inventiveness in relation to structural constraints among people who use drugs
(Grundetjern & Sandberg, 2012; Haritavorn, 2014; Sandberg & Fleetwood, 2016). I argue
that the balance between agency and structure in the feld of illicit drug use is itself deter-
mined by structural forces. The strategies used by street-involved youths did not always
enable them to avoid police arrest or mitigate the disempowering efects of structural forces.
In some cases, it led to more harms and sufering, reproducing a vicious cycle in which those
who are oppressed are unconsciously complicit in their structural subordination (Bourdieu,
2000). This proves that Kleinman, Das and Lock (1997, p. ix) were right in arguing that,
“social sufering results from what political, economic and institutional power does to peo-
ple, and reciprocally, from how these forms of power themselves infuence responses to social
problems”.

395
 Ediomo-Ubong E. Nelson

My fndings support the case for structural interventions to reduce drug-related harms
for street-involved youths. Importantly, they highlight the need for a public health approach
to street-level policing, which involves the exercise of discretion by law enforcement ofcers
in order to balance diferent interests, including crime control, health and human rights
(Moore, 1992; Maher & Dixon, 1999). Government should prioritize and invest in treat-
ment services for people who use drugs, particularly for street-involved youths who use in
potentially harmful ways (Mallet, Rosenthal, & Keys, 2005; Nelson & Francis, 2021d) and
face signifcant barriers to healthcare services (Barker, Kerr, Nguyen et al., 2015). The Ni-
gerian state should follow the example of other countries who have found decriminalization
of drug possession for personal use efective in reducing consumption and facilitating access
to treatment for dependent users. Decriminalization of personal drug use is also an essential
measure for curbing drug-related corruption in the police and safeguarding the rights and
dignity of people who use drugs.

Conclusion
Despite the large investments that have gone into government eforts to curb cannabis use
through enforcement-based approaches, such eforts have not delivered their expected im-
pacts. Instead, they have served as structural and systemic mechanisms that mediate violence
and sufering in the day-to-day lives of street-involved youths, reinforcing the very condi-
tions that facilitated their use of drugs in the frst place. This is so because current policies
do not consider the social-structural and political economic forces that infuence drug use
behaviors. A distorted view of drug use that blames individuals and exonerates the system
contributes to inefective policies that are based on misguided priorities (e.g. investment in
policing while neglecting treatment and social services for young people who use drugs). I
argue that street cannabis use (and retail trade) will persist as long as young people are struc-
turally excluded from basic social and economic benefts through the failure of the Nigerian
“petro-state” to redistribute oil revenue and redress fundamental structural inequality. The
development of social policies that promote equity and inclusion and improve access to basic
social services for the vast majority of young people ofers scope for the reduction of drug
consumption and related harms in Nigeria.

Note
1 None of the participants admitted being involved in criminal activities, but attributed such activ-
ities to anonymous others.

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 24
ETHNIFIED INTOXICATION –
KHAT USE AND THE SOMALI
COMMUNITY IN SWEDEN
Johan Nordgren

Introduction
Khat is a plant that is grown and used for its stimulant efects in several nations on the Ara-
bian Peninsula and in East Africa. The ways in which khat is used vary between settings, but
its use is generally a male pastime, where the recently harvested leaves and stems of the plant
are chewed and stored in the cheek (Carrier 2007). Specifcally, this chapter focuses on khat
use and its association with a Somali community in Sweden.
In places where khat is a legal commodity, the consumption often takes place in special
khat cafés, known as a mafrish in Somali, where users meet to socialize, gossip, give advice,
support each other or watch the news or sports (Carrier 2007). The pleasurable efects of
khat use are referred to as mirqaan in Somali (Carrier & Klantschnig 2012: 29) and entail a
stimulation of the central nervous system which facilitates social interaction. Khat users of-
ten spend a few hours of pleasurable socialization and conversation with friends or acquain-
tances, which could be comparable to the “Western” habit of after-work beer drinking. This
aspect of khat use as a somewhat socially accepted pastime is common in countries where
khat is a legal commodity, for example, in Somalia. Consequently, migrating to countries
where khat is classifed as an illicit substance changes the context for use (Anderson et al.
2007; Carrier 2007).
Khat is currently an illicit substance in most European countries, with Norway and Swe-
den as the frst to criminalize khat in 1989, followed by Denmark and Finland in 1993. The
Norwegian and Swedish bans on khat were primarily based on customs interceptions of khat
at airports, and since the plant material contained cathinone and cathine, two substances
banned both in Sweden and internationally, khat as a plant material was rather quickly
classifed as an illicit drug. In the late 1980s, khat was not extensively used in Sweden, and
the decision to ban khat was based on the pharmacological classifcations of the UN drug
conventions (Nordgren 2017).
The use of khat has subsequently been controversial in Europe. Carrier and Klantschnig
note that: “Perceptions of [khat] are polarized: some see it as a noxious drug destroying
health and the social fabric, while others extol its virtues as a mild stimulant whose con-
sumption binds people together” (Carrier & Klantschnig 2012: 29). This division in attitudes
toward khat is notable in production countries, but has also been seen in diaspora contexts in

400 DOI: 10.4324/9780429058141-31

 Ethnified intoxication

Europe. Klein has summarized some of the negative efects ascribed to khat use: “Khat,
it is claimed, diverts active Somali men from the workplace, drains state-beneft-dependent
household budgets, puts a strain on family relationships, and prevents the integration of
Somalis into the UK mainstream” (Klein 2007: 57). This type of discourse about khat has
shaped discussions about the criminalization of khat in the Netherlands and in the UK. Khat
was classifed as a “soft drug” in the Netherlands at the beginning of 2013 and as an illicit
class C drug (least capacity for harm) in the UK in the summer of 2014 (Nabben & Korf
2017). As khat was criminalized in the Netherlands and in the UK, there has been a shift in
the type of khat used in the diaspora, from newly harvested khat to dried khat in the form
of leaves or a green powder, referred to as grabo. Dried khat is signifcantly less potent than
fresh khat but is easier for users to access through international parcel shipments (Kassim
et al. 2015).
In the early 2000s, khat use began to be described in media reports as explicitly of con-
cern to Somali immigrants and their culture, not only in Sweden, but also in other Scandi-
navian countries. The use was claimed to cause unemployment, divorce, violence, psychoses
and other mental health issues, as well as lack of integration, family fnancial issues and var-
ious social problems (Osman & Söderbäck 2011; Nordgren 2017). The public debate about
khat in Sweden focused exclusively on khat use as a signifcant problem among the Somali
community. Khat was an issue that mobilized diferent actors in the Somali diaspora over
several years in Sweden. Anti-khat campaigns were initiated by Somali ethno-national orga-
nizations, and voices calling for increased police focus on khat use and smuggling appeared,
and the various physical and social harms of khat use and abuse were reported in daily
newspapers. Local social services, medical institutions and Somali ethnic organizations were
engaged in stopping khat use and ofering help and care to those who used khat in problem-
atic ways. These initiatives were often deployed at the local municipal level in cooperative
projects initiated by local Somali organizations. The notion of “cultural competence” was
frequently employed in khat projects as a tool to get Somalis to quit using khat, for exam-
ple, by recruiting Somalis of high standing in the community to inform about the potential
harms of using khat (Nordgren 2017).
Taken together, these developments have made the use of khat an example of what I call
ethnifed intoxication. This concept denotes the process by which a psychoactive substance and
its use is “made ethnic” in social discourses and practices (Nordgren 2017). For example,
by the time specifc municipal projects against khat use were initiated in the second half of
the 2000s, khat had become thoroughly associated with Somali immigrants, as seen in the
projects’ tendencies to target the Somali ethnic minority as a whole. This was a general de-
velopment in the Scandinavian countries, judging by the synchronicity of similar projects in
Denmark and Norway at that time (Nordgren 2017).
Public discourses and societal interventions about Somalis and khat use in Sweden com-
bine into an interesting case in which a criminalized drug becomes associated with a par-
ticular ethnic group. Ethnicity is a notoriously slippery concept that is used in diferent
ways across scientifc disciplines, theoretical schools of thought and in everyday language
(Baumann 1996; 1999; Jenkins 2008; Eriksen & Jakoubek 2019). My perspective on ethnic-
ity follows scholars such as Richard Jenkins and Gerd Baumann and is processual and con-
structionist, which means that ethnicity is something that is continually socially constructed
through everyday interactions and through societal discourses. This view makes it difcult
and to some extent futile to pinpoint what ethnicity is. Instead, the focus lies on how eth-
nicity is made, what changes occur over time and how it is understood in diferent social settings
( Jenkins 2008).

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Overall, this chapter is about interrelationships between intoxicants and ethnicity. Taking
a point of departure in qualitative interviews with ethno-national civil society organization
representatives in the Somali community in Malmö, Sweden, it examines how khat use and
Somalis as an ethnic minority in Sweden have become entangled in public discourse.
My analysis is another example of a long tradition within social sciences to research
how ethnicity and intoxicants or illegal drugs have become entangled (Musto 1973/1999;
Helmer 1975; Reinarman 1979; Bourgois 1996/2003; Manderson 1997; Jenkins 1999; Buce-
rius 2014). An important theme in research about drug use and ethnic minorities is construc-
tions and associations between ethnic or racial minorities and how these have infuenced
drug policy and attempts to control the use of drugs in society. Common threads in existing
research are that moral panics regarding drugs and ethnicity occur because of racism, stereo-
types, systematic discrimination and socioeconomic class relations between social groups.
The entanglement of ethnicity and drugs is a sensitive issue, considering that drug use is a
criminal ofense and is associated with a strong social stigma, particularly if one is physically
dependent or engages in problematic drug use (Singer & Page 2014). In Sweden, khat use
is ethnifed as a kind of illicit drug use engaged in by members of the Somali community.
In the following, I will frst briefy present some methodological considerations about my
feldwork at Somali ethnic organizations in Sweden and the interviews I conducted with
community representatives. I will then present the main fndings from the study, with a
focus on how the Somali organization representatives engaged with the issue of khat use. Fi-
nally, I will discuss my fndings by drawing attention to how ethnicity and intoxication can
be understood through diferent “construction sites of ethnicity” – arenas where ethnicity
comes into play and becomes important.

Methods and data

During a period of feldwork from 2014 to 2016, I conducted 16 qualitative semi-structured
interviews with persons who were active in Somali ethno-national organizations (see Nor-
dgren 2017 for the original study). In total, 11 diferent organizations are represented in the
empirical material. The site of the feldwork was Malmö, Sweden, a city of around 300,000
inhabitants in the south of the country. Several Somali organizations in the city ofer a range
of activities, help and resources to persons who identify as ethnic Somalis. To some extent,
these organizations, which often have locales situated in socioeconomically marginalized
areas of the city, act as “integration centers”, as members and visitors are ofered practical
help, for example, with their contacts with various governmental bodies. The organizations
also ofer integration projects, youth activities and study circles.
I contacted the chairpersons in several Somali organizations, who I interviewed and
who referred me to other interviewees they felt had valuable knowledge about khat use in
Sweden. The interviews concerned the interviewee’s personal background in relation to
engagement in a Somali organization, his or her views on khat and khat use, an assessment
of the extent of khat use in Malmö, views of khat in relation to Somali ethnicity, and the
potential for stigmatization of the Somali ethnic minority while discussing khat use as a So-
mali problem, and also covered methods of helping those who use khat in problematic ways.
Five of the interviewees were women, refecting the fact that there were few women in
general having elected positions in the organizations. The organizations are similar to those
studied by sociologist Nauja Kleist’s in her study of Danish-Somali ethno-national orga-
nizations. Kleist found those to be male-gendered spaces of recognition within a diaspora
context, where “high-status Somali men use associational and community involvement to

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create alternative social spaces of recognition”, where social esteem and respectability can be
acknowledged (Kleist 2010).
The interviews took place face to face, in the locales of the organizations, in cafés or at
my ofce at the university, and each interview took around one hour to conduct. I asked
to record all of the interviews, but four of the interviewees did not want to be recorded. In
those cases, I took detailed notes during the interview and expanded these notes as soon as
possible after the interview. Three of the interviewees were not comfortable conducting the
interview in Swedish, so these interviews were carried out in English. I have made minor
grammatical changes to the quotations, while trying to retain the colloquial nature of ev-
eryday speech. I have anonymized the interviewees and their organizations. Although I felt
I achieved empirical saturation during the feldwork, 16 interviews is a somewhat limited
sample and I use the interview material to theorize about ethnicity and intoxicants, not to
generalize about Somali ethnic organizations or their representatives.
In the work on this chapter, I have revisited the empirical material from the original study
in order to draw up some further research fndings about ethnifed intoxication. My ana-
lytical approach when returning to the transcribed interviews has been abductive (Charmaz
2014) in the way I have let the analysis be guided by both my thematic coding of the empir-
ical material and by theoretical literature concerning intoxicants and ethnicity.

Results
In the following, I will discuss how the Somali organization representatives understood and
discussed the issue of khat use and how they navigated between diferent discourses about
ethnicity and intoxicants.
The Somali representatives who I interviewed were keen to discuss public discourses about
both the Somali group in Sweden and perceptions about khat use. The Somali community has
become more visible as increasing numbers of people from Somalia have migrated to Sweden
since the 1990s. This migration pattern is associated mostly with the Somali civil war, which
has created a Somali diaspora in the West (Pérouse de Montclos 2003). In Scandinavia, the
Somalis, as a group, are constructed as a particularly vulnerable and at-risk population, often
described in discourses about the integration of all ethnic minorities as being the specifc group
“most difcult to integrate” (Fangen 2007). Somali minority members have been stereotyped
as engaging in khat use, female genital mutilation, criminality and Islamic radicalism. Stigma-
tizing public discourses about the Somali community meant that the interviewees discussed
the public image of Somalis in Sweden. One of the Somali organization representatives dis-
cussed his view on how Somalis are portrayed in Sweden:

The problem [with the image] is that you have a whole lot of people who don’t have any
problems. People of Somali background who work, do research, play football, and so
on. That never shows in the media. /…/ What you hear about Somalis often concerns
khat or war or terror or pirates. /…/ When these are the only things discussed it gets
really problematic. /…/ I claim that this contributes to creating a [negative] image of
the Somali group in Sweden. /…/ It’s khat, female genital mutilation, pirates, and so on.
(Caadil)

Caadil and other interviewees resisted this construction and stereotyping of the Somali mi-
nority as a homogenous problematic ethnic collective. Khat use was one piece of this stigma-
tizing puzzle, and the interviewees expressed great concern about this unwanted association

403
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between a criminalized intoxicant and their ethnic minority group. They actively resisted
this association because they argued that it created stigma toward the Somali ethnic minority
as a whole. One organization representative said:

You stigmatize a whole group for something that maybe one or two percent of that
group does. So I think that it’s no problem to focus on the khat issue, but you have to
bring up this issue in a way that does not stigmatize a whole group.
(Mursal)

A common view held among the representatives was that projects specifcally targeting the So-
mali ethnic minority in relation to khat did not represent the best way forward. Instead, initia-
tives focusing on structural issues such as making it easier for Somalis to get employment and
enroll in education were proposed. Some of the interviewees argued that it was “unfair” that
Somalis were targeted exclusively, since they could identify other ethnic categories of people that,
in their view, were prone to using khat. This was a way to resist the meaning ascribed to khat use
as relating to Somali ethnicity, by claiming that khat use was not exclusive to Somalis:

It is not only Somalis who chew. /…/ Alright, it is the largest group that chews. But also
the Ethiopians chew. People from Yemen chew.
(Shamso)

Similarly, Mursal engaged in ethnic boundary-making (Eriksen & Jakoubek 2019), situating
khat use mainly within Yemeni culture:

Khat grows in Ethiopia and Kenya. If it were part of our society, then it would have
grown also with us [Somalia and Somaliland are dependent on khat importation from
neighboring countries]. And also, when people say that it is our culture, I mean, it orig-
inally came from Yemen.
(Mursal)

By attempting to include a larger population, those from other East African nations and from
the Arabian Peninsula, the interviewees aimed to reduce the ethnic targeting of Somalis in
general in relation to khat in the Swedish setting.
In public discourse, khat use has often been discussed as an important reason for socioeco-
nomic marginalization among men of Somali background (Anderson et al. 2007). Most of
the interviewees, however, tended to describe khat use as a way of navigating and handling
a situation of marginalization and discrimination in Swedish society, turning the dominant
discourse of cause-and-efect on its head. This was related to a symptom perspective held
by several of the interviewees, a view that explains individual drug use as a way of handling
difcult structural socioeconomic circumstances. In a way, what the interviewees were say-
ing was that khat use is a social problem that has been put in an ethnic disguise (cf. Ålund
2002; Eliassi 2013). The interviewees nuanced the image of khat use as a problem of Somali
ethnicity or culture, by bringing up complexities regarding socioeconomic marginalization
and gender issues in the Somali diaspora setting. Bilan recounted a story which represents an
example of the gendering of khat use:

One husband who chewed too much khat always came home late after chewing and by
then everyone in the family had gone to bed. This man then always slept throughout the

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day and when he woke up the wife had gone to work and the children to school. One
day the husband saw a small child in the apartment and asked his wife whose child that
was. The wife told him that it was their child, whereupon the husband replied: “When
did we get that?”
(Bilan)

In Bilan’s narrative, the husband is lacking in his care of the family and he is depicted as
a weak fgure in comparison to his responsible wife, who is active and works, and their
children, who go to school. The husband is unemployed and spends as much time as he can
socializing with his friends away from the family, employing the functions of khat use, a
pleasure only he can partake in. The husband is so irresponsible that he even forgets who
his own children are. Bilan’s narrative can be put in relation to what has become known as
“getting the black sack”, described by Kleist as “women, tired of their unemployed, good-
for-nothing husbands chewing khat instead of helping out with the daily chores, kick them
out with their belongings in a big black rubbish bag” (Kleist 2007: 141, italics in original).
This narrative highlights gendered socioeconomic problems in a diaspora setting, rather than
explaining khat use as explicitly ethnic.
The interviewees also framed the issue of khat use through more nuanced lenses than
the perspectives represented in public discourse. The interviewees frequently described khat
use as a serious social problem, but also spoke about the functions associated with khat use,
which include being social, engaging in building strong social relationships and eforts in
understanding and helping each other. This was seen as important to those who use khat
regularly, since those users experienced social exclusion and marginalization. However, this
exclusion was also seen as a consequence of the users spending too much time engaging
in khat use with their friends or acquaintances. Mursal and several others pointed out the
positive social functions of khat use, a function that nevertheless could become problematic:

So all these problems mean that people start or continue to chew khat. And then that
turns into a social club. They chew together, it’s a club. They share experiences, they
speak about their problems, and no one else in the society understands them better than
they themselves can understand each other. So each person is dependent on the other,
on the active listening of the other. And when you have lots of problems then you want
someone who listens. And the more you chew together, the more you listen to each
other. And this has become some sort of therapy for the Somalis.
(Mursal)

Although the use of khat in Sweden is extensively explained in ethnic terms, the represen-
tatives of Somali organizations framed the issue of khat use as a social problem, specifcally
by drawing on discourses pertaining to what are generally referred to as “drug and alcohol
problems”. They argued that it is possible to use khat in a controlled manner, but that some
people become addicted or use khat too frequently. Those who use khat too much were
referred to as being muqayil. “That means that that person chews a lot /…/ [Somalis] don’t
really have a word for [drug] abuse… [khat is seen] as eating food, nothing dangerous. But
muqayil means that this person doesn’t do anything else besides chewing” (Caadil). This kind
of person represents the stereotypical khat chewer, a male person who is unemployed and
who spends day and night chewing khat to the detriment of his familial responsibilities.
The notion of muqayil hints at a division between the use and abuse of khat. Ayax argued
that:

405
 Johan Nordgren

There are users and abusers. Right now there are no users anymore, only abusers, be-
cause the users cannot get hold of khat when they want. A user might have a day of on
Friday, but [the khat shipment] doesn’t come on Friday but on Monday
(Ayax)

Since the khat market is criminalized, the users have a hard time planning their use, being at
the mercy of when and where new shipments of khat enter the country. In Ayax’s argument,
this means that it is difcult to use khat in a non-problematic way, since the irregularities
of the illicit market mean that one would have to forsake regular activities such as work or
education. Extending this argument, Ayax said that the khat user can use khat when he wants
to or feels a need to do it, but the khat abuser: “He might take grabo or fresh khat, he doesn’t
work. Because he only waits and waits [for khat], he’s an abuser. He has nothing to lose be-
cause he has lost his life” (Ayax).
Descriptions of being muqayil were similar to the ways “drunkards” and “drug addicts”
have been described in alcoholism and drug addiction discourses (cf. Singer & Page, 2014),
and these descriptions draw not on ethnicity, but relate to “drug problems”. The interview-
ees thus made a clear distinction between use and abuse of khat and ofered a more nuanced
view of khat that distinguished problematic khat use from recreational khat use.
Considering the way cultural competence has been framed as the solution to the problem of
khat use in both Sweden and Scandinavia broadly, it is interesting to note that the representatives
from the Somali organizations instead proposed interventions more in line with how drug abuse
prevention and treatment are generally organized in Sweden. They focused on regular substance
abuse treatment options and prevention work in the form of readily available information, but
no one suggested that these interventions would be tailor-made for the Somali ethnic group in
particular. Those who rejected specifc projects and interventions concerning khat instead argued
for broad structural developments that would allow more Somalis to gain employment or educa-
tion. In their statements, the interviewees more commonly suggested that problematic khat use
would be resolved by a focus on enabling Somalis to acquire employment or education. Mustafe’s
statement is an example of a common view among the interviewees:

Those who are in some form of dependency situation, it’s difcult for them. Perhaps
they need professional treatment methods. But those who only chew khat, and who are
still young, it’s very easy to turn their behavior around through vocational training,
work and school. There must be other things put in place that show them a better future.
(Mustafe)

This conceptualization was common, meaning that drug treatment was suggested for those
who had a problematic use of khat, while most users would be able to stop using if only they
were able to fnd employment or enroll in education. Mursal elaborated on this position:

What you need to do is to identify these individuals and create jobs for them. People
I know who used before stopped because they got a job or began to study. Then they
got into another [social] sphere, they changed friends. So [khat use] is more a thing of
peer-pressure and a social thing. /…/ It’s a habit, you get habituated to a vicious cycle
/…/ It’s not that you miss [khat] so much that your body shakes and so on. But if that
person can get into a situation where he can see happiness and feel that the situation is
positive, then he will be able to stop.
(Mursal)

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 Ethnified intoxication

However, this solution was often understood as problematic because of discrimination to-
ward the Somali ethnic category in Sweden, which makes it difcult to get a job. Mursal
insisted strongly on the need to create work opportunities for the Somali group. That was
a common theme in the interviews, and several of the interviewees spontaneously spoke at
length about the difcult situation within the Somali community in relation to work and
possibilities to gain work experience. The suggestion of employment opportunities instead
of treatment is interesting since it implies a view of khat use as more of a negative habit,
rather than as an “addictive behavior” or a “khat use disorder”, as suggested by medical
research (Duresso et al. 2016). Although khat use might sometimes be used in problematic
ways, the interviewees constructed the solutions to problematic khat use less in relation to the
drug itself or to ethnicity and culture, and more to the socioeconomic situations of the users.

Discussion
As seen in the interviewees’ statements, khat use is a complex phenomenon that can be ex-
plained in a wide range of ways. Although ethnic explanations loom large in prevalent un-
derstandings of khat use, all of the ethnic explanations have non-ethnic counter arguments
brought up by the Somali community representatives. How can we make sense of this?
A useful tool when disentangling processes relating to ethnicity is Richard Jenkins’ no-
tion of contexts of ethnic categorization. Jenkins (2008) discusses several “construction sites” of
ethnic categorization that range from formal to informal, including classifcations of ethnic-
ities made by governments, organized politics and everyday social interactions. For example,
organized politics is a “construction site” of ethnicity where social problems might become
constructed as identifed with ethnic groups and categories. Politicians, public ofcials, news
media journalists and commentators may shape and promote moral panics concerning eth-
nically constructed social issues ( Jenkins 2008: 71). Khat use is one such social problem
which in Sweden has tended toward becoming a drug scare, although not a full-blown one
(Nordgren 2017). Musto (1973/1999) analyzes how some drug use in the U.S. has been
ascribed to ethnic minorities, permitting more punitive measures to be taken against mi-
norities when blamed for what are essentially “domestic evils” integral to American society
(Musto 1973/1999: 298). As Jenkins argues, politics has historically provided a platform
where ethnic chauvinism and moral panics about ethnic problems are expressed, thus fur-
thering inter-ethnic conficts in society ( Jenkins 2008).
Jenkins also highlights the way ethnicity is constructed by ethnic organizations that aim
to represent ethnic minorities in society ( Jenkins 2008: 68). For example, the Somali civil
society ethnic organizations in Sweden claim to represent Swedish-Somalis and constitute
an arena of ethnic construction, both internally to the group and externally to the Swed-
ish ethnic majority society. Contexts of ethnic classifcation and construction are not hier-
archical however; they “overlap systematically in complex and interesting ways” ( Jenkins
2008: 73). This overlapping between diferent social contexts contributes to the resilience
of certain constructions of ethnicity. For example, if ethnicity becomes signifcant in many
diferent settings, ethnic explanations become robust and resistant to change ( Jenkins 2008).
How can the organization representatives engaged with the issue of khat use be under-
stood by reference to these construction sites of ethnicity? In the Results section, we could see
that the representatives had identifed several settings where the notions of Somali ethnicity
overlapped. In most cases, the ethnic identifcation was negative and stigmatizing, and so the
representatives resisted becoming caged by involuntary chains of associations, particularly
associations between “Somaliness” and illicit drug use, but also other stigmatized activities.

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When Somali organizations in Malmö initiated projects against khat use they reached
out to members of the Somali community and tried to infuence those who used khat to
quit using. As such, the project activities were aimed internally at the ethnic group, but also
externally at the ethnic majority society by way of signaling that khat use is a Somali ethnic
problem that the community is taking seriously. In public discourse and in societal interven-
tions such as projects aiming to stop khat use in Sweden, khat use has been strongly defned
as a “Somali problem” (Nordgren 2017). Drugs such as alcohol, amphetamine or cannabis in
Sweden are not seen as ethnic, and thus there is no specifc ethnic community that is singled
out to take responsibility for reducing their use. Use of these “non-ethnic” intoxicants is
rather a problem for the state, municipalities, the police and health care system to respond
to. Regarding khat use, a range of national and local municipal actors implied that there was
a responsibility of the Somali community to stop khat use. This notion has been identifed
by Goddard (2012) as a “responsibilization of communities”, meaning that ethnic minority
communities or organizations are sometimes pressured to reduce or solve social problems
that are constructed as “their own”. An interesting overlap here is that the organizations
wanted to stop khat use in the setting of everyday interactions, but also wanted to consider
the political arena and how Somalis and khat use are discussed in the media.
One informal ethnic construction site is public interactions with others, such as “verbal
and non-verbal cues which are used to allocate unknown others to an ethnic category”
( Jenkins 2008: 66). Studies by, for example, Bourgois (1996/2003) or Bucerius (2014) ofer
micro-sociological analyses of the way ethnicity, race and social marginalization interact in
the daily lives of people. For most of the interviewees, it was not problematic to say that some
Somalis use khat; this was a kind of ethnic construction of khat in the everyday setting. But
they were generally very sensitive to the fact that defning khat use as something Somali on
the political arena might have more far-reaching implications. This is because everyday con-
structions of social problems that are sanctioned by public discourse and national and local
institutions can acquire a privileged status ( Jenkins 2008). As noted before, the interviewees
were very concerned with the predominantly negative public image of Somalis in Sweden,
and one way of defecting this was to engage in ethnic boundary-making by stating that
other ethnic groups also use khat. In Sweden today, being identifed as Somali is more often
negative and pejorative than not, and for the organization representatives, khat use is one
reason for that. Thus, the Somali organizations acted to balance the need to help and sup-
port community members who use khat in problematic ways, with the risk of increasing the
stigma of assumed propensity for khat use to be transferred to people of Somali background
living in Sweden in general.
Another formal “construction site” is, as mentioned, the ofcial classifcation of ethnic-
ity, when governments conduct population censuses or surveys, or scientists study drug use
prevalence within diferent ethnic groups. These classifcations of people are an often used
knowledge base infuencing how policy formulation, targeted resources and social control
measures through institutional and governmental ascription of ethnicity are enacted (Gut-
mann 1999; Jenkins 2008). Ofcial classifcation of ethnicity is common within epidemio-
logical approaches to intoxicant use where respondents are asked to self-identify by choosing
from a list of “ethnicities” or “races”. These categories are then compared to each other in
relation to prevalence of self-reported drug use (De Kock et al. 2017). Such ofcial classi-
fcations of ethnicity aim to reduce the complexity of everyday ethnic identifcation into
manageable variables. The classifcations are often used by social welfare actors in order to
provide services to specifc groups that might be categorized as marginalized. In the UK,
for example, “black and minority ethnic” populations have been in focus for health care

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 Ethnified intoxication

and social welfare interventions (Beddoes et al. 2010). The interviewees seldom suggested
solutions and help based on ethnicity or cultural behaviors, although such interventions
are prevalent in social work and public health projects related to khat use in Scandinavia
(Nordgren 2017). This is not very surprising, given the way the interviewees often resisted
the association between Somalis and khat use. In their statements, the interviewees more
commonly suggested that problematic khat use would be resolved by focusing on enabling
Somalis to acquire employment or education.
The case of khat as an ethnifed intoxicant is thus an example of how the entanglement
of ethnicity and drugs encompasses diferent sites of ethnic construction. The results of
the study show that in a setting where a specifc kind of illicit intoxicant use is defned as
inherently ethnic, the interviewees could ofer other viable explanations for the use. The
over-determination of ethnic explanations ( Jenkins 2008) is problematic since other struc-
tural issues such as unemployment, poverty, marginalization, gender relations and social ex-
clusion tend to disappear from view. Approaches to understanding intoxicant use that do not
refect critically about defnitions and uses of ethnic explanations thus inadvertently mask
structures of inequality and can obscure other social causal forces impacting on groups and
individuals (Bourgois & Schonberg 2009).
More broadly, drug use among migrant minorities has become a social and political issue
in most “Western” countries (see, for example, Bucerius 2014; Lalander 2017). In Sweden
and Scandinavia, persons with a migrant background who use intoxicants have been de-
scribed in public discourses centered around social work as “vulnerable immigrants” rather
than “threatening immigrants” since the late 1980s (Nordgren 2017). Having been a ref-
ugee, experiences of forced migration before arriving in Sweden and the psychologically
distressing situation of waiting for permits and staying in refugee centers were all defned
as important reasons for immigrants starting to use drugs in Sweden. The so-called “drug
abusing immigrants” have been viewed by government institutions as a population at risk
and in need of targeted initiatives in order to make treatment attractive to them (Nordgren
2017). As early as the 1990s, the Swedish National Board of Health and Welfare wanted to
enroll migrants into treatment, and asked: “What can we do to ensure that drug abusers with
an immigrant background get access to our drug addiction treatment?” (quoted in Nordgren
2017). Treatment itself is often presented as crucial, amounting to a form of treatmentality,
where treatment is posited as a self-evident solution to address problematic drug use and, by
extension, a way of exercising social control and producing normalization ( Jöhncke 2009).
Through historical case studies of ethnifed intoxicant use and both repressive political rhet-
oric and ethnic conficts as a backdrop, we can see that in the case of Sweden’s extensive
welfare state focus, khat is ethnifed, but with the aim of including ethnifed drug users
rather than excluding them. While Chinese Canadians during the 1920s opium drug scare
were defned and targeted as a threatening and risky population that should be deported
(Carstairs 1999), Somalis in Sweden are instead defned and targeted as a population at risk, a
specifc group seen as burdened by khat use and thus entitled to social welfare interventions
(Nordgren 2017).
Within social welfare provisions, once a social problem has been ethnifed, it is difcult
to take a step back and ponder other explanatory models that could be used to understand
the problem at hand. It is also possible that a social problem is not really a problem, which
is an issue that has been extensively discussed in social problems theory (Goode 1990) but
which is beyond the scope of this chapter. In cases where the use of an intoxicant has be-
come entangled with ethnicity, my suggestion is to ask the following critical questions:
Why has this particular intoxicant become associated with an ethnic group? Who is making

409
 Johan Nordgren

and proposing the association? Are there underlying or unexpected motives or intentions
behind the associations made (such as ofering help and care, normalization, or racism and
discrimination)? What are the potential and plausible efects of the entanglement? What
other, non-ethnic, explanatory aspects might be of use in order to understand the problem?
I think that these questions can be important in furthering our understanding of ethnifed
intoxicants in a way that does not lean too much on ethno-cultural explanations and that
promotes critical and nuanced analyses of intoxicant use in society.

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 25
SYMBOLIC MEANING OF
THE AMPHETAMINE-TYPE
STIMULANT PROBLEM
THROUGHOUT THE
RESTORATION OF JAPANESE
SOCIETY AFTER WWII
Drug control and the construction of the other
Akihiko Sato

Introduction
Amphetamine and methamphetamine are categorized as amphetamine-type stimulants (ATS
hereafter). Japan is one of the frst countries to establish a law to control ATS. The Stimulant
Control Law in Japan was passed in 1951 and has been amended more than 20 times since.
Although ATS was almost eradicated in the 1950s by strict control, it returned, with people
abusing the drugs and becoming addicted in the 1970s and 1980s. Japanese society has of-
cially experienced an ATS epidemic several times since the end of WWII.
Considering the history of the ATS problem and its control in Japan, many current
Japanese scholars believe in a narrative, supported by ofcial documents, that “the Stimu-
lant Control Law was established because ATS caused addiction and psychosis after losing
WWII”. However, it is argued that this narrative may be a retrospectively constructed in-
vention. This chapter will give an alternative account of the ATS problem and its control in
Japan. In so doing, it will be shown that ATS in post-war Japan is not just a drug that has af-
fected the health of Japanese people but has functioned as a symbolic device with which Jap-
anese society has drawn its political, economic, and social boundaries. Furthermore, ATS as
a symbolic device has been used to maintain social order throughout the restoration period
of post-war Japanese society. Such a process is vital in understanding Japanese drug policy.
In the following, this chapter will begin by describing the process in which the Stim-
ulant Control Law was established and amended in the 1950s, presenting a legitimate
story of the law. This explanation of the process draws on a condensed description of the
author’s previous studies on ATS, followed by further consideration of the conversion of
medical knowledge on ATS (Sato 2006, 2009a, 2020). Second, the chapter will show that

412 DOI: 10.4324/9780429058141-32

 Symbolic meaning of the amphetamine-type stimulant problem

ATS control, both in the 1970s and in the 1980s, was, respectively, organized based on
each stage of the process of restoration of Japanese society, which yielded a newer symbolic
meaning for ATS.

Material and methods

In order to discuss the processes and the mechanism of ATS control, contemporary doc-
uments of the period on ATS have been used, including newspaper reports, news mag-
azine reports, the minutes of the Japanese National Diet (equivalent to the parliament),
and academic articles in medical journals. All news items related to ATS in three major
newspapers in Japan after WWII until the end of the 1980s have been examined: Asahi
Shinbun (hereafter Asahi), Mainichi Shinbun (hereafter Mainichi), and Yomiuri Shinbun
(hereafter Yomiuri). When referring to a report, the name of the newspaper source and its
date of publication will be displayed in the text. All minutes of the Japanese National Diet
(hereafter ND) discussions in reference to ATS during the same period have also been ex-
amined. However, only the minutes referred to in the chapter are listed in the references.
These materials were used to describe the historical process on ATS-related matters. The
chapter draws on a sociological method of the historical description that Gusfeld used
in his studies of the Temperance Movement in the United States (1968). As he pointed
out, the purpose of the sociological description of a historical process is to interpret and
generalize the properties of the process (Gusfeld 1968). For example, he analyzed the
discourse and the rhetoric of the Woman’s Christian Temperance Union using a wide va-
riety of printed materials. He revealed that the function of Temperance was to maintain,
and even improve, the status of the declining old middle class in the new and mobilizing
circumstances of American society early in the twentieth century. Although the present
study’s phenomenon takes place in a diferent time, Gusfeld’s method is still applicable in
analyzing movements for the control of ATS in Japanese society. Following his study and
method, the chapter focuses on discussing functions of the movement to control ATS in its
original context using the abovementioned material.
Additionally, all the medical papers related to ATS which were published in Japan, since
the frst detailing the discovery of methamphetamine (Nagai 1893), until the end of the
1980s, were examined and analyzed with the perspective of discourse analysis. Discourse
analysis is a method for analyzing talk and texts as social practices and describes the resources
that are utilized to make those practices possible, drawing on ethnomethodology, speech act
theory, and semiology (Potter and Wetherell 1987; Potter 1996). As used in many textbooks
on qualitative research methods in sociology and social psychology (Richardson 1996, Sil-
verman 2021), discourse analysis is seen as being one of the efectual qualitative methods for
analyzing discourse in sociological investigation. In Discursive Constructionism (Potter and
Hepburn 2008), a perspective of discourse analysis, talk, and text are treated in their own
right, “not” to show any reality that is assumed to lie behind such talk and texts. Rather, talk
and texts are analyzed as constructing work, in which some available discursive resources are
used to construct a reality relevant to the context of such talk and texts (Potter and Hepburn
2008). By using discourse analysis, medical papers on ATS have been analyzed in terms of
what functions those papers – and the medical knowledge produced – perform in the given
context. This discourse analytic approach, along with Gusfeld’s method, enables the robust
analysis necessary to show how medical knowledge both established and sustained the foun-
dation of the crucial processes in problematizing ATS and institutionalizing ATS control. In
the following sections, the symbolic process of ATS will be discussed in detail.

413
 Akihiko Sato

Te beginning of the ATS problem afer the war

Dominant story on ATS control

The ATS problem has quantitatively been the most prioritized drug problem in Japan (see
Figure 25.1). Compared to other countries, it is one of the most unique features of the Jap-
anese drug scene. In other words, in order to investigate the Japanese drug scene and drug
policy, it is vital to discuss how ATS and its control in Japan are problematized. Legislative
control of ATS began with the Stimulant Control Law of 1951.
Ofcial documents on the establishment of the Stimulant Control Law often referred to a
narrative as follows: Japan had a recognizable methamphetamine problem soon after WWII,
because many people were using stimulants as a means to relieve their mental stress, after
losing the war. The prevalence of ATS addiction and psychosis consequently led to the estab-
lishment of the law (Tadokoro 1998). Statistical data on the number of arrests for violation
of the Stimulant Control Law illustrates the increase (Figure 25.1).1 In the 1970s when the
second wave of a Stimulant Abuse Epidemic hit Japanese society, the same story was again
referenced, in order to legitimize contemporary measures.
However, as previously discussed, this narrative was constructed retrospectively, that can
be labeled “the post-1954 framing”, and is, therefore, an invention (Sato 2020). The post-
1954 framing was constructed during the movement for the eradication of ATS in 1954, and
consequently rationalized the strict control over ATS by re-writing the earlier history of
the ATS problem. An alternative account of the narrative, supported by the contemporary
documents analyzed for this chapter, will be discussed.

60000

50000

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10000

0
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Stimulant Cannabis Narcotic & Psychotropic

Figure 25.1 Number of arrests for violation of drug laws in Japan 1951–2019

414
 Symbolic meaning of the amphetamine-type stimulant problem

Beginning of ATS control and the condemnation of some groups

in the late 1940s
Methamphetamine was discovered in Japan in 1888 (Nagai 1893). However, it sank into
oblivion in Japan until the 1940s, when several researchers began to argue for its medical
application (Horimi et al. 1940; Ariyama 1941; Miura 1941). ATS was then made available
for commercial use in Japan as various patented medicines (Sato 2009a: 721). Philopon (i.e.,
methamphetamine) was one of the most popular ATS and its name was synonymous with
ATS until the 1970s. ATS was used even by the Imperial Japanese Armed Forces during
wartime.
Some contemporary documents suggested that many people after the war recognized that
ATS was useful for enhancing their productivity of work.2 One such record was found in the
minutes of the ND, with one representative of the ND calling into question the administra-
tive measures for ATS in November 1949 after Philopon was designated as a powerful drug
to prevent abuse. The representative complained about a limited allocation of production to
control the amount of ATS,3 claiming,

I have some questions about the Philopon problem. The Ministry of Health and Wel-
fare, in the name of the permanent undersecretary, asked every pharmaceutical com-
pany to stop producing or reduce the amount of production of Philopon and other
stimulants. However, the general working public and the industry have been sufering
from such measures. According to medical and pharmaceutical points of view, the stim-
ulants represented by Philopon are excellent drugs.
(ND 1949, November 24: 1116)

He added that the problems associated with Philopon were confned to small groups of users
and that it would be better to enforce strict control over them, rather than controlling ATS
use by the entire population.
As shown above, ATS had already drawn people’s attention by its abuse. However, it also in-
dicates that people in the late 1940s still talked about the positive efects of ATS, even after it was
claimed to be problematic. The problems associated with ATS were not attributed to the drug
itself but to specifc groups such as novelists, performers, and students, who were thought to be
responsible for the ATS abuse problem (Asahi 1949, March 29). In other words, the ATS problem
was not interpreted as an “ATS induced problem” but a “specifc groups induced problem” (Sato
2006: 242). The discourse of the representative of the ND constructed and defned the current
problem as related to ATS, as the situation was caused not by the efect of ATS but by the specifc
group of people. The “general working public” also used the same drug, but with no blame. This
was the beginning of the symbolic process of ATS in Japan.

Moral judgment and medical knowledge

One of the reasons behind adopting two measures on ATS by the Ministry in 1949, i.e., the
designation of being a powerful drug and the guidelines for ATS production, was prior to
their adoption. It is traced to the two conspicuous deaths of celebrities: the death of a pop-
ular comedienne, Miss Wakana (Kikuno Kawamoto, 1910–1946), in October 1946 and of a
famous novelist, Sakunosuke Oda (1913–1948), in January 1948. Both were well known for
using Philopon and their deaths were attributed to it (Sato 2009a: 723).

415
 Akihiko Sato

Te demand for ATS control by medical doctors

After Miss Wakana’s death, the frst medical paper claiming an ATS problem in Japan was
presented at a conference on internal medicine in 1947. The paper mentioned just one case
related to the acute intoxication of methamphetamine (Nakazaki and Mori 1947). However,
attendees of the conference were quick to respond to the case and vehemently insisted upon
the need for control of ATS by medical doctors, referring to Miss Wakana’s death and also
to ATS abuse by other performers.
It can be argued that those comments at the conference demonstrate that a conversion of
discourses in ATS studies had begun. The contents of these comments had explicitly con-
verted from those of the ATS studies published before Miss Wakana’s death. For example,
Taro Horimi commented on the 1947 medical paper, arguing that his research experience
had indicated the need for controlling ATS by medical doctors (Horimi 1947). However,
in his paper of 1940, which was the very frst paper on ATS, he discussed the possibility of
medical applications of ATS with no mention of such problems as discussed at the conference
(Horimi et al. 1940). A signifcant gap existed between the existing medical studies of ATS
at that time and the discussion of the ATS researchers at the conference. This suggests that
ATS studies were converted in the days before the ND’s debate on the establishment of law
to control ATS. The following section argues how such a conversion happened and how it
functioned.

Te condemnation of specifc people

At the 1947 conference, Miss Wakana and other performers’ ATS use was specifcally prob-
lematized. However, the use of ATS by healthy and busy workers was not seen as a prob-
lem by the medical community. Following the conference presentation, medical doctors
discussed that ATS should be controlled by medical doctors and that specifc groups were to
be held responsible for causing the problem. Shigeo Iwata of Osaka Medical College, who
worked at the same laboratory as the two abovementioned presenters (Nakazaki and Mori),
referenced the death of Miss Wakana and claimed that medical doctors should have been
aware of the fact that some performers used ATS carelessly. He argued that methamphet-
amine needed to be controlled by medical doctors, insisting that the medicine was inhumane
because it was based on the “unscrupulous studies” (Iwata 1947: 99), in which people of
less competence were forcibly stimulated to do menial work at night during wartime (Iwata
1947). He added that ATS was “suitable for the workers who make irresponsible remarks”
(Iwata 1947: 99) such as performers and novelists, but unsuitable for the workers who do
proper work, such as healthy ofce workers. “Inhumane and irresponsible”, these are the rea-
sons why ATS should be controlled by medical doctors. Iwata’s comments show two functions
of a new medical discourse on the ATS problem. The frst function is a justifcation of the
conversion of medical knowledge on ATS, because those existing studies were conducted in
“inhumanely”. Iwata’s account on the inhumanity of the existing studies gave rise to a new
context for Nakazaki and Mori’s presentation and as a rationalization of their presentation.
The second is an exertion of a moral judgment on the performers and other ATS users from
the medical perspective. The comments suggested that many users like performers were
working irresponsibly and that their conscience was numbed. Iwata’s view was not unique,
with similar discourses being found in the following years (Suzuki 1949).
Other contemporary discourses outside of the medical feld help us to understand the rea-
sons why, for example, novelists were accused of abusing the use of ATS. Novelists, known

416
 Symbolic meaning of the amphetamine-type stimulant problem

to use ATS, had been categorized as being of the “après-guerre” (post-war) generation like
Sakunosuke Oda mentioned earlier. They were often censured as being immoral, partly
for their decadent literary style, but also partly for their use of ATS. Some critics suggested
that their ATS use refected the wartime darkness because ATS use was associated with the
Imperial Japanese Armed Forces that forced young people to engage in Kamikaze attacks
(Hirano 1949).
These discourses on the AST problem insisted upon the relationship between ATS abuse
and immoral groups like performers and novelists, whereas healthy workers were not ac-
cused of ATS use. One representative review article on ATS in 1950, written at the request
of the Japanese Medical Association, suggested that healthy ofce workers could use it with-
out becoming addicted. The reason for their drug use was formulated as not being due to any
internal craving but as an insignifcance, in which they had to fnish heavy work schedules
(Kasamatsu and Kurino 1950).
These two opposing discourses clearly demonstrate that moral judgment and medical
evaluation worked together to set a boundary between ATS use by ordinary people and
ATS abuse by immoral people like performers and novelists. Immoral people were also often
interpreted as being psychopaths in medical articles, and such diagnosis functioned as the
reason for addiction (Kasamatsu and Kurino 1950). Papers even evaluated the content of
theater scripts from a medical perspective. For example, one study discussed a comedy actor,
who abused ATS and was hospitalized. It analyzed his script and concluded that the cause
of the problem existed in the actor himself; “his association of ideas was superfcial, but he
was deluded that he enhanced his ability while using drugs. That is because he could enter-
tain a lowbrow audience with such scripts” (Motoyoshi 1949: 9). Medical analysis judged the
value of the scripts, treating them as evidence for his psychological problem. Consequently,
lowbrow entertainment was interpreted as being a symptom of such problems. In contrast,
the same medical perspective insisted that ATS use by healthy and busy workers was not
problematic. These descriptions reveal that medical knowledge of ATS began to function as
the agency which delineated the boundary between “use” and “abuse”. This case evidences
a transformation of the medical knowledge on ATS after the war. In the following section, I
will elaborate on the transformation, because it indicates a crucial basis for the establishment
of ATS control.

Conversion of medical research on ATS

After ATS became problematized, the scientifc properties of ATS became fxed to legiti-
mize the problem narrative of ATS. These fxed properties, in turn, became the criteria for
appraisal. Appraisal discourse is the basis for establishment of laws and other means of control
of ATS.

Te initial studies on ATS

In order to illustrate the conversion of medical knowledge and its function in post-war Japan,
the initial ATS studies in the early 1940s need to be examined. Until the problematization
of specifc ATS users, all medical studies on ATS “inquiry” (i.e., examining the properties
of ATS) are based on several types of experiments. The description of the initial studies is
formulated as follows. They began with a consideration of the properties, based on the struc-
tural formula of ATS, followed by several hypothetical features verifed with experiments.
Most of the experiments consisted of observations of the behaviors under the infuence of

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ATS and the reports by trial subjects on the physiological and psychological infuences. The
trial subjects consisted of several categories of people, including patients sufering from de-
pression. The discussion and considerations pointed out both positive and negative efects
of using ATS. Positive efects included feeling great, confdent, aggressive, focused, etc.
Negative efects included sleeplessness, lack of appetite, sudation, etc. (Horimi et al. 1940;
Ariyama 1941; Miura 1941).
After these initial studies were published, many subsequent ATS studies followed and
began to adopt more objective methods of measurement of the efects, such as measuring the
strength of back muscles and speed of free association. Various studies emerged from phar-
macology, neurology, internal medicine, and biochemistry that constituted a whole body of
ATS research. All of them adopted similar types of descriptive sequences as the initial studies
to inquire the properties of ATS. The method of these studies should be interpreted as the
typical and standard way of scientifc investigation. The method adopted a standard pro-
cedural sequence of verifying the hypothesis based on the features of the material deduced
from the structural formula of ATS and other existing studies (Uchimaru 1942; Tanaka
1943; Oota and Egami 1944; Yoshino 1943). This type of medical discourse is called “in-
quiry discourse” (Sato 2006: 223–227).
Using a discourse analytic perspective (Potter & Wetherell 1987), we now look at how
those descriptions are formulated to achieve certain functions rhetorically. What all these
early studies on ATS reveal are constructed elements. Those studies did not merely report
the scientifc facts of ATS. What they achieved in those texts was that the studies con-
structed elements of what ATS does in a given context (see Potter & Wetherell 1987). They
proposed and constructed particular features of ATS, which were subsequently used to
associate all of the results of the separate experiments. In other words, the features of ATS
derived from the structural formula, and the verifed results function as the connecting
plugs, by which all the experiments on ATS connect together, even if those experiments
were undertaken by separate people in separate situations. For example, Ariyama (1941)
grouped a total of 156 students for an experiment of ATS use and asked them to report on
several efects they felt when taking 10 mg (43 cases), 20 mg (56 cases), and 40 mg (57 cases)
of the drug. Among the results, for example, “liveliness” was reported by 19% of 10 mg us-
ers, 25% of 20 mg users, and 53% of 40 mg users. “Liveliness” was designated as one of the
features of ATS use. Following the discourse analytic perspective, referring to “liveliness”
acquires a discursive function that serves to connect every case of the experiment drawing
on this ATS study. All described features function as such in the ATS studies (Sato 2006).
Scientifc practice on ATS was realized with “inquiry discourse” that made any general
reference to the features of ATS possible by going beyond every local study situation. It
means that inquiry discourse is the discourse discussing the properties of ATS, making it
possible for the description of the ATS studies to connect one to another. Referring to the
features of ATS is performative, which gives rise to the connection of local experiments,
thus establishes a category of “ATS studies”.

From inquiry to appraisal discourse

A gradual conversion occurred after the problematization of ATS users involves two ways of
change. The frst conversation is observed in the way in which the contents of the studies are
organized. For example, newer studies always began by referring to the contemporary situ-
ation of ATS, e.g., a claim that the ATS user caused problems in society, instead of referring
to a hypothesis derived from the structural formula of ATS and the results of the existing

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studies. The explicit reference to the problems in the society functions as the basic assump-
tion to “appraise” the properties of ATS. The reason why and/or to what extent ATS caused
the problem became the principal purpose of study instead of searching for and discovering
any new features of ATS. Therefore, the feature of ATS is constructed as being already fxed,
that is, something bad which will cause problems. This is then formulated as a basic assump-
tion of newer ATS studies. Clinical observations became one of the most important sources
for the appraisal and discussion as mentioned above (Motoyoshi 1949).
Another change took place in the structure of the ATS research feld. In the early days of
research on ATS, various types of studies were carried out with their own research questions,
shaped by varying disciplines. However, newer studies posed common questions related to
“the reason and the extent of the ATS problem” and consequently, gave rise to a unifying
structure in the feld. The aforementioned review article typically exemplifed such conver-
sion (see 2 pages before in this chapter for Kasamatsu and Kurino 1950). It collected many
existing ATS studies from various disciplines and reviewed and re-organized them in order
to answer the question regarding the ATS problem, including intoxication. However, no
experimental study gave any satisfactory answer to the question, nor evidenced any factor
to support their claim of these fxed features. Only psychopathological studies with clinical
observations provided the answer. For example, pharmacological studies were reviewed by
referring to some aspects of ATS features related to the pharmacological efects like the phys-
iological changes of the body such as a rise in blood pressure. In short, the review only sug-
gested the scarcity and high value of ATS as an adrenergic derivative, without any reference
to the cause of the problems. Psychological studies were also reviewed, suggesting that there
were numerous reports on both positive and negative psychological efects. However, when
summarizing the efects in psychological studies, Kasamatsu and Kurino devalued those pos-
itive efects as being false and imagined. Indeed, their own psychopathological observations
gave some satisfactory descriptions to address the cause of the problems. The authors found
a diference in the ATS efects between healthy ofce workers and those people with a weak
will, fippant personality, or with mood problems (Kasamatsu and Kurino 1950: 96–98).
Here, a categorization by them is evident. The former people (i.e., healthy ofce workers)
who used ATS were not problematized, while the latter were formulated as being abusers of
ATS. They were categorized as psychopaths in the texts, and even suggested that they were
the cause of the problems, attributing to the personality of the psychopath or drawing a link
between the drug and the personality.
Furthermore, the study concluded the need to control sales of ATS, but this recommenda-
tion was based solely on their own psychopathological study. This had profound implications
because the psychopathological study became the key to unifying the ATS feld by providing
a primary frame to interpret the features of ATS and its problems. The psychopathological
framework became the default framework in the feld. As such, the psychopathological study
by Seijun Tatetsu and his colleagues in 1956 (Tatetsu et al. 1956) has been referred to as “the
classic” ATS study even today (Yanagida and Itsumi 1993). ATS studies with the psycho-
pathological framework continued to stand in the frontline of the ATS feld, which will be
discussed further in the penultimate section on the 1980s.
The type of medical discourse discussed above is called “appraisal discourse” (Sato 2006:
225–229) in contrast to the “inquiry discourse” of the initial studies. What all these newer
studies on ATS did and achieved in their texts is that they constructed and substantiated a
specifc value by which the results of the experiments and observations were “judged and
appraised” (Sato 2006: 226). The features of ATS had already been fxed as something bad,
causing problems. As Canguilhem discussed in his book titled The Normal and the Pathological

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(1989), physiological pathology fundamentally needs a basic value based on which objective
observation and analysis can be developed. Such a value intrinsically derives from the sub-
jective experience of a patient, sufering from any difculty. Psychopathological thought, in
contrast to physiology, was constructed and based not on the subjective value of patients,
but on a moralistic value. Such a moralistic value was repeatedly invoked and accomplished
as “appraisal discourse” (e.g., Saito 1952). What “appraisal discourse” achieved is that the
descriptions of searching for and even discovering the factors gave account of the fxed fea-
tures of ATS. “Appraisal discourse” subsequently accomplished the realization of the specifc
value on which such searching and discovering were premised. Clinical observations, being
formulated as the successful description of discovering the factors with a psychopathological
frame, achieved a moralist value, based on which the psychopathological framework was
organized as the moral judgment.
There still existed a few studies which are organized around “inquiry discourse” (e.g.,
Tanaka 1948). Later, some of the contents of those studies were then converted to resources
to answer a new question. For example, Mitsuru Higo discussed ATS in terms of “respiration
of brain”, which is categorized as an “inquiry discourse” (Higo 1949). Hiroshi Tai and his
colleagues a while later tried to verify the cause and process of ATS intoxication with Higo’s
study (Tai et al. 1955); yet, they failed to do so. As such, ATS studies as “inquiry discourse”
were located at the fringe of the research feld. The results of those studies were to be utilized
as a resource for “appraisal discourse”, as in the abovementioned review. This phenomenon
is called the conversion “from inquiry discourse to appraise discourse” in ATS studies (Sato
2006). Notably, the conversion from inquiry discourse to appraise discourse seems to have
taken place gradually.
This conversion is highly signifcant in the process of problematization of ATS and the
establishment of its control, because it substantiated the activities which drew the boundary
between the normal and the pathological, instead of the moral and the immoral. In other
words, newer medical discourse, “appraise discourse”, helped to distinguish between the
moral and immoral without a moralist vocabulary. The distinction was justifed only with
medical or psychopathological vocabulary. For example, two medical doctors were invited
to the Diet as witnesses to testify on the cause and the extent of ATS problems in the dis-
cussion of the Stimulant Control Law in 1951 (ND 1951, February 15: 1–10). “Appraise
discourse” produced by them worked well in drawing the boundary between the morals
of ordinary people and the immoral, namely rowdies, gamblers, and other delinquents such as
psychopaths with weak wills, who can be categorized using a medical vocabulary. Testimony
using medical vocabulary therefore substantiated the need for a legitimate control of produc-
tion and sale of ATS and constructed a substructure to establish the Stimulant Control Law,
which will be discussed in the following section.

Youth problem and the reason for ATS control

In this section, the movement leading to the establishment of the Stimulant Control Law will
be discussed in detail. Let me now return to the main route and discuss my alternative story
on the establishment of ATS control. In the late 1940s, when the aforementioned conversion
of medical knowledge was gradually proceeding, ATS problems outside of the medical feld
were still being attributed to the specifc groups of users, whereas busy and healthy ofce work-
ers, who did make use of ATS, were not accused. In order for a movement to establish strict
control, such as total prohibition, other crucial factors that were supposed to be infuential
across society were required. What are considered here are those factors concerned with the

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responsibility for the causes of youth delinquency. Unlike today’s treatment of youth, young
people were not accused during that period; they were treated as victims.

Youth as victim of ATS problem

During 1949 and 1950, ATS began to be associated with a problem related to street children.
Many of them were war orphans and the population was huge. Ofcial statistics for 1948
showed that the number of orphans was 123,511 with only 12,202 of them (9.8%) being
housed (Findings of the national research on orphans in February 1948 by the Ministry of
Health and Welfare). Their problems were often attributed to ATS use (ND 1949, October
24). However, street children were not so much blamed for their ATS use but were rather
seen as victims of adult hoodlums. For example, street children were exploited by those
adults who ofered them ATS in exchange for stealing things (Asahi 1949, November 22).
The children could not purchase ATS themselves as it was controlled as a powerful drug.
The National Council of Youth Problems, made up of representatives from all prefectures
and Ministries, sat on December 9 and 10, 1950 in order to discuss youth problems. One
division of the Council discussed several causes of the problems, such as smoking, drinking,
and ATS abuse. They insisted that education was needed to prevent young people from
delinquency and that the smugglers who distributed ATS to the youth had to be controlled
(NCYP 1951). The conference delegates demanded legal measures to control the production
and distribution of ATS to help solve youth delinquency and related problems.
During the Council’s discussion, the National Police Headquarters fnally revealed that
ATS produced by Toyama Chemical, a pharmaceutical company, had caused a “mass sexual
assault incident” in Saitama Prefecture. One hundred young people were arrested over the
incident and almost all of them had used ATS.4 The National Police added that the company
produced over 10 million ampoules of ATS quarterly, whereas its production quota by the
Ministry was set at only 51,000 ampoules. However, the quota limit was just an administra-
tive guideline and had no legal basis. As a result, Toyama Chemical was fned only a small
amount of money. This was subsequently labeled as the Toyama Chemical Incident. Because
of it, the Police Headquarters strongly stressed the need to pass legislative control of ATS
production, including its distribution and sale, to prevent young people from committing
delinquent acts (NCYP 1951: 98).

Te Stimulant Control Law of 1951 and the prohibition of possession

Researchers in the 1980s insisted that the Stimulant Control Law of 1951 was established be-
cause of the problematizing of ATS efects that were highlighted when the abovementioned
“mass sexual assault incident” was reported (Tamura 1982). The reason why the mass sexual
assault incident later resurfaced will be discussed further below. However, as the discussion
in the previous section shows, the cause of youth problems was not attributed to the efects
of ATS, but to its production, distribution, and sale. In the discussion to establish the Law in
the Diet, some psychopathologists testifed that it was immoral people, i.e., psychopaths, who
were likely to become addicted to ATS, and therefore it needed to control the distribution
of ATS. The Stimulant Control Law was intended to control production and distribution in
order to prevent people from using ATS and becoming addicted.
One signifcant aspect of the new law was the provision to prohibit the possession of ATS.
If the main problem was thought to lie in the psychopathological efect of ATS, as misinter-
preted today (Tamura 1982), the possession by users should also have been strictly controlled.

421
 Akihiko Sato

The law, however, was intended to maintain strict control over smugglers. A government
ofcial clarifed the issue of possession in the Diet:

Clause number fourteen prohibits possession. One of the most difcult matters that of-
fcial control bodies are faced with is the lack of a legal basis for controlling possession.
They cannot prosecute those who possess stimulant to sell in the town like Ueno.
(ND 1951, May 23:14–15)

The Stimulant Control Law was passed in June 1951. It prohibited smugglers from possessing
ATS, so that they, not the users, were arrested. However, ATS users also became the target
of enforcement after 1954 (Sato 2020). After the Stimulant Control Law was established in
1951, with its sole purpose being to control production and distribution, ordinary people
stopped using ATS and the majority of users shifted from being busy workers to delinquent
youths, who had access to underground markets. This might be one of the reasons why the
connection between youth problems and ATS use was often given so much attention, even
after the law was established (Sato 2020).

Political factors and ATS in the 1950s

Just after the Stimulant Control Law came into force in July 1951, almost all newspaper
reports on ATS dealt with issues of smuggling and of illegal production. Those reports on
the enforcements refected the very purpose of the new law. They also suggested that there
still remained the youth problem of ATS use. However, by the middle of 1952, a new dis-
course related to ATS emerged. The new elements were, surprisingly, Koreans living in Ja-
pan and communists. A Korean village was reported to be the site for smuggling ATS and
interestingly, one of the arrests made was revealed to be an ex-member of the Communist
Party (Asahi 1952, August 25). The reason why the news at this time suddenly referred
to “Korean village” and “communist” was because the relationship of these words had
become signifcant in post-war Japanese society.5 In the following, the political context
of Japan in the 1940s and 1950s will be explained in detail, in order to fully understand
the peculiar reference made to those terms suddenly emerging in ATS-related reports and
media articles.

Context of the new words “Korean” and “communist”

After losing the war in 1945, Japan had been occupied by the General Headquarters/Supreme
Commander for the Allied Powers (GHQ/SCAP) under the leadership of General Douglas
MacArthur. During the period of occupation, armed forces of the Communist Party of
China gained superiority over the forces of the Chinese Nationalist Party on the Chinese
Mainland next to Japan. The People’s Republic of China was founded by the Communist
Party in 1949. General MacArthur demanded that the Japanese Communist Party should be
designated illegal. Therefore, the Japanese Cabinet decided to purge all communists from
ofcial positions. As a result, over 10,000 people lost their jobs. In addition, the Korean War
broke out in June 1950 and the menace of communism began to be talked about even in the
Diet.6 This trend continued further in 1952 when large anti-government demonstrations
were organized on May Day in several big cities. The government ofcially announced that
“foreign communist countries” were to blame for such disturbances (ND 1952, July 1). This
was the context in which new terms such as “Korean village” and “communist” began to

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appear in ATS-related news around 1952 (Sato 2006: 339–341). The illegal production and
smuggling of ATS began to be interpreted as being connected with the communists through
the Korean villages.

Ill-founded connection and a missing discourse on ATS production

In the years following, ATS discourse containing the words “Korean” and/or “communist”
was often found in texts that discussed matters related to ATS (Yomiuri, 1953, July 3). How-
ever, the connection between the menace of communism and the illegal activities related
to ATS was still unclear and almost always ill-founded. The head of the crime prevention
department of the Metropolitan Police insisted in the Diet in October 1953 that 71% of the
arrests were Koreans and that the police forces were raiding Korean villages as their utmost
priority (ND 1953, October 30). However, this might be seen as a self-fulflling prophecy,
because prioritized investigations in the Korean villages realized a high rate of arrests, with
38,514 being made in 1953. This accounted for the upward curve in the number of arrests for
violations of the Stimulant Control Law in the 1950s (see Figure 25.1). The trend continued
until 1954, when the connection between communism and ATS was more explicitly made,
despite there being no evidence (see the next section for further elaboration).
It is noteworthy, though, that there was a discourse, which should have received more
attention, to understand the reason why the Korean people illegally produced ATS. ATS
production had become a way for Korean people to make a living during this period which
was marked by disorganization and destitution after losing war. However, this discourse
did not appear except in a few newspaper articles. One of them reported that ATS had been
distributed to rural areas and that illegal manufacturers were mostly occupied by Korean
workers as follows:

The Metropolitan Police thought that because Korean people could no longer expect
dealing with second-hand clothes, unrefned sake, and tobacco as the ways for making a
living, they shifted to manufacturing Philopon, because it is relatively easy to produce
it in a small space.
(Asahi 1953, August 17)

Although the article fnally used this situation of poverty as the reason for the implicit com-
munist intervention, it is a very rare discourse in which the production of ATS is represented
as a way of making a living.
While the ATS problems related to “production and distribution” were thought to be
responsible for the Korean people during this period, the problem related to “use” was
still connected to Japanese young people. However, the people responsible for the problem
moved from street children to delinquent youths, who had access to underground mar-
kets. The problem therefore became viewed as being a family problem of delinquent youth.
Newspapers sometimes reported that the criminal behavior of young sons was often caused
because they could not aford to purchase ATS. For example, there was a report of a mother,
who complained that her son never worked and spent all his parents’ money on ATS (Yomi-
uri 1953, March 7). The lazy and violent life of a youth, who craved ATS, was also reported
in a feature article, stating that the father could no longer stand his son’s violence, and had
killed him (Yomiuri 1953, April 12). These issues and anti-ATS movements against the Ko-
reans merged into one social movement to “protect” young people from the harm of ATS,
caused by the Koreans and communists (Sato 2020).

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A new discourse on the ATS problem and a campaign to eradicate it

The year 1954 can be considered a milestone in the history of ATS control in Japan. As
discussed above, while the Stimulant Control Law of 1951 was established to control illegal
production and smuggling, ATS use was not its primary target. However, the Kyoko Inci-
dent in 1954, described below, and its subsequent interpretation, began to alter the meaning
of ATS use.

Kyoko Incident 1954

In April 1954, an 11-year-old schoolgirl, Kyoko, was sexually assaulted and murdered in the
restroom of a primary school in Tokyo. After the arrest of a suspect, the cause of the inci-
dent was fnally interpreted as being his abnormal psychological and behavioral problems.
Philopon was believed to be responsible, a view based on the psychopathologists’ account
of the incident. Contemporary newspaper articles began to denounce Philopon and stressed
the importance of eradicating ATS, advocating that the drug made young people lose their
minds and commit crimes (Asahi 1954, May 7).

Merger of the discourses on ATS and the campaign to eradicate it

The denunciation of Philopon indicated that the two discourses on ATS merged at this time
– one that ATS caused psychopathic problems and the other that ATS was a substance used
for a possible communist invasion. In June 1954, the Stimulant Control Law was amended,
in part to impose heavier punishment for violations of the law. The amendment was not
meant, at that time, to secure the eradication of addicts and users but instead smuggling and
illegal production. In the discussion in the Diet, responding to a representative of the Diet
who had argued that addicts should be arrested and treated as criminals, the chief of the
Metropolitan Police replied that addicts should be treated as patients unless they committed
crimes (ND 1954, May 20). However, the question asked by the representative nevertheless
highlights that people had begun to think that addicts should be treated as criminals.
The objective of the amendment in 1954 was meant to be a fght against the Koreans and
communists. In a Diet debate regarding this amendment, the law was also discussed in terms
of revising the Immigration Law, including the enforced repatriation of Korean people (ND
1954, May 25). This refected the public perception that Korean people living in Japan were
smuggling ATS and that many of them were communists or communist sympathizers.
In October 1954, the government launched a campaign for the total eradication of ATS,
which resulted in 55,664 people being arrested, as shown in Figure 25.1. It is still the largest
number of arrests in the history of the Stimulant Control Law. The campaign was directed
against assumed hostile forces, i.e., the Koreans. When it was launched, the head of the crime
prevention department of the Metropolitan Police commented that the police would tighten
control over the smugglers, even if the Koreans tried to interfere in their work (Asahi 1954,
October 15).

Nationalist discourse on the ATS problem

The Metropolitan Police published their report of the campaign with a nationalistic tone
in the following year: “In order to maintain the purity of Japanese ethnicity and, especially
to attempt to raise young people ensuring our future generations, now is the time when we

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have to pluck up our courage to eradicate stimulants” (Metropolitan Police Headquarters

1955: 1). The latter part of the report referred explicitly to the Koreans:

70 percent of these smugglers, illegal producers and bootleggers consist of Korean people and
they gnaw at the bodies and spirits of approximately one million and fve hundred thousand
of our fellow countrymen. At its most extreme we seem to be living with a large crowd of
people going insane and becoming brutal ofenders… Our fellow countrymen, especially
young people, are the victims of Korean people pursuing their own interests…
(Metropolitan Police Headquarters 1955: 19–20)

As these remarks show, the amendment and the resulting movements were undertaken to
tighten control over smuggling and the illegal production of ATS that were interpreted as
a way for the Koreans to proft. Interestingly, the police stopped referring to communism
because they could not fnd any evidence of communist invasion. There were also numerous
campaigns in many cities for the parents of young addicts. Young addicts were interpreted
as the victims of the Koreans’ misdeed (Sato forthcoming). Finally, the success resulted in a
maximum number of arrests in 1954 and 1955 (Figure 25.1).
In the course of the campaign, the arrest of people who used ATS was interpreted as a
means of fnding the smugglers and producers. Many parents even wished that their children
be arrested, saying that they had become violent and spent their money only on drugs. At the
same time, the need for hospitalization and treatment of users began to be discussed publicly.
This led to the amendment of the Mental Health Law in the following year, 1955, making
it possible to hospitalize users.

Afer the 1954 campaign

After the campaign, the Stimulant Control Law was again amended in 1955 to impose a
heavier punishment for possession and to control the raw materials of ATS. In the discussion
for this amendment, North Koreans, instead of mere “Koreans”, were especially mentioned
as being responsible for the ATS problem in Japan (ND 1955, July 12) referring to its com-
munist background.
The White Paper on Crime of 1960 summarized the ATS problem in the latter half of the
1950s. As it shows, the rate of prosecution dropped dramatically from 63.5% in 1955 to 37.1%
in 1958, which meant that those cases viewed as in need of punishment had decreased sharply
(Table 25.1). The White Paper also revealed that the proportion of categories of violation of

Table 25.1 Rate of prosecution (The White Paper on

Crime 1960: 110)

Number of newly Rate of

Year registered suspects prosecution (%)

1953 34,944 53.6

1954 53,352 63.6
1955 32,099 63.5
1956 6,645 58.0
1957 1,823 41.7
1958 609 37.1

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 Akihiko Sato

the Stimulant Control Law had changed. In 1959, illegal ATS production led to only 1% of
all arrests for violation of the law (The White Paper on Crime 1960: 111).
As discussed above, ATS problems in the 1950s were mainly argued as being a political
problem in the post-war Japanese society. There were several discourses that gave rise to
various meanings of the ATS problem; “ATS was a means to promote invasion by Koreans
and communists”, “ATS causes crime”, “ATS makes young people commit crimes”, “ATS
makes people go insane”, etc. Although these diferent discourses were used depending upon
the specifc situation, the discourse on invasion by the Koreans and communism often acted
as the dominant story in constructing the view that ATS was a problem. Consequently, the
ATS problem in the 1950s had begun to function as a political symbol operating to create
boundaries between Japanese people and others.

Te second wave of epidemic and crime syndicates

At the start of the 1960s, ATS was given little attention as a dangerous drug, compared to
other narcotics, such as heroin. Narcotic addicts were reported to be observed in port cities
such as Yokohama, and violent syndicates, called Boryokudan, were believed to be responsible
for the prevalence of use. However, the number of narcotic-related arrests decreased around
the middle of the 1960s as shown in Figure 25.1, because of the tightening control over
narcotics based on an amendment of the Narcotics Control Law in 1963. Given this decline,
ATS problems began to be reported again. An important distinction exists between small-
scale violent syndicates and large-scale ones. The former was labeled a “violent syndicate”,
an independent organization within its local territory, whereas the latter was called a “crime
syndicate”, a united organization of multiple “violent syndicates” exerting its power over
wide areas. Both types of syndicates were crucial to any investigation of ATS problems in
the 1970s.
Until around the middle of the 1960s, ATS-related illegal activities were still mainly
discussed within a discourse which associated their use with the notion of a Korean invasion
(Asahi 1962, July 10). However, by the late 1960s, the role of violent syndicates began to be
viewed as responsible for the ATS problems. This relationship became one of the key issues
in ATS control. In order to understand the reason why this relationship began to appear, it is
important to examine the process of democratization of Japanese society.

Japanese society and the “feudalistic” way

The violent syndicate and its problem had been debated in the ND since 1947 (ND 1947,
July 4). The debate had continued for an unexpectedly extended period and fnally ended in
1991 when a law to control the syndicates, the Act on Prevention of Unjust Acts by Orga-
nized Crime Group Members 1991, was established. The reason why the debate began just
after the end of the war was because of the transformation of the Japanese social and political
systems that occurred in the post-war period. Japanese society had been forced to change
from a “feudal” type of society to a more democratic type because traditional Japanese
ways of operating were viewed as the cause of the war.7 Violent syndicates were perceived
as symbols of the “feudalistic” society. For example, an editorial of Asahi Shinbun in July
1947 insisted that “feudalistic” violent groups were a menace to civil society and the reason
for social disorder; “It is needless to say that the boss of violent syndicate is the typical ex-
ample” of feudalism (Asahi 1947, July 1). Violent syndicates increased dramatically after the
war because they amassed huge profts from underground markets that fourished because of

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shortages of food and daily goods. While the National Police Force exercised strict control
over them from 1947 onward, and their numbers declined, nevertheless they regained their
strength after 1952 with the repeal of the Regulations of Organizations Act, the end of the
GHQ occupation, and the beginning of Japanese sovereignty.
In spite of police crackdowns, the syndicates gradually united to organize and transform
their activities from proft-making using threats and violence to more subtle types of activ-
ities, including right-wing political campaigns to collect donations and/or fxing dissenting
voices at stockholders’ meetings. A number of companies made use of crime syndicates in
labor disputes, such as that of the Mitsui Mi’ike Coal Mine in 1960, one of the most famous
labor disputes in post-war Japan (Asahi 1960, March 30). In the course of such transforma-
tion, some of the syndicates began to use narcotic smuggling as a source of revenue.

Te rise of crime syndicates and ATS smuggling: from the 1960s to the 1970s
Because of the strict enforcement of the law, the number of violent syndicates and their
membership had gradually decreased, however crime syndicates were increasing in number
(see Table 25.2). The percentage of members of crime syndicates rose from 25.9% in 1963 to
55.7% by 1972. The corresponding percentage of crime syndicates themselves also rose from
22.2% in 1963 to 71.1% by 1972. Crime syndicates developed widely, occupying the place
that local violent syndicates had previously occupied.
Concerning the enforcement at that time, police forces adopted two methods. One was to
intervene in the relationship between the boss and the henchman. To protect such a relation-
ship was always thought to be a feudalistic duty for the henchman. “It was a very Japanese
way of thinking” (Asahi 1965, March 2), and it was almost impossible to intervene. The
second way was attempted to interrupt the fow of funds. This was successful, but also led
to the rise and development of “wide-area” crime syndicates, who found proftable ways of
smuggling illicit but top-selling items like guns and drugs. As such, smuggling ATS became
an appealing business for crime syndicates.

ATS as a symbol of the outlaw economy

Control over crime syndicates and ATS were separately discussed at an ofcial level during
the 1950s. For example, the Metropolitan Police set up a countermeasure headquarters for
violent syndicates and, separately, for ATS in November 1954 (Asahi 1954, November 10).
However, the connection between them became more widely acknowledged in the 1970s.
Crime syndicates had begun to manufacture ATS in the 1970s – thereby acquiring a source
Table 25.2 Number of violent and crime syndicates 1963–1972 (made by the author based on The White Paper
on Police 1973)

Year 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972

All violent groups 5216 4573 3944 3790 3752 3603 3500 3781 3214 2957
and crime members 184019 177035 156393 147171 142660 138288 139089 138056 129432 123044
syndicates
Wide-area groups 1158 1242 1157 1367 1364 2285 2251 2296 2214 2102
crime % 22.2% 27.2% 29.3% 36.1% 36.4% 63.4% 64.3% 60.7% 68.9% 71.1%
syndicates members 47604 49609 46732 52514 51631 69575 73161 74909 71884 68523
% 25.9% 28.0% 29.9% 35.7% 36.2% 50.3% 52.6% 54.3% 55.5% 55.7%

427
 Akihiko Sato

of funding, while other sources were cut of from them by the police forces. The notion that
“ATS was a source of funding for crime syndicates” only emerged in the early 1970s.
Interestingly though, the actual process of smuggling ATS was not occupied by the crime
syndicates. People other than syndicate members were reported as smuggling ATS in the
1970s. A typical example was one of the most famous and largest smugglers of the 1970s,
named Tamamoto. He was often referred to during this period (Asahi, 1973, January 19),
even in the Diet (ND 1973, July 17). He was known as the general manager of the largest
smuggling project in Japan. Although some crime syndicates cooperated with his distri-
bution, he himself was not a member of the syndicates but an ex-CEO of a ballast digger
company. Therefore, people other than syndicate members were reported on for smuggling
and distributing ATS. Almost all of them confessed to their motivation to acquire funds for
their business.
According to newspaper articles, ATS smuggling was not just a problem concerning
crime syndicates but also encompassed ordinary people pursuing profts by illegal measures
in the frst half of the 1970s. Rather, illicit trafc by the crime syndicates was interpreted as
just one kind of various illegal economic activities:

One of the non-negligible aspects of the cases is that this type of illicit trafc has some-
times been treated as an object of investment or speculation by ordinary companies.
(Asahi 1973, January 24)

Later, smuggling ATS became the principal fund-raising activity for crime syndicates.
“Sixty-three percent of crime syndicate’ funds come from ATS” (Asahi 1978, September
8). It has been suggested that eradicating ATS in the 1970s functioned as a way of excluding
people from the illegal economy, and, as a result, such an illegal economy became more
concentrated in the hands of the crime syndicates.
Here, there is a signifcant shift in the symbolic meaning of ATS. As the eradication of
crime syndicates funds typically shows, ATS problems in the 1970s were always focused on
and discussed as the illegal economic activities. On the contrary, ATS was the symbol of
politics in the 1950s as mentioned earlier. Even the violent syndicates were problematized
because of their symbolic meaning of “feudalism”. However, as the post-war era ended, the
symbolic meaning of the syndicates shifted from the political to the economic. ATS also
became a commodity of illicit trafc outside the boundaries of respectable Japanese society.
Therefore, the strict law enforcement against ATS-related activities can be interpreted as a
symbolic efort to mark the boundaries of society, especially during the period of economic
growth in the 1960s and the 1970s. Japan experienced a remarkable high economic growth
from the late 1950s until the middle of the 1970s, also known as the “Japanese Miracle”
( Johnson 1982). Thus, ATS became a symbol of the outlaw economy of Japanese society.
So far, the conversion of the symbolic meaning of ATS, from being a political tool in the
1950s to an economic tool in the 1970s, has been discussed. The following section will show
another symbolic conversion, the change to the psychological.

Psychopathological features of ATS and their symbolic meaning

“Afer-efects” and “Stop using stimulant otherwise give up being human”

In this section, “after-efects” discourse is important in the conversion process of the sym-
bolic meaning of ATS. As the crackdown on crime syndicates continued, a brutal incident

428
 Symbolic meaning of the amphetamine-type stimulant problem

occurred in June 1981, known as the Fukagawa Random Street Murder Incident. Four peo-
ple were killed and two people injured on a street in the Fukagawa area in Tokyo. After the
arrest, the ofender confessed that he murdered people after he became frustrated when his
job application for a sushi restaurant was rejected. However, almost all newspapers reported
that the murders were caused by the efect of ATS, and linked to his career of using ATS.
This soon became interpreted as the “after-efects” syndrome of ATS.
The “after-efects” discourse was originally developed by psychopathologists, but its
application to ATS addiction was sometimes questioned, even by them (Kato 1981). After
this incident, the media started to use the discourse when reporting on accounts of brutal
crimes caused by ATS users, or even ex-users, regardless of whether the drug itself had
been taken at the time of the incident. “After-efects” became a very convenient concept
for any ATS problem. Similar ATS-related incidents were reported on during 1981 and
1982 that use of the drug always caused psychopathological crimes, i.e., unusual and ab-
normal crimes.
The Fukagawa incident attracted people’s attention so much that it was even referred to
in the Diet, which discussed an order that a person, when being deemed a threat to society,
could be taken into custody even if he or she had not yet committed a crime (ND 1981, Oct
14). The order was called “Foan shobun” and the ATS addict was discussed as a typical case.
ATS began to be treated as an evil substance, capable of provoking anyone, even those who
did not have abnormal characters, to commit psychopathological and unusual crimes. The
symbolic meaning of ATS had gone beyond the political symbol of the 1950s. Most signif-
cantly, this new formulation of ATS became linked to one of the most famous slogans against
the drug in Japan: “Stop using stimulants otherwise give up being human”.

Boundary of the society and ATS use

The very discourse of “ATS always causes psychopathological and unusual crimes” – which
is underpinned by the “after-efects” concept – has been the key to understanding the con-
trol of ATS in Japan since the Fukagawa Random Street Murder. The slogan was repeatedly
stated and, by the 1980s, had become common knowledge.8
Furthermore, legal action changed, based on a psychopathological idea. If ATS caused a
psychopathological crime, the ofender should be treated as a patient, not a criminal. The
ofender should be interpreted as losing control of oneself. However, a new category of
ATS mental disorder, named “Anxiety-situational reaction type”, was invented by the psy-
chopathologist Akira Fukushima (1977). From the mid-1980s onward, it became a domi-
nant pronouncement in ATS cases when judging criminal responsibility (Aoki 1996).9 The
invention of the new category consequently changed the interpretation of the criminals’
capacity, to being located between taking full responsibility and temporary insanity. Thus,
when ATS caused a psychopathological crime, the ofender began to be treated as a crim-
inal, not a patient.
However, several psychiatrists and law researchers began to criticize this diagnosis for
two reasons (Aoki 1996; Nakatani 1999). One was because “Anxiety-situational reaction
type” was just an idea, and therefore it was difcult to isolate it from other disorders within
clinical experiences. A second is because Fukushima went beyond the role of a psychiatric
examiner. As he insisted, this category was introduced on the assumption that the general
public had been unconvinced if an ATS addict had received immunity from responsibility.
He manifestly introduced moral judgment into the psychiatric test of ATS, and therefore, the
category has been criticized as being against the psychiatrist’s ethic.

429
 Akihiko Sato

Whether valid or not, this new category has frequently been adopted in psychiatric test-
ing in ATS cases. It has introduced the moral judgment, that “ATS addicts should be pun-
ished”, into medical or psychopathological discourse on ATS. With the slogan “Stop using
stimulant, otherwise give up being human”, ATS use draws the psychological and social
boundary of society.

Conclusion: symbolic meaning of ATS and the reconstruction

of Japanese society
This chapter has illustrated how the symbolic meaning of ATS has changed throughout dif-
ferent time-periods in post-war Japan. In the 1950s, ATS became a political symbol to create
both political and ethnic boundaries. However, in the 1970s, when the Second Wave of ATS
Epidemic hit, it became an economic symbol, marking the boundaries of sound and immac-
ulate economic activities. During the 1980s, it was reformulated again, with a new symbolic
meaning emerging, that established the psychological and behavioral boundaries between
citizens and outsiders. Such boundaries were often rationalized using the newly introduced
medical interpretation and its popularized notion. The dominant story and discourse of each
period led to the construction of each framework in which ATS, and related activities, ac-
quired their symbolic meanings. The frame therefore refects each period.
Consequently, ATS cannot be viewed solely as a psychoactive substance, but instead must
also be viewed as a symbolic device constructing diferent boundaries within Japanese so-
ciety. Several discourses that constituted symbol and symbolic acts organized people’s per-
ceptions and feelings concerning drug use and drug-related problems. Medical knowledge
often functions as a discursive device to support such activities. These are the keys to un-
derstanding Japanese drug policy. As Gusfeld and other researchers discussed in their work
(Reinarman and Levine 1995), rhetoric and other discursive devices always exert great in-
fuence in the process of constructing drug policies. Furthermore, this chapter has discussed
that it is important for researchers to scrutinize the performative features of discourses on
matters related to intoxicating substances. It is also noteworthy that scientifc knowledge can
sometimes play a key role in these processes.
Finally, we are left with one simple question: Why did Japanese society need those activ-
ities to create such boundaries? As the moralist and nationalist discourse typically suggests,
Japanese society needed “others” to draw the contour of “ourselves”. After losing WWII
and the subsequent destruction of social order, Japanese society persevered in its efort to
reconstruct itself and to restore its precious and respectful political, economic, and social
order. In this process, ATS legislated as an illicit drug operated as a symbolic device, helping
in diferent ways to construct boundaries around a notion of “otherness”.

Notes
1 Figure 25.1 displays ofcial statistics from the White Papers, published by the Ministry of Justice in
Japan. It suggests that there are limitations in representing the prevalence of those drugs in terms
of a “dark fgure”. National and school surveys based on representative, probabilistic samples with
self-reported data on present and past drug use should be the ideal, but there is no such survey
within Japan. The best option therefore is to use the ofcial statistics of drug law violation.
2 Besides the contemporary documents, the author interviewed elderly veterans on post-war meth-
amphetamine use and was informed that once the war was over, they took home with them meth-
amphetamine which had been stockpiled in the Armed Forces and used the drug to remain awake
while studying or working through the night. They claimed that ATS was a very useful medicine
and did not cause any harm (Sato 2006, 2009a).

430
 Symbolic meaning of the amphetamine-type stimulant problem

3 In March 1949, the Ministry of Health and Welfare announced that it had already designated
ATS as a powerful drug, meaning that it could not be purchased by people under 14 years of age,
nor could it be bought without a prescription. In the autumn of 1949, the Ministry also issued
administrative guidelines (i.e., order without legal basis) and regulations to every pharmaceutical
company to refrain from the production of ATS.
4 The “mass sexual assault incident” was reported in October 1951. Approximately 100 young
people in Tsuchiai village in Saitama Prefecture were arrested on charges of rape, robbery, and
other crimes (Sato 2009a, footnote 12). The incident was also discussed as a typical post-war de-
linquency in the National Diet (ND 1950, November 29).
5 It is important to note the reasons why many Korean people had been living in Japan. The most
infuential reason was that the Korean Empire was annexed to the Empire of Japan. Korea became
a protectorate of Japan by the Japan-Korea Treaty of 1905, following the Japanese victory over the
Russian Empire in the Russo-Japanese War (1904–1905). Following this treaty, Japan formally
annexed Korea with the Japan-Korea Treaty of 1910. The annexation continued for 35 years, until
September 1945, when the Governor-General of Korea surrendered to the Allied Powers. Under
the rule of Japan, many Korean people migrated to work in Japan, resulting in the formation of
Korean communities, especially in the large cities. Korean people were also commandeered to
work on the Japanese mainland after the National Mobilization Law was established in 1938. The
population of Korean people living in Japan in 1940 was approximately one million, two hundred
and forty thousand (National census of 1940).
6 The Korean War was a war between a socialist state, North Korea, supported by China and the
Soviet Union and a capitalist state, South Korea, supported by the United Nations, principally
organized by the United States.
7 The meaning of the word “feudalistic (‘houkenteki’ in Japanese)” which was often used just after
the WWII can be interpreted as “authoritarian paternalism supported by pseudo-familial rela-
tionship”. Such a relationship had been typically observable between the Japanese Emperor and
his Japanese people since the Meiji Restoration (1868). The Meiji Restoration is always referred
to as the beginning of the age of modernization in Japan. Interestingly, Japanese modernization
progressed based on the reestablished anti-modern relationship.
8 The pragmatic meaning and implication of the slogan “give up being human (‘Ningen yame masuka’
in Japanese)” in Japanese society might be diferent from its literal translation in English. The
slogan actually means “stop using ATS otherwise you will become an abnormal existence and
be excluded from our society”. In Japanese society, there is a great deal of pressure to ft in with
everybody else. If one is excluded from society, this would mean a sort of social death. The slogan
precisely captures the Japanese attitude toward ATS and its users in the 1980s, insisting that they
should not be hospitalized as patients, but excluded from the society. Consequently, they were
treated as something similar to “internal others”. A self-help institution called the DARC (Drug
Addiction Rehabilitation Center) in Tokyo was established for “recovery” from ATS and other
drug addiction in the middle of the 1980s against such social circumstances (Sato 2009b).
9 “Anxiety-situational reaction type” was a condition incorporating paranoid illusion. However, as
Fukushima insisted (1977), such illusion can be comprehensible with the information about the
situation in which the patient lives and the carrier of the patient, whereas the illusion of paranoid
schizophrenia cannot be comprehensible. Such comprehensibility was interpreted as evidence that
there still remained a reason.

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Asahi Shinbun 1947, July 1, “Social justice and eradication of violent syndicate”.
1949, March 29, “Philopon, designated as a powerful drug”.
1949, November 22, “Fearful Philopon disaster”.
1952, August 25, “Illicit manufacturing a hundred thousand of Philopon”.
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1960, March 30, “A crash between the external organization and the picket”.
1962, July 10, “Members of an illicit manufacturing group were arrested en masse”.
1965, March 2, “New stage to unearth violent syndicates”.
1973, January 19, “An arrest warrant against Tamamoto”.
1973, January 24, “Need to enforce stricter control on stimulants and narcotics”.
1978, September 9, “Stimulant ruin the citizens”.
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1953, July 3, “Crack down 6 illicit manufacturing sites of Philopon”.

433
 PART VII

Discourses shaping intoxication

and people who use intoxicants
 26
RISK, INTOXICATION
AND DEATH
Contemporary media framing of
drug-related deaths

Susanne MacGregor and Betsy Tom

Introduction
Concern about the issue of intoxication and death from substance use has moved through
various phases and, associated with this, perceptions of problems and solutions have also
changed. In the UK in the 1970s, deaths from barbiturate use and multiple drug misuse
were identifed as a problem; in the 1980s, heroin overdose became more prominent. In the
1990s, the focus was on ecstasy deaths then, in the early twenty-frst century, binge drinking
became a key issue with worries about ‘out of control’ intoxication, especially among young
people in city centres, and early death due to liver cirrhosis. In the past two decades, rising
attention has been given to drug-related deaths (DRDs) with prescribed opioids and then
illicit fentanyl being identifed as major concerns.
Debate has focused on the risks associated with the consumption of psychoactive sub-
stances, with overdose and death being the ultimate risk. Intoxicating substances are linked
with a number of dimensions of danger, including overdose, psychological dependence, un-
intended injury, violence, acute or chronic mental or physical illness, and death from chronic
illness. These dimensions of danger are related, in turn, to mode, pattern and context of use
and who is using (including one’s developmental stage, physical and mental health) (Room
and Lubman, 2010).
Intoxication as a form of danger can be acute or chronic. Acute intoxication tends to be
the headline event but chronic intoxication also contributes to outcomes. Yet another efect
of intoxication is the pleasurable efect of altered consciousness, which, indeed, is one of the
purposes of using alcohol and drugs. The perceived positive efects of intoxication can also
infuence body functioning, for example, producing increased concentration or relaxation,
or sexual pleasure (Hunt et al., 2007; Milhet et al., 2019; Teodorini et al., 2020).
Underlying these discussions are diferent understandings of the concept of ‘risk’. How-
ever, how risk is understood in the public domain generally draws on people’s fears (Reinar-
man, 1994). The ‘rational choice’ neo-liberal ideology underlying the ‘risk society’ approach
to public health in contemporary Western societies assumes that each individual citizen will
be able to assess their own risk, alter their behaviour accordingly and take responsibility
for the outcomes of their decisions and actions (Beck, 1986; Lupton, 1993) – a view which

DOI: 10.4324/9780429058141-34 437

 Susanne MacGregor and Betsy Tom

carries the implication that those who cannot operate in this way are non-citizens to be
excluded or controlled. In practice, much public health advice involves addressing people’s
fears and focuses on the avoidance of risk.
The media provide a key means through which understanding of risk, the links between
risk and behaviour and the adoption of ‘appropriate’ responses are refected and disseminated.
The diferential attention given to selected deaths can present a distorted image of risk, ham-
pering individuals’ awareness and ability to calculate their own risk. In addition, risk is not
evenly shared and is not solely under individual control. Social or collective behaviour also
matters. And while public health debates tend to focus on ‘evidence’, in the feld of policy,
values are as important. Perspectives on DRDs are underpinned by implicit assumptions and
values, such as what constitutes acceptable behaviour, who is a ‘worthy’ person, the nature
of responsibility and blame for negative consequences.
Based on the recent phenomena of steeply rising numbers of drug-related and overdose
deaths, this chapter analyses how these have been accompanied by various competing expla-
nations. Drawing on the literature and our own research, we consider how DRDs have been
framed in the media and how such media framing has impacted on public perceptions and
policy responses. Explanations reviewed below in this chapter generally defne the issue as a
crisis and propose solutions. An overriding argument is of policy failure, with the number of
deaths being seen as a key indicator. One set of explanations focuses on ‘bad actors’ such as
drug dealers and organised crime, Big Pharma and associates such as lax-prescribing doctors
and chemists, and new substances, especially illicitly produced fentanyl. Another set focuses
on the characteristics of victims, such as an ageing cohort of entrenched illicit drug users left
over from earlier heroin epidemics, and social responses to them, singling out the operation
of stigma and social marginalisation, exclusion and isolation. Lack of services for this group is
also seen as a contributory factor, linked to inadequate funding due to policy choices such as
fscal austerity or generally weak welfare regimes, and to ideological features deriving from
prohibitionist policies which act against harm reduction measures such as access to naloxone
or Safe Injecting Facilities. Other explanations identify more long-term social determinants,
such as educational and income inequality, and spatial inequalities linked to the decline of
employment opportunities in post-industrial societies – phenomena captured as ‘diseases of
despair’ (Case and Deaton, 2015).
These varied explanations emerge clearly in research examining rises in DRDs in the
USA, Canada, Australia, Sweden, Scotland and elsewhere, (for example Man et al., 2019,
National-Academies-of-Sciences-Engineering-and-Medicine, 2019).
To contextualise our analysis of diferent explanations, we begin by presenting brief de-
tails of rising trends in DRDs in a range of countries. We then provide an overview of key
themes relevant to our topic drawn from the literature, noting especially analyses of the
media as a key player in shaping public and ofcial perspectives and its role as a political
platform. Finally, we present the fndings of a small study of national and local print media
coverage of DRDs in the UK.
Throughout the chapter, apart from where we quote directly from other sources, we use
the term ‘drug-related deaths’ (DRDs). It is important to note, however, that across the lit-
erature and in media sources, a number of diferent terms are used to describe deaths where
drugs were directly or indirectly associated with death. These terms include death from
‘drug overdose’ or ‘opioid overdose’, ‘drug-related suicide’, ‘fatal drug-related poisoning’,
‘intentional’ and ‘unintentional’ drug-related death. The diferences between the terms are
important, indicating the type of substance involved and intentionality, diferences which
are likely to afect how the death is framed by doctors, relatives or the media.

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Te issue of rising numbers of drug-related deaths

Rates of DRDs vary widely both across and within countries. Table 26.1 provides some
examples of national estimates. Keeping in mind that the sources of information for these
estimates may difer in many respects regarding how DRDs are defned and recorded, the
date data were collected, how the information is gathered and how complete the data are,
and cultural and policy diferences, nevertheless, they provide a good indication of why the
issue of DRDs may provoke greater concern in one country compared to another.
Rising rates of DRDs and perceptions of reasons why this is happening can be illustrated
by looking at the USA, Canada and Europe, regions where there has been increasing con-
cern and discussion on the topic.
In the USA, between May 2019 and May 2020, 81,230 Americans died of drug over-
doses – the highest number of drug deaths ever recorded in a 12-month span (Centers-for-
Disease-Control-and-Prevention, 2021). In Canada, there were at least 15,393 opioid-related
deaths between January 2016 and December 2019 with the highest number of deaths occur-
ring in 2018 (Canadian-Centre-on-Substance-Use-and-Addiction, 2020). In Europe, more than
7,000 DRDs are reported every year, equivalent to a mortality of circa 18 deaths per million pop-
ulation aged 15–64 years (Millar and McAuley, 2017, p. 2). However, there is considerable vari-
ation in the extent of DRDs within European countries: for instance, the rates reported in many
of the northernmost European countries exceed 40 per million population, whereas in many
southern European countries, there are fewer than ten DRDs per million per annum. Scotland
now has the highest rate of drug deaths in Europe (National-Records-of-Scotland, 2020); 1,264
DRDs were registered in Scotland in 2019, 6% more than in 2018. This was the largest number
ever recorded and more than double that of ten years earlier (545 in 2009).

Table 26.1 Examples of estimated DRDs by country and date

National estimate per 1 million

Country Date population age 15–64

Portugal 2017 6.5

Italy 2018 8.6
Luxembourg 2018 9.4
Slovakia 2018 17.7
Germany 2018 23.6
Estonia 2018 46.0
Kenya 2016 48.9
Iran 2017 53.6
Russian Federation 2018 54.2
UK 2017 82.9
Finland 2017 83.9
N. Zealand 2016 88.5
Sweden 2017 92.8
Australia 2017 102.6
Canada 2018 179.8
USA 2017 314.5

Source: DATAUNODC https://dataunodc.un.org/data/drugs/Mortality

accessed March 15th, 2021.

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 Susanne MacGregor and Betsy Tom

Among the factors proposed as contributing to the rise in DRDs, four stand out. First,
increases or changing use of diferent substances – increases in opioid use, including pre-
scription opioids and fentanyl (Gomes et al. 2018; Felbab-Brown et al., 2020), and a rise
in cocaine-related deaths (Hedegaard et al., 2019; Hamilton and Eastwood, 2020, Hede-
gaard et al., 2020). Second, the role of social actors, in particular the activities of the phar-
maceutical industry, and over-prescribing by doctors (Felbab-Brown et al., 2020). Third,
it has been reported that, in some countries at least, an ageing, opiate-using cohort cur-
rently dominates demand for substance misuse services and this will continue into the future
(ACMD, 2019, p. 8). Finally, the impact of social environmental conditions – specifcally
deprivation – has been reported as a key factor in relation to inter-country DRD rates
(House-of-Commons-Scottish-Afairs-Committee, 2019; Peters et al., 2019; Allik et al.,
2020; Hamilton and Eastwood, 2020). In some cases, several of these factors are seen to
combine to increase the likelihood of DRDs. Peters et al. (2019), analysing data from the
USA, identifed that there is not a single opioid overdose epidemic, rather multiple and overlapping
ones: a prescription opioid epidemic, a synthetic-prescription mixture epidemic, a heroin
epidemic and an opioid overdose syndemic (consisting of all three of the above). Their study
found that, in the USA, the prescription-related epidemic counties could be described as ‘left
behind’ the rest of the nation. These communities were less populated, more remote, older
and mostly white, with a history of drug abuse and were former farm or factory areas that
had been in decline since the 1990s (Peters et al., 2019, pp. 28–29). By contrast, high heroin
and opioid syndemic counties tended to be more urban, connected, diverse and in general
more economically secure. So, they argue, it is primarily the prescription epidemic counties
that exemplify the ‘deaths of despair’ narrative (Case and Deaton, 2015; Copeland et al.,
2020). Similarly, analysing trends in DRDs between 2001 and 2018 in Scotland, Allik et al.
(2020) commented that:

High rates of mortality from alcohol, suicides and drugs, especially in the more de-
prived areas, can be better explained by theories emphasising marginalisation – lack
of power (political and economic) opportunities and social support structures to
overcome adverse life events. They speak of despair, of self-destructive behaviours
that can have a direct efect on mortality through suicide or an indirect impact
through substance abuse.
(Allik et al., 2020, p. 7 of 10)

These explanatory themes emerge again when we look at how DRDs are framed in diferent
social discourses.

Framing the problem and proposing solutions: competing paradigms

Adopting the approach found in the work of Carol Bacchi (Bacchi, 2012), we now con-
sider how deaths from drugs are problematised. Expert accounts and common sense percep-
tions merge together in policy discussions and often utilise ideas of danger (MacGregor and
Thom, 2020). Both approaches in contemporary societies build on assessments of risk pro-
fles (Moore, 2018). A shared ambition is to reduce overdose risk. Ways of framing (Gofman,
1974) the issue of drug deaths are set within broader competing paradigms of ‘prohibition’
versus ‘regulation’ and of ‘abstinence’ versus ‘harm reduction’.

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Prohibitionist/abstinence arguments and related policies

Prohibitionist arguments and policies focus on views of the risk properties of substances. The
schedules at both international and national levels are supposed to arrange drugs in a single
hierarchy of dangerousness.

There is a long history of psychoactive substances being regarded as dangerous and

subsequently being banned or forbidden. Often the bans were introduced on substances
new and unfamiliar to a society, which were viewed as more dangerous than substances
which were well known and enculturated.
(Room and Lubman, 2010, p. 97)

The recent dominant policy response to rising DRDs has concentrated on opioids and
focused on controlling supply by reducing diversion of prescribed opioids and promoting
appropriate opioid prescribing, as well as on improving the care of people with opioid
use disorders, with, for example, new guidelines for clinical practice being issued in both
the USA and Canada in 2016 and 2017, respectively (Gomes et al., 2018; Ballreich et al.,
2020; John-Hopkins-Bloomberg-School-of-Public-Health, 2020). Since 2012, the per-
ception has been that the illicit opioid market has become more toxic, especially due
to the emergence of clandestinely manufactured fentanyl, leading to a sharp increase in
opioid-related fatalities (Gomes et al., 2018). In this view, bad actors, illicit suppliers
and dangerous substances are highlighted, especially illicit fentanyl, along with alcohol,
cocaine and benzodiazepine.
Similarly, in the UK, the Conservative government – prior to the coronavirus pandemic –
aimed to launch a new initiative to drive down DRDs and tackle addiction. New measures
would be taken to tackle over-prescribing of opioids. The policies were based on the percep-
tion that substance misuse/addiction is a key driver of crime, can fuel mental health crises,
prompt homelessness and lead to an early death (Conservative-Party, 2019).

Regulation/harm reduction arguments and related policies

Harm reduction approaches focus on risk profles and aim to reduce the risks of use (Release,
2019). Attention is also paid to characteristics of the environment within which use takes
place, the aim being to manage risk, especially to avoid death (Houborg and Asmussen,
2014). One aim of engagement and treatment is, over time, to discourage intoxication and
replace this with stable or moderate substance use. Harms are seen as arising from policy
itself, especially the illegal status of certain substances which leads to variations in the form
and content of substances. Because of a lack of testing, users do not know what they are tak-
ing. Because of the need to avoid scrutiny, use is covert: such hiding away makes it difcult
for others to intervene in the event of overdose.
An alternative set of perceptions and policy proposals have developed in parts of USA
(Oregon) and Canada (Vancouver): responding to the crisis, Vancouver in 2020 voted to
decriminalise street drugs (Winter, 2020). This would potentially put them in confict with
the federal government. The aim would be to remove the threat of criminal sanctions for
possessing small amounts of street drugs for personal use within the city.
Arguments for harm reduction approaches are made by campaigning organisations like
Release and Scottish Drug Forum in the UK. Noting that there have been local agreements

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between police and local agencies to allow front of house drug checking at festivals and
clubs, Release argues that Drug Consumption Rooms (DCRs) are also a proven harm
reduction response. So, Release concludes, ‘The only reason they would not extend the
same thinking to DCRs is likely because of the profle of those who would use this facil-
ity, namely poor, marginalised groups who have little access to support from anywhere
else’ (Eastwood, 2019).

Competing frames
Both of these competing frames utilise a concept of ‘vulnerability’ with risks being linked
to polydrug use and social marginalisation, and overdose receiving particular attention. Dis-
tinctions are made between drug users, with some being seen as more worthy or deserving
than others. These frames are conveyed into the public arena in multiple ways, especially
through political statements and policy documents, organisational practices and research
publications. The media is one important player and the following section focuses on the role
of the media in framing and explaining DRDs.

Te media as the key player and political platform

The shape of policy is the outcome of competition between alliances of actors – like experts,
advocacy organisations, politicians – upholding or challenging established sets of arrange-
ments (MacGregor, 2017). The main sites of struggle are within the institutions of the state
itself and associated groups, like political parties, parliaments, civil service, and pressure
groups and the mass media. The latter are an important set of players in their own right and
they also provide the forums within which competing ideas and interests argue their case.
Press, television and radio, along with social media, have infuence at national and local lev-
els. In this chapter, particular attention will be given to the role of the media in infuencing
the framing of the problem of drug deaths.
In a recent UK parliamentary report, Sharon Brand, an individual with lived experience
of problem drug use who is now in recovery, is quoted as saying:

The media have a huge part to play, with the language they use and how they portray
people who use drugs. […] The language and the images the media sometimes use are
horrendous. They dehumanise people. They do not treat people as human beings; they
treat them as less than that. That has been the case for a long time—since the war on
drugs, I think.
(House-of-Commons-Scottish-Afairs-Committee, 2019, p. 52)

There is currently a moral panic around DRDs. Stan Cohen introduced the concept of
‘moral panic’ to explain what happens when a condition or group of persons becomes de-
fned as a threat to societal values and interests (Cohen, 1973, p. 9). When this happens,
the issue is presented in a stereotypical fashion by the mass media, politicians comment on
related moral principles and experts pronounce their diagnoses and solutions. Sometimes,
nothing changes in spite of this furry of concern but at other times perceptions are altered
and policy change ensues (Cohen, 1973).
Much analysis of the media focuses on the way in which conventional hostile views of
drugs and drug use have framed policy debates. Opinions stated in the press are taken as ex-
pressions of public opinion by politicians and, in turn, infuence public opinion. Nick Davies

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commented, for example, that the Daily Mail (a key right-wing newspaper in the UK) is not
so much a defender of the establishment as concerned principally to respond to and shape its
readers’ views (Davies, 2009). Malcolm Dean, like Davies, a respected investigative journal-
ist, has commented that ministers adjust their policies on drugs and law and order to ft with
what the tabloids want (Dean, 2012).
Studies of the role of the media have charted the media’s role in framing and reframing
the issues of drugs and DRDs in recent years. Observers have noted a turn towards a limited
acceptance of harm reduction approaches.

Te fear of drug deaths and a ‘war on drugs’ mind-set

David Altheida has analysed the role of the news media in promoting a public discourse of
fear and shown how the mass media and public perceptions of social problems are inexorably
linked: the mass media play a large role in shaping public agendas by infuencing what peo-
ple think about (Altheide, 1997). Altheida analysed the media forms and frames guiding the
selection and presentation of reports emphasising fear (such as crime, drugs and violence) and
observed that bad news always wins out over good news stories. He says:

Frames are the focus, a parameter or boundary, for discussing a particular event. Frames
focus on what will be discussed, how it will be discussed, and above all, how it will not be
discussed … An example is treating illegal drug use as a ‘public health issue’ as opposed
to a ‘criminal justice issue’.
(Altheide, 1997, p. 651) (our italics)

The mass media are part of a problem-generating machine geared to entertainment, voyeur-
ism and the quick fx. The problem frame ‘promotes a discourse of fear that may be defned
as the pervasive communication, symbolic awareness and expectation that danger and risk
are a central feature of the efective environment’ (Altheide, 1997) p.648). In media culture,
he argues, there is an absence of the ordinary (Altheide, 1997, p. 652) and the discourse in-
volves attributing blame. The target of fear is socially constructed. Often, the persons used
to inspire fear are members of the despised and powerless groups in society (Altheide, 1997,
p. 663). In the USA from the 1980s onwards, fear merged with drugs, especially linking to
crime and violence in 1994. Gangs and drugs were highlighted. Fear provides politicians
with agendas, dramatic scripts and news media pronouncements of remedies to ‘make us safe’
(Altheide, 1997, p. 665).
In another study, Forsyth examined the representativeness of newspaper reports of deaths
attributed to illegal drug use. He found that some drugs were more likely to be mentioned in
newspaper stories concerning drug deaths than others. Atypical drug fatalities such as those
involving teenage females or recreational drugs, especially ecstasy, received a disproportion-
ate amount of press attention. He argued that it is the very unusual nature of some illegal
drug deaths that renders them newsworthy. By focusing on certain drugs or certain types of
deaths, the media oversimplify complicated issues (Forsyth, 2001).
Forsyth’s account focused on Scotland and pointed out that in the late 1980s, fewer than
ten deaths per annum were recorded as being as a result of drug dependence. This situation
changed dramatically during the 1990s (Forsyth, 2001, p. 436). Forsyth observes that cru-
cially a context of more drug deaths means more selective press reporting. His study looked
at ofcial data for the whole of the 1990s, identifying 2,255 toxicologically confrmed drug
deaths and compared these data with a sample of newspaper reports. Seven-hundred ffty

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news reports concerned fatalities, 546 of which were all directly attributed to illicit drug use.
His study found that a large proportion of these newspaper cases carried very little supple-
mentary information about the circumstances of death, such as which drugs were involved
(Forsyth, 2001, p. 440).
Scientifc explanation of drug deaths highlights a complex pattern of poly-substance use.
Forsyth’s study found however that in news reports there was a stereotypical ecstasy death
at frst time use of only one pure MDMA pill – this type of occurrence was in fact very
rare (Forsyth, 2001, p. 443). Forsyth concluded that there ‘seems to be little correspondence
between individual drug deaths reported in the newspapers and those recorded by the Reg-
istrar General for Scotland’ (Forsyth, 2001, p. 444). Reporting of deaths in the news focused
on events which were newsworthy. Forsyth concluded that there was ‘a tendency for the
press to devote more column inches of newsprint to deaths characterised by teenage, female,
ecstasy use rather than to those of older, opioid/benzodiazepine using males which predom-
inate in the toxicological statistics’ (Forsyth 2001, p. 446).
The 2000s saw a proliferation of media reporting about an opioid epidemic in North
America. Webster and colleagues conducted a qualitative thematic analysis of 826 articles
in Canadian popular news media between 2000 and 2017 (Webster et al., 2020). These
reports described an array of opioid-related harms, such as addiction, overdose and over-
dose mortality. The study found that patients tended to be dichotomised as either inno-
cently following physicians’ prescriptions or involved in drug-seeking as an aspect of lives
characterised by addiction and street crime. Thus, they argue, the social construction of
the opioid epidemic polarised individuals as good or bad. Stigmatising references were
made to so-called addicts. Many articles used dramatic and sensational language. Eforts
were made to identify which individuals or groups to blame, with criminality being a key
theme. In the early period of the epidemic, explanations focused on the naivety of users
and physicians. By 2012, media coverage clearly conveyed a sense of danger around pre-
scription opioids. Later, concern was expressed about fentanyl. In these media accounts,
very little light was shone on the associations between opioid use, mental illness, alcohol
use and poverty. Members of higher status groups who became addicted, such as those
who were white and middle class, were more often portrayed as innocent victims. This
study supports the analysis made by Mendoza and colleagues, who contrasted the attention
given to a surge in opioid overdose deaths among suburban and rural whites in the USA
with the war on drugs of the 1980s and 1990s, when DRDs were framed as largely afect-
ing urban Black and Latinx populations. They claim that community groups and policy
makers have been much more sympathetic to the white and middle-class victims of this
new epidemic (Mendoza et al., 2019).
The racial dimension in narratives has also been explored. Daniels and colleagues ob-
served how discussions in mainstream news media altered during the opioid epidemic (Dan-
iels et al. (2018). Their work focuses on depictions in television shows in the USA. They
note that American drug policy has been driven by racism, evidenced by the fact that about
half of people in the US federal prisons are there for drug ofences. They too comment on
the recent turn towards more sympathetic views on drug users, which concentrate less on
racist notions of (Black) drug fends, and more on seeing the white women – who are often
now the focus of concern – as victims, based on assumptions about their supposed innocence.
Conventionally, they say, ‘active drugs users are routinely portrayed as risk-taking outsiders
who should be actively excluded from society’ (Daniels et al., 2018, p. 332). However, where
white drug use is concerned in the US narratives, it is more often portrayed as a medical
rather than a criminal problem.

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Fraser and colleagues carried out research on newspaper coverage of drugs in Australia,
focusing on accounts of the deaths of non-celebrities (Fraser et al., 2018). They found that
the metaphors mobilised presented overdose as the natural result of the dangers of drugs and
of the personal problems and characters of those afected. They found an absence of detail
about the lives of those who had died from opioid overdose. The accounts supported com-
mon sense notions of overdose as fundamentally the efect of drug consumption, addiction
and the criminality of consumers. Drugs fuel overdose but those afected somehow have
within them the seeds of their own destruction.
The logic presented ran as follows: drugs are dangerous; they can lead to death, especially
among those imperfect souls touched by mental illness, trauma or deprivation (Fraser et al.
2018, p. 32). This analysis of newspaper coverage of accidental death by overdose showed
that it tends to anonymise victims and treat their deaths as part and parcel of their fawed,
half-lived lives. Where death occurred, its signifcance was in the pain it caused to immedi-
ate family (Fraser et al., 2018, p. 34). They conclude that newspaper coverage supports ex-
isting discourses of addiction, which overwhelmingly present lives afected by it in singular
terms as pathological, disorganised, harmful and tainted. They argue that ‘until the lives of
opioid consumers come to be considered grievable, the measures known to reduce overdose
deaths may struggle to fnd public support’ (Fraser et al., 2018, p. 18).
From an analysis of 1,735 articles published between 1990 and 2017, Jaufret-Roustide
and Cailbault conclude that the public conversation leaves little room for drug users ( Jauf-
fret-Roustide and Cailbault, 2018). Their study focused on the issue of DCRs. Various stud-
ies have shown that DCRs diminish the rate of overdoses. Jaufret-Roustide and Cailbault
looked at the context in which DCRs were debated in France; that is how the issue was
framed. They looked at the relation between the local and the national levels and highlighted
how current actions and discourses borrow from past controversies. For some time, DCRs
were invisible in the media. Events then propelled the issue to the national stage. At the local
level, opposition to DCRs focused on the threat perceived to local residents’ well-being and
quality of life: there was fear of attracting marginalised populations to their neighbourhood.
The voices of drug users themselves were barely present in these debates. Drug users were
discounted as they were assumed to be irrational, irresponsible and untrustworthy.
In the prohibitionist/war on drugs paradigm, chronic or hard drug users are seen as
unable to operate rationally and thus for their own and the general public good should
be subjected to controls through the criminal justice and public health systems. In the
harm reduction approach, drug users are granted agency and seen as able to act together
to protect themselves if placed in supportive conditions (Stimson, 1989, Rhodes, 2002).
Adverse events (leading to DRD) are as much a result of social exclusion as of the toxicity
of substances.

Te turn to support for harm reduction and a regulation paradigm

The issue of DCRs also fgured in Scottish debate (Atkinson et al., 2019). Atkinson and
colleagues reviewed 174 articles, noting a rhetoric of abstinence and recovery underpinning
arguments against DCRs. They conclude that attempts to introduce and gain public and po-
litical support for harm reduction responses through the news media face challenges within
the context of prohibitionist UK drugs policy.
However, in their study, Atkinson et al. found also that while politically right-leaning
and Scottish sources were more likely to portray proposals for DCRs negatively, a propor-
tion of reports were supportive of the proposals.

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Overall, they found that at this time a discourse of public health dominated over that of
criminalisation, with proposals for a DCR being set within what was seen as a public health
emergency. The focus was however very narrowly on the injecting event itself, with a lack of
attention to the need for provision in housing, employment and welfare support. A discourse
of urgency emphasised the need for policy change. The concept of vulnerability was again
also employed, for example, with reference to the issue of an ageing population of people
who used heroin.
So, it was the acute crisis of rising DRDs and overdoses which seemed to have allowed
a turn towards increased acceptance of a harm reduction approach (increasingly referred
to as a ‘public health’ approach in places like Scotland, Canada and the USA though one
quite narrow in focusing on safe injecting alone). There had arisen, it seemed, a consensus
that the problem was one of public injecting, drug use, HIV infections and DRDs among
a specifc group of individuals in the city centre of Glasgow. Around this, the old debates
between harm reduction and abstinence revolved. Diferent actors drew on diferent statistics
in difering ways to support their arguments. However, the voices and experiences of people
who use drugs were absent and silenced, relative to the voices of experts, professionals and
politicians. There was a lack of attention to the individual lives of the people who were using
drugs. ‘The news media and actors chose to draw on and prioritise statistical evidence and
ignore individual stories and experiences’ (Atkinson et al., 2019, p. 72).
A study of 54 English language Canadian newspapers found that the volume of coverage
doubled in 2008 and quadrupled in 2016, linked to critical changes in Canadian drug prob-
lems and policies (Wild et al., 2019). Supervised drug consumption accounted for almost half
of all newspaper coverage. These authors conclude that Canadian newspapers independently
shaped public discourse, frequently characterising harm reduction positively and from a
health perspective. However, while progressive, this move was limited as the debate was
distorted by over concentration on supervised consumption which crowded out discussion
of other harm reduction interventions and tools.
Similarly, Quan and colleagues explored how Canadians’ perceptions of the opioid crisis
developed over time, infuenced by one newspaper’s reporting over an 18-year period (Quan
et al., 2020). Six-hundred ffty relevant articles were reviewed with peaks noted in 2009,
2012 and 2016. Responsibility for the epidemic was attributed to pharmaceutical companies,
physicians and foreign countries. Of the 650 articles reviewed, 22.3% referred to general
statements of risk as evidence to support their claims. The factors mentioned included the
potency of fentanyl and other drugs mixed with opioids when sold illegally. Articles warned
about the risk of overdose and mentioned ways to mitigate overdose deaths such as naloxone
kits. The study found that over time from 2009 to 2018, the use of stigmatising language
such as ‘junkies’ or ‘addicts’ declined with, especially from 2016 onwards, more use of terms
like ‘people who use drugs’ or ‘people who sufer from addiction’. ‘The shift towards less
stigmatizing use of language was closely interlinked with the framing of the opioid crisis
as a public health rather than criminal issue’ (Quan et al., 2020, page 5 of 11). However,
there remained an emphasis on fear-based campaigns. Only 11.4% of all articles discussed
secondary causes of the opioid crisis such as gaps in the healthcare system. The root causes of
high-risk drug use such as social inequity, socio-economic disparities and unresolved trauma
were mentioned even less often.
Collins et al. have also shown how conventional moralistic messaging around drug use
stigmatises people who use drugs (Collins et al., 2018). In the context of the recent unprec-
edented North American opioid overdose crisis, they argue that it is important to shift mor-
alistic messaging to its alternative of evidence-based harm reduction because of the impact

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of discourse on reinforcing stigma and the need to shift the discourse to allow alternative
solutions to the problem of overdose deaths. Solutions favoured include the low threshold
‘supervised injection facilities’ termed ‘overdose prevention sites’ in British Columbia. The
term ‘overdose prevention sites’ focuses attention on prevention in the context of a public
health emergency and is deliberately preferred to the terms ‘supervised injection facilities’
or ‘drug consumption rooms’ – terminology which risks evoking moralistic interpretations.
Related interventions which can also be promoted within this frame of ‘overdose preven-
tion’ include syringe exchange schemes, naloxone distribution and opioid agonist therapy.
Words matter when in the midst of a public health emergency.

A comparison of national and local news coverage in the UK

Infuenced by the fndings of prior research, we carried out a small study of media coverage
of DRDs over a 12-month period in the UK. The aim was to compare national and local
coverage of the issue to explore any diferences between national and local levels.
It was decided to focus primarily on print media: for this analysis, we took a 12-month
period, November 2018 to November 2019, and accessed newspapers analysable via Factiva
at the British Library. We selected to focus on Daily Mail, The Times and Sunday Times, The
Bolton News, Manchester Evening News, Paisley Daily Express, Birmingham Mail and Birmingham
Post. The selection aimed at geographical spread and inclusion of local, regional and national
newspapers. Choice of the Daily Mail and Times newspapers was deliberately to focus on
those most likely to infuence the current Westminster Conservative government, in power
since 2010 (omitting the more liberal papers such as The Guardian and Independent). In addi-
tion, we looked in a preliminary way at BBC online, STV online, HufPost (Hufngton Post)
and The Irish News online. Search terms were drugs/substance use/abuse/deaths.
A number of ofcial reports were frequently cited from national bodies like Public Health
England (PHE), Ofce for National Statistics (ONS), National Health Service (NHS) and
Scottish government and from local government bodies as well as from think tanks like the
Centre for Social Justice (CSJ) and issue-specifc parliamentary groups like All Party Parlia-
mentary Groups (APPGs) (Table 26.2).

National coverage of drug-related deaths

At national level, most coverage was analytic – detached and at a high level of abstraction.
Coverage focused on issues and policy remedies, prompted by reports from reputable or
infuential bodies like ONS, PHE, CSJ or APPGs, demonstrating the role of experts and ev-
idence in providing material for national coverage. Reports on individual deaths were rare.
Where they were reported, they were of celebrities or the children of celebrities. Detailed
stories about individuals were restricted to the unusual or exceptional.
Responsibility for the problem included blaming those afected but there were few pro-
fles of the individuals involved: for example, no detail was provided on deaths in prisons,
where it was said that prisoners were ‘dropping like fies’ (although it was pointed out that
most had underlying health issues). The individuals who died were often seen as naïve, un-
healthy or fawed, perhaps as the result of early trauma. Even so, chaotic users were seen as
responsible – ‘knowing the risks she still took it’. Danger was also seen to lie with ‘dangerous
substances’, such as spice, Xanax or fentanyl, or with ‘dangerous groups and people’, espe-
cially illegal sellers and sources. Particular attention was paid to the ‘new’ – new drugs or the
new dangerous space of the internet (Table 26.3)

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Table 26.2 Themes and evidence sources in UK newspapers

Number
Newspaper of items Themes Illustrative items Evidence sources

Daily Mail 176 Party policies 28.8.2019 PHE report

Policy debate Britain’s drug disgrace – drug capital APPG report
Role models of Europe Individual stories
Opioid Britain 12.9.2019 from elite or
Addiction can afect ‘this was an individual who took drugs celebrity families
people in all classes andvoluntarily and has succumbed to the Inquest reports
ages side efects of those drugs accidentally’ CSJ reports
Ease of access to drugs 12.11.2019
Role of prescriptions
The Times 463 Drug crisis 30.12.2018 Investigative
and Sunday Fear of US style ‘call for shooting galleries as fatalities reports – Sunday
Times epidemic rise’ Times Opioid
Variety of substances 24.2.2019 Crisis series
and sources – online/ In depth story on hostel for homeless analysed a
festivals/dial up; 7.4.2019 decade’s worth
cocaine, opioids, Since 2007 the annual number of of data
tranquillisers, skunk opioids prescribed by GPs has risen by NHS reports
Policy debate in UK and 10 million Obituaries
in Scotland 20.4.2019 Ofcial statistics
Who to blame – SNP? Four prisoners die after taking bad Inquest reports
Purdue Pharma? batch of spice ONS reports
Inequality? Deprivation? 25.6.2019 PHE reports
GP prescribing? ‘Safe’ rooms as response to substance Expert opinions
Innovations – SIF? abuse deaths
Medical cannabis? Drug 14.8.2019
testing? Generation X most likely to die from
Variety of people drug overdose
afected – celebrities 4.10.2019
and families; MPs and Rugby players die in Sri Lanka –
families; musicians; ‘innocent about narcotics’
rugby players; ordinary 17.10.2019
Scots teens No progress in Drug Crisis after 550
more deaths
The Bolton 103 Policy and practice role 5.1.2019 Inquest reports
News and of local drug teams drug tragedy of bright and intelligent PHE reports and
Manchester Easy access to drugs man local data
Evening Efects and dangers of 7.9.2019 ONS
News drugs tragic life and death of loving mum
Homelessness hooked on drugs from age 11
Toxic substances: 11.12.2019
Mixing cocaine and beaten stabbed and humiliated – the
alcohol reality of life on the streets of Bolton
Fentanyl; painkillers 11.1.2019
Middle aged drug tragedy of mother addicted to
problem painkillers for 28 years
Role of black market 25.6.2019
tragedy of beautiful mum with
painkiller addiction

448
 Risk, intoxication and death

Paisley 51 Numbers of dead 17.1.2019 Report to Health

Daily Rising rates tragic case/recovery and Social Care
Express SCF 19.9.2019 Board
Characteristics of dead fresh moves to end drug-related deaths Court cases
Key drugs
Decriminalisation
Homelessness
Recovery
Birmingham 96 Poverty 28.9.19 Inquest reports
Mail and MPs/policy rethink Driver high on drugs Criminal cases
Birmingham Policy reform -heroin 23.10.19 Local data on
Post prescribing Cocaine death/spiked drugs drug deaths
Causes of death 2.5.19
Deaths caused by Heroin and homeless death
irresponsible substance 17.10.19
users Addict left girl friend to die in crash
Recovery
Main substances
Homelessness

Table 26.3 Illustrations of coverage in national newspapers

Newspaper Evidence Policy references/ explanations References to individuals

Daily Mail UK one in three of cuts to treatment budgets by

Europe’s overdose local authorities
deaths
The Times 23 people a week Illicit online pharmacies Two British rugby players
die in Scotland from Illegal unregulated purchases – innocent about narcotics’
suspected overdose Adulterated substances – died in Sri Lanka after
‘Super strength’ drugs taking ‘brown sugar’
Bad batch of spice A young father overdosed
Very inexperienced user on Valium he bought on
the web; age 32 he had a
successful career as a product
manager. His addiction was
fuelled from illicit online
pharmacies
Sunday Times Extensive Tramadol and codeine Sarah gang raped as a
investigation into obtained free from GPs child in foster care – later
Britain’s opioid crisis Crack cocaine bought with became a sex worker – had
money from sex work 11 children – all taken into
Value or not of naloxone care at birth – found dead
– a hostel staf member has aged 30 in her hostel room
revived 15 people with as a result of an overdose of
naloxone and CPR fentanyl and heroin

449
 Susanne MacGregor and Betsy Tom

Local coverage of drugs issues and drug-related deaths

As at national level, local reports were often based on publications from ONS or PHE, which
then prompted coverage of the issues and provided local data. Again, as at national level, the opi-
oid crisis in the USA provided a template for a discussion of the drugs issue with commentaries
on whether or not this epidemic could happen in the UK. The relatively extensive coverage of
issues relating to substance use leads us to conclude that drug use and drug problems have become
normalised in media discourse. Particularly notable was an assumption of the normality of cocaine use,
with references to ‘recreational cocaine use’ even by ofcials and in court reports.
Along with the ordinariness of drug use – and thus it not being counted as newsworthy –
was the theme of unpredictability which was deserving of comment. Unpredictability was seen
to arise because of the context of illegality but also because of the inherent uncertainties in
the drug market and the phenomenon of varied individual reactions – what kills one person
might not have killed another. The theme of an ordinary person put into extraordinary
circumstances because of drug use also fgured where drug use could produce paranoia and
extreme behaviour. So, at local level in the accounts, unpredictability and fate and bad luck were
themes, along with occasional undertones of unfairness.
Special attention to the new is a notable feature at local level, as at national, with new
dangers including that of combining substances (such as cocaine, alcohol, codeine, antide-
pressants and painkillers) – the mixing of legal and illegal substances was highlighted. There
was a prominent discussion of new substances (such as fentanyl). There was also some atten-
tion to a new age group – the ‘middle aged drug problem’.
Explanations at local level also pointed to naïve innocent users, for example, in the ‘trag-
edy of beautiful mum with painkiller addiction’ who had been prescribed tablets for a bad
back and pains in her legs. This was an unlucky and inexplicable event: this combination of
drugs might kill one person but not another – we ‘can’t say exactly why she died – she took
an excess and combination of drugs’.
Inquest reports selected for coverage focused on the strange and sensational but also
showed the complexity of the circumstances surrounding a drug death. Cause of death was
rarely simply an overdose, though this did fgure such as high levels of heroin ‘well over the
level which would prove fatal to even a repeat drug user’ or combinations of substances – a
‘fatal cocktail’. Other events and factors were also shown to have played their part, such as
hanging, blood poisoning or sepsis.
The question underlying the local reports, as at national level, was how to account for
these deaths and who to blame: and as at national level, the drug, the user and the seller all
fgured in these accounts. Risk-taking individuals who died were seen as ultimately respon-
sible – they knew what they were doing but perhaps could not control themselves. So, these
deaths were of fawed individuals. But, after death, some attempt would be made to recover a
sense of them as individual human beings – for their sake but perhaps more so for the family.
In Coroners’ summings-up, there seemed to be an ethical concern to respect the living rela-
tives and respect the dead: ‘he was a person and it is important to recognise that there were
times when he was successful’; ‘it is clear to me that Tracy was a lovely lady’.
At local level, there was also some discussion of what services had done or not done: had
drug services done enough to refer people to appropriate services or had emergency services,
like police or fre, responded appropriately? The notion of trying to learn lessons from these
sad cases featured.
There were also examples of ‘recovery’ stories where people had been able to ‘turn their
life around’ (Table 26.4).

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 Risk, intoxication and death

Table 26.4 Illustrations of coverage in local newspapers

Newspaper
location Evidence Policy references/explanations References to individuals

Bolton Inquest reports fuctuating strength and ordinary people living at

purity of heroin purchased home with their families
illicitly Woman addicted from
Poly substance use a young age, had used
Variety of substances – intravenously previously,
crack cocaine, diazepam, smoked 20 cigarettes a day,
pregabalin, methadone drank heavily, had chronic
Chronic drug use; long liver disease, COPD and
histories of drug use Hep C
Criticism of local drug walking a tight rope every time
teams she took drugs
Manchester Inquest reports Mental illness – perhaps George, a devoted daddy, a
Police reports induced by drug-taking family man, a true friend, age
Physical efects of 25, working as a sales assistant
substances vary in – lived with his partner
diferent people and baby. Death due to a
heart attack or seizure – the
level of cocaine taken – said
the toxicologist – was only
what might normally be taken
recreationally
A young mother died after
drinking and taking drugs on
a rare night out – death due to
acute cardiac failure, partly
caused by cocaine use. The
toxicologist said her alcohol
level was low and her cocaine
level recreational
Birmingham Ofcial reports – Links to poverty 32 year old father of two
number of people MPs call for rethink on children, died of a heart
dying from drug use policy attack after taking cocaine
in the West Midlands Local crime commissioner with friends – the cocaine in
at highest level since calls for heroin prescribing his system was at an amount
records began in 1993. Homelessness well below levels normally
521 deaths in West associated with fatalities –
Midlands in a three- pathologist – he had pre-
year period. existing heart disease and
Inquest reports this combined with a chest
infection and cocaine use led
to the heart attack – mother
said – I think the cocaine was
spiked and that killed him.
Homeless man was ‘a loving
and caring man’ whose life
had simply spun out of control

451
 Susanne MacGregor and Betsy Tom

Online and TV coverage of local events and action

Online articles are not as restricted in length as print media are. They respond to events
quickly and immediately. For example, there were reports on seven suspected drug deaths
in ten days in Belfast in November 2019. BBC online covered this story: a ‘shocking cluster
of deaths’ is newsworthy.
Similarly, The Irish News covered this event, describing what was known about those who
had died and linking to warnings issued by public health agencies. They also quoted political
leaders who called for changes in policy and practice – more early intervention, easier access
to harm reduction support, detox treatment and crisis response – and one who said, ‘Behind
those who have died are mothers, fathers, sons and daughters and we can no longer sit back
and allow this to continue’.
In December 2019, STV News reported on a candlelight vigil being held in Glasgow for all
those who died in DRDs in the past year. Around 800 wooden crosses had been planted in the
garden of Springburn Parish Church to represent those who had died after taking narcotics since
April. The church minister said that drug addiction must be treated as a public health emergency
as he revealed that around a third of the 500 funerals he had conducted over the last fve years
were drugs-related. Campaigners aimed to break the stigma surrounding drug use, accept that
deaths are happening, start a public conversation and see the links to homelessness.
The radical campaigning platform HufPost reported on ‘This Is How Austerity Is Ex-
acerbating Dundee’s Drugs Crisis’ in November 2019. This was a collaboration between
Huf Post UK and investigative journalism platform The Ferret and looked at the impact of
the government’s austerity policy in Scotland. The article reported on the death of a woman
whose post-mortem revealed that she had taken etizolam, pregabalin and methadone. She
left behind a seven-year-old daughter. She also became another one of the 400 DRDs in
Dundee over the past decade.
The article quoted Ewan Gurr, a former drug user who established the city’s frst food
bank and said that there are a myriad of reasons why people use crack and heroin, but it’s
widely acknowledged that deprivation is linked to drug use. This online article quoted from
a report by the Dundee Drugs Commission, which said that poverty was one of the root
causes of the city’s drug crisis. The article also quoted from a former heroin user, co-founder
of Recovery Dundee who said that:

there’s now three generations of families that have been unemployed. So you’ve got
three generations of people that have been addicted, and then their grandchildren and
children are now becoming addicted. I think that the impact of what happened 30 years
ago is now showing and manifesting in so many diferent ways in communities like
mine especially.

In summary
The type of reporting of drug deaths varies with the level of the targeted readership, that is,
whether it is local to a town or city, regional or national. The degree of abstraction increases
with distance. At local level, there is more detail on individual lives, often drawing on re-
ports from Coroners Courts. Apart from discussions based on the detail of individual deaths,
other coverage may consider policy proposals and build around reports from expert bodies.
Extensive in-depth reporting and use of quotations from people with living experience of
drugs is rare in newsprint though found in television reporting. Online reports are willing to

452
 Risk, intoxication and death

make links to austerity, poverty and deprivation and structural and cultural infuences, whereas
print media more often confne themselves to focusing on immediate behavioural choices.

Conclusion
In recent years, in parts of North America and Europe, debate on drug overdose and DRDs
has become more nuanced and better informed. This has been brought about to a large
extent by attention to a crisis of DRDs, informed by reports from public health bodies and
expert commissions as well as by the sophisticated building of alliances between reformist
pressure groups and health journalists and the use of committees and commissions to mo-
bilise evidence and opinion. The role of relatives and friends of those who have died has
also been infuential in reducing stigma and revealing the ‘grievable’ human lives which lie
behind bare statistics. This turn has been played out in the space of media coverage.
A constellation of players has come together to focus on the issue of drug deaths and in
places these actions are bringing about a shift in perceptions and policies. A key role has been
played by the accumulation of compelling evidence in reports by experts (Collins et al.,
2018; Tsai et al., 2019; AMA OPIOID-TASK-FORCE, 2020; Lippold and Ali 2020; Insti-
tute-for-Clinical-and-Economic-Review, 2021) which is then mobilised in alliance with
pressure groups of advocates, drug users and family members (Smith, 2021).
Change is evident in places such as Vancouver and Scotland. The Scottish government has
established a Drugs Deaths Taskforce and the First Minister has become directly involved in
the debate. A former drug user turned activist, Peter Krykant, raised the profle of the issue
of Safe Consumption Rooms in Glasgow by taking the initiative to provide these himself
with a mobile van. He parked his white van in the streets of Glasgow to give people a safe
place to inject illegal drugs.
Through this direct action, media attention has focused on the issue and raised it higher
on the political agenda. These actions combined with pressure from advocacy groups like
Anyone’s Child have added a diferent kind of expert evidence to the debate – derived from
people with direct experience of drugs and drug deaths.
Policy and the law respond to people’s fears. At the same time, fears are socially con-
structed, including through press reports. Societies are selective about what fears to focus on.
Insofar as death occurs among the poorer and marginalised, they cause few ripples on public
life and do not infuence debate or lead to policy changes. These are, as Fraser et al. (2018)
call them, ‘ungrievable lives’ with little signifcance for powerful decision makers. The issues
which prompt attention are being at the top of international league tables or alarming rises
in the number of deaths. A turn towards acceptance of a harm reduction approach seems to
be emerging, with important support coming from police, with coverage of the issue in the
media encouraging politicians to respond. However, the understandings of harm reduction
are thin. The search seems often to be for a simple solution such as providing an overdose
prevention site/SIF with much less attention to underlying longer-term causes of poor health
or addressing the gaping holes in social and health support services.

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 27
CLEARING THE AIR
Toxic healthism and cigarette(s)
(smoke) as (in)toxicant(s)

Qian Hui Tan

‘Toxic’ as a new buzz word: geographies of toxicity

In the last few years, the word ‘toxic’ has been mobilised quite ubiquitously to denote an
unsavoury mode of power dynamics in both academic and popular discourses. Such ‘toxic’
machinations of power operate on a variety of scales (on a macro scale, e.g. to critique set-
tler-colonialism and on a meso/micro scale, e.g. toxic sexism/masculinities; see Cielemęcka
and Asberg 2019). Taking this furry of interest in the politics of ‘toxicity’ as a point of de-
parture, I attempt to complicate bio-medicalist interpretations of (second-hand) smoking as
necessarily toxic or intoxicating. In teasing out some of the key points I have gleaned from
the literature on toxic and smoking geographies, I make a bold case for the ways in which
healthism as a discursive and material practice is ultimately a toxic one.
As a human geographer by training, I suggest that it may be instructive to review a resur-
gence of research emphasis on toxic spaces within the discipline. I suggest that the burgeon-
ing scholarship on the environmental geographies of toxicity and other closely associated
ideas such as contagion and pollution are ostensibly relevant to a more specifc phenomenon
pertaining to the geographies of smoke and smoking intoxication. Consequently, I hope to
synthesise these two discrete bodies of work in order to better inform a more robust con-
ceptualisation of toxicity/intoxication vis-a-vis a healthist rhetoric on cigarette smoking. A
geo-environmentalist perspective on the spatiality of toxicities does not entail intoxication
per se. Nevertheless, I demonstrate that the key takeaways from this body of work are highly
applicable to (second-hand) smoking, which is plugged into a ‘new age of toxicity’ (Walker
2011; i.e. ‘the ubiquitous condition of chemically altered living-being’; Murphy 2017: 497).
Overall, I identify two general but pertinent points in the literature on toxic geographies.
First, the dissipation of toxicants is highly uneven across space, which, in turn, perpetuates
the asymmetrical power relations between diferent social groups. In modern toxicology, a
scientifc-technocratic defnition of toxicity (and toxic risk) is based on specifc quantities of
allowable pollution, thereby determining the extent to which a substance might endanger
living organisms. However, this is a deceptively simplistic view not just because it is often
difcult to quantify toxic exposure but also because it may be difcult for the body to regis-
ter it qualitatively (see later discussion on sensory perplexity). Moreover, the fetishisation of
the wayward particle as the inherent (micro-)locus of toxicity would occlude the ‘contours

DOI: 10.4324/9780429058141-35 457

 Qian Hui Tan

of position and power’ that shape who or what gets deemed as toxic on a much larger scale
(Calvillo 2018; Fiske 2018: 394; Liboiron et al. 2018).
Unsurprising, (infra)structures have been put in place to ‘neutralise’ toxic bodies/entities
and to shield the ‘pure’ and privileged from toxic exposure (Murphy 2004). Aside from
calls to espouse environmental justice, Cielemęcka and Asberg (2019: 105) propound that
everyone therefore is complicit in the material/discursive (re)production of toxicity within
a consumerist/capitalist system. Correspondingly, an attunement to politics toxicity can il-
luminate the kinds of power relations that enable non-toxic lifestyles while extinguishing
toxic ones (Liboiron et al. 2018).
Despite the installation of such (infra)structures, more individuals have come to realise
that toxic pollutants/contaminants/waste cannot be bound in space. For Litvintseva (2019),
there is therefore no spatial ‘outside’ for externalising toxic materials. If this is the case, then
no entity can fully protect itself from being vulnerable to, neither can it be absolved from
being responsible for toxic exposure. However, Cielemęcka and Asberg (2019: 105) have
alluded to the conundrum that societies are in, that a colonialist-medicalist impulse to detox
or purify every single sphere of one’s existence in a bid to return to some idealised pristine
state is also equally unviable.
Second, (feminist) environmental geographers and other social scientists have highlighted
the importance of fxing the analytical gaze on the ‘geography closest in’—that of embodi-
ment. Scholars have insisted that the biochemical materiality of corporeality matters vis-a-
vis a somatic-sensory awareness that is responsible for rendering toxins perceptible (or not,
even) after a protracted period of exposure (Cielemęcka and Asberg 2019; Davies 2019; Mah
and Wang 2019). For this reason, toxic efects and afects are mutually imbricated (e.g. with
toxic smoke being smelled and felt), along with the corporeal as both a ‘mechanism of toxic
worlding and a toxic world unto itself ’ (Nading 2020: 211).
Notably, Senanayake’s (2020: 1555) conceptualisation of ‘sensuous perplexity’ ofers an
invaluable insight into how bodily responses to toxicity can sometimes perpetuate ‘uncer-
tainty about what harms and what heals’ while living in polluted locales. Accordingly, ‘em-
bodied witnessing’ can be so much more ambivalent than what scientists and policy makers
make it up to be. As a corollary, confusions about the health and ecological risks from toxic
exposure are multiplied rather than mitigated through diverse and conficted versions of so-
matic knowing (Senanayake 2020). Sensory perplexity therefore complicates a reductionist
apprehension of toxicity by modern scientifc knowledge. Having outlined the academic
context whereby studies on toxic geographies are situated, the rest of this chapter proceeds
to zoom in on the (in)toxic(ating) geographies of cigarette smoke/smoking.

Te ‘(not-so-)toxic’ geographies of smoking/smoke

Intoxication has been pathologised by bio-medicalist and public health institutions. Af-
ter all, a subscription to a physiologically injurious act must be logically fawed and
morally reprehensible (Hunt and Frank 2016). Just as how a bio-scientifc model of
toxicology strips environmental pollution of its complexity, a dominant public health
approach bent on eradicating toxic-induced harm similarly fails to recognise other ways
of theorising (in)toxication (see Bancroft 2009; Hutton 2020). Such a bio-medicalisa-
tion of cigarette smoking usually implies identifying and isolating its (psycho)active
ingredient, i.e. nicotine. Nicotine is not exactly the most toxic component in cigarettes
(compared to e.g. tar and carbon monoxide) but it is ‘addictive’ (i.e. connoting physical
dependency) and is therefore intoxicating.

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Besides the long-term smoking of regular cigarettes, other forms of nicotine self-poison-
ing include an excessive inhalation of the nicotine solution loaded in e-cigarette vaporisers
(Hughes and Hendrickson 2019) or the copious use of nicotine replacement therapy patches
(Woolf et al. 1996). Crucially, the construction of the smoker as a nicotine ‘addict’ reduces
them into a Pavlovian automation lacking in volition (see Berridge 2003).
But what is perhaps most unique to this phenomenon (including cigars and weed which
lie outside the ambit of this chapter) is that smokers are arguably not just (in)toxicating them-
selves. Rather, in spewing out noxious fumes, they are also jeopardising the health of other
non-smokers who are reluctantly made to inhale second-hand smoke. Major health organ-
isations have reported that there is ‘no safe level of exposure to tobacco smoke’ and there is
a general scientifc consensus that second-hand smoke can cause respiratory tract infections
in non-smokers (Öberg et al. 2011; Barnett et al. 2016). Couching smoking/smoke in the
language of risk/threat thereby justifes the draconian regulation of cigarette sale (packaging
with gory pictures and no logo), purchase (minimum age for smoking) and consumption
(public smoking bans).
I have previously argued (Tan 2013a; 2017) that smoking introduces an invasive sensory
assault on non-consenting passive smokers akin to that of respiratory rape. Regardless of
whether the sensory efuent generated by smokers is chock-full of carcinogens, the foul
odour of second-hand smoke is all it takes to invoke a visceral response enough to ‘subjec-
tively justify the expulsion of the source’ (Dennis 2016: 132). Simultaneously, Fiske (2018)
reminds us that such embodied responses of revulsion do not necessarily provide evidentiary
claims of a substance’s toxicity. Yet, the smoker who carelessly leaves behind malodorous
smoke/smell and cigarette butts in their wake is a ‘quintessential polluter of space’ (Marković
2019: 488) and a vector of toxicity (Tan 2013a; 2016d; 2017). In this case, the medicalisa-
tion of smoking works in tandem with a culturally infected sensory citizenship to reify the
smoker as a toxic(ating) presence overspilling their corporeal boundaries. Consequently,
bio-medicalist and public health institutions might beneft from a more holistic appreciation
of the ‘cultural algorithms’ (Bancroft 2020: 69) and sensual relations that smoking is caught
up in it.
As mentioned earlier, the odorous and odiously toxic nature of second-hand smoke has
shaped interventionist public health policies and spurred urban design projects at arresting
its proliferation (Tan 2013a). Smoking bans in both indoor and outdoor public spaces have
been progressively extended across many cities, such that smokers are increasingly only
allowed to light up in designated smoking areas. For instance, a pilot project launched in
2013 touted Yishun as the frst completely smoke-free residential neighbourhood/constit-
uency in Singapore (where my research on smoking spaces was based; The Straits Times
2013a; 2013b). This entailed that smokers in Yishun would have to refrain from lighting
up even in open air areas (selectively permitted elsewhere). Instead, they could only do so
in about 50 dedicated smoking ‘pavilions’ dotted all over the neighbourhood (The Straits
Times 2017; Figures 27.1–27.3).
Such sheltered ‘pavilions’ were three by three metres in size, partitioned on three sides
and furnished with benches as well as a cigarette butt disposal bin (The Straits Times 2014a;
2014b). Consonant with the intention to enhance air quality (by eliminating aero-conta-
gion/toxicity, Tan 2017) and curb the littering of butts, these smoking points were placed
strategically at grass patches, away from housing units and thorough fare. This purportedly
ground-up initiative was shored up by volunteer smoke-free ambassadors, private sponsors
(for the construction of the smoking huts) as well as a collaboration with Health Promotion
Board and National Environmental Agency.

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 Qian Hui Tan

Figures 27.1 Interior of a designated smoking point in Yishun, Singapore

Source: Author’s own.

Smoking’s shrinking geographies (see Collins and Procter 2011; i.e. a more censorious
socio-spatial climate for smoking/smokers) may seem like a reasonable or rational devel-
opment on frst glance. Despite the existence of an ever-expanding public smoking ban
(and the recent raise in the minimum age limit for smoking to 21), members of the public
in Singapore are still calling for more stringent and punitive means to ‘stub out’ the ‘(in)
toxic(ating)’ habit (The Straits Times 2021a). After all, The Straits Times (2021a) has reported
in an almost alarmist tone that ‘300 non-smokers die each year because of exposure to sec-
ond-hand smoke’, with 383 such deaths in 2016 (The Straits Times 2021d; without the proper
citation of sources).
On closer inspection, however, socio-legal regulatory regimes that purport to ‘protect’
innocent non-smokers from toxic exposure to second-hand smoke are problematic on at
least two fronts. First, such regimes are profoundly political and by extension, possibly
steeped in toxic violence. Public health institutions and state agencies exercise what Fou-
cault (1982) calls pastoral power, which gains its legitimacy from attending to ‘the wellbeing
and moral propriety of both individuals and communities’ (Martin and Waring 2018: 1293).
This justifes the (toxic) infantalisation of both smokers (as passive victims of Big Tobacco)
and non-smokers (as passive victims incapable of moving away from second-hand smoke and
hence, necessitating pastoral care). Additionally, pastoral power underscores an afectively
charged pre-emptive governmentality that is bent on preventing future smoking-related
mortality/morbidity in the present (Tan 2016b; 2016c).
Second, some of these regulatory policies are thoughtless at worst and ridden with discur-
sive contradictions at best. The porous boundaries between the public and private domains

460
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Figure 27.2 A designated smoking point in Yishun, Singapore

Source: Author’s own.

imply that urban planners, policy makers and public health experts will have to consider
how (a) traditional methods of spatially managing toxic smoke/smell via separation or dis-
tanciation, and/or containment are highly inefective (see Tan 2017); and that (b) smoking
prohibitions in one location merely divert the practice somewhere else. For Liboiron et al.
(2018: 332), such traditional ‘hallmarks of 20th-century pollution control’ are anachronistic
because they are erroneously premised on the possibility of ‘material purity’ or a non-toxic
reality.
It is by now an acknowledged reality that comprehensive public smoking bans displace
smokers into the domestic realm, thereby exposing vulnerable segments of the population,
such as children, pregnant women and individuals with respiratory problems to second-hand
smoke (Ho et al. 2010). Nonetheless, the impact of the recent COVID-19 restrictions on
smoking practices in public and private places has been less commonly discussed. During a
pandemic-induced ‘circuit-breaker’ (or lock-down) in Singapore, smokers were not permit-
ted to leave their residential units just for a puf because smoking was classifed as a non-es-
sential activity. Smoking corners at outdoor eateries such as cofee shops and hawker centres

461
 Qian Hui Tan

Figure 27.3 Inside a designated smoking point in Yishun, Singapore

Source: Author’s own.

were closed (following a no dining-in policy), and all designated smoking points along
Orchard Road (a retail belt downtown) were not in operation either (ibid). The scarcity of
public smoking areas and work-from-home arrangements entailed that more were smoking
within the confnes of the home (as opposed to at the workplace). Correspondingly, com-
plaints of incoming second-hand smoke from smoking neighbours rose during that time.
Because of how cigarette smoke and smell disrespect spatial boundaries, shutting one’s win-
dows was not very helpful in keeping them out (Tan 2013a; The Straits Times 2020b).
Smoking at home is lawful; yet, smokers have been constantly advised by authority fg-
ures to smoke away from their windows, balconies and doors (The Straits Times 2020b).
Contestations over clean (non-toxic) air space between smokers and non-smokers escalated
during the last two years, to the extent that a formal ban on smoking at home near open win-
dows was broached in Parliament (The Straits Times 2020d). A combination of soft (e.g. moral
suasion) and hard (e.g. ‘the big stick of enforcement’) methods (The Straits Times 2020a) was
mobilised by the state and other stakeholders to incite in smokers a sense of sensory civic
responsibility/response-ability (Tan 2016d; Liboiron et al. 2018). While the proposed home
smoking ban conceded to infringing on an individual’s right to smoke in one’s personal
space, it had conveniently omitted the fact that that would invariably be subjecting the
smoker’s family members to the toxic sensory efuent instead. Discussions within popular
and academic discourses that multiply agency/action among smokers and non-smokers are
urgently needed. Set against the backdrop of a ‘permanently polluted world’ (Liboiron et al.
2018: 332), such discussions are also required to foreground the untenability of smoking

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away from non-smokers (indoors/outdoors) in a high-rise, densely built urban environment

like Singapore. Following many other critical geographers working in the feld of toxicity,
I call for new ‘ethical grammars’ to be developed in the technical and aesthetic responses to
living in a toxic world (Graeter 2020; Nading 2020, see also Liboiron et al. 2018).
While I have expounded on the perception of smokers as an intoxicated source of toxicity,
there is still room for reappraising smoking as a not-so-(in)toxic(ating) lifestyle. This is especially
the case since critical intoxication studies have begun to problematise the notion of (smoking)
‘addiction’ and ‘intoxication’. The scope of ‘intoxication’ has been extended substantially to en-
compass less forid shifts in consciousness compared to, for instance, a more conspicuous man-
ifestation of drunkenness from alcohol. Critical scholars have contended that there is a range
of altered/intoxicated states of consciousness (Hunt and Frank 2016), some of which may even
be integral to maintaining a semblance of normalcy. Bancroft terms this mode of maintenance
‘functional intoxication’ (2009: 147) vis-a-vis the judicious pharmacological use of intoxicants.
Keane (2020) has observed that smokers perform the persona of the ‘addict’ only in
selected situations. For the most part, their rationally driven ‘controlled loss of control’
(Measham 2004) is designed to assist them with getting through the work day. Far from
being enslaved to or debilitated by their nicotine ‘addiction’, such a calibrated mode of in-
toxication (Hunt and Frank 2016) serves as a means of self-actualisation. Self-actualisation is
accomplished by an assertion of one’s ‘rights to pleasure, hedonism or escapism’ (Riley et al.
2010: 37). Accordingly, on top of unpacking smoking’s socio-cultural signifcance, scholars
are paying more attention to the embodied, sensorial and afective registers that smoking
(intoxication) can conjure up (see Tan 2012; Hunt and Frank 2016). The term ‘chemosoci-
alities’, for instance, addresses the intersections between the social and the sensory-afective,
with intoxication facilitating nonbiological modes of belonging (Shapiro and Kirksey 2017).
On another note, the rituals of cigarette smoking have evolved over the years, from hand-
rolled, machine-rolled, to electronic cigarettes. This novel mode of ‘smoking’ e-cigarettes/
vaporisers, also known as vaping, has stirred up much debate on whether they are less (in)
toxic(ating) for the self and other as compared to traditional cigarettes (see Marković 2021).
Bell and Keane (2012) have put forth some incisive points on how the advent of e-cigarettes
muddies the medical-discursive binary between ‘good’ and ‘bad’ nicotine as well as toxic
and not-so-toxic fumes (vape is not entirely free from toxic aerosols, but it is supposedly an
odourless mist). On the one hand, e-cigarettes have been perceived as a slightly safer alter-
native to combusting/smoking tobacco. They are supposedly safer because they rehabilitate
the ‘bad’ nicotine in traditional cigarettes with ‘good’ therapeutic doses (sans some of the
toxic chemicals in traditional cigarettes), not unlike those present in nicotine replacement
patches and Nicorette chewing gum. On the other hand, e-cigarettes have been cast as the
‘latest incarnation of the tobacco menace’ (Bell and Keane 2014: 49).
Despite eliminating the production of carcinogenic acrid fumes and, in turn, a likely
reduction of second-hand smoke-related diseases, the sale, purchase, possession and use of
e-cigarettes (and their accessories) remain illegal in Singapore (since 2018, for various rea-
sons, with one of them being a pre-emptive strike against a gateway to traditional smoking,
see Bell and Keane 2014; Today 2019; The Straits Times 2021a; 2021b). The prohibition of
e-cigarettes/e-smoking has not mitigated its upward trend, especially among youths. Rather,
it has merely led to an illicit trade of e-cigarettes (even with regular hauls and seizures by
the Health Sciences Authority, The Straits Times 2021d) and stealth vaping (The Straits Times
2021c; see also Marković 2019). In other words, the prohibition of e-cigarettes contributes
minimally to a reduction in toxic exposure among non-smokers while exacerbating the mar-
ginalisation of e-smokers (e.g. driving them underground and branding them as criminals).

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Detoxifying healthist discourses on intoxication?

I wish to clarify that I am by no means denying the voluminous epidemiological evidence
pointing towards the slew of toxicants packed in cigarette smoke and how it undermines
both the smoker and the passive smoker’s physical well-being. However, in view of the salient
points that I have teased out on the geographies of toxicity, I propound that healthism per-
petuates the notion of health as an individualised moral imperative, and is hence a somewhat
toxic enterprise, on both epistemological and empirical grounds. Health as an imperative is
often inextricable from an overarching biopolitical governmentality that incites a neoliberal
responsibilisation of the self. The performance of such a normative responsibility hinges on
one’s competency at being clean (i.e. detoxed) and healthful which, in turn, maintains the
purity of one’s surrounding air spaces. Healthism as a genre of toxic harm therefore operates
by delineating the addicted abject smoking body as the symbolic other or constitutive out-
side of the rationally regulated non-smoker. Put another way, toxic healthism disrupts some
practices (i.e. smoking) in order to reinforce others (i.e. the denormalisation of smoking; see
also Liboiron et al. 2018: 335).
Additionally, the ‘toxic’ properties in healthism are derived from what Nixon (2011: 2)
calls ‘slow violence’ in which ‘delayed destruction’ is dissipated across time and space such
that it is occluded and ‘typically not viewed as violence at all’. The subjugation of alternative
cultural narratives of intoxication/intoxicants (usually because they are deemed as unscien-
tifc) reinforces the epistemic authority of biomedical and public health claims while infict-
ing epistemic violence on others.
Toxic violence can be unpacked via its two interrelated constituents, i.e. the intention to
be brutal as well as the evidence of brutality (see Mukherjee et al. 2011). Smoking denor-
malisation programmes deliberately manufacture health/olfactory stigma against smokers
so as to ‘scare them straight’ into quitting via gory images of bodies ravaged by carcinogens
plastered on cigarette boxes (Thompson et al. 2009; Bell et al. 2010). Nevertheless, the ques-
tionable ethical implications of establishing smoking as a site of moral approbation in the
name of public health tend to be swept under the carpet. Consequently, the emotional geog-
raphies of slow healthist violence, such as self-condemnation and guilt, are ‘literally hidden
into the tissues of subaltern [smoking] bodies’ (Nixon 2011; Armiero and Fava 2016: 79; see
also Mahtani 2014). Meanwhile, the brutality wielded at smokers is evident in apartheid-like
urban architectures, from zoning (very few smoking areas relegated to the periphery of
compounds or in secluded areas) to cloistering (closet like smoking enclosures or rooms; Tan
2016a). The marginalisation of smokers spatially reminds them of their social marginalisa-
tion, that they are a public health menace or liability to society, even as they are learning to
be more considerate to non-smokers (Tan 2016d; 2017). The pervasiveness of healthist dis-
courses has made it challenging to even extend a sympathetic critique of the smoker’s plight
(e.g. their socio-spatial exclusion and denigration) without stirring up a furore—of either
speaking in favour of Big Tobacco or subverting commonsensical public health knowledge
(see Bell and Dennis 2013)—because how could anyone be against health and detoxifcation?

Concluding thoughts
In this last subsection, I advocate for a diversifcation of not-so-toxic or not-so-healthist
discourses on smoking. I am most inspired Berlant’s (2007) ruminations on ‘self-medication’
(see also Valverde 1998 as a means of ‘getting by’. I posit that this not-so-toxic slant acknowl-
edges the sensorial perplexities if not the pleasures that are precipitated by a state of moderate

464
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intoxication. For example, this implies not glossing over the not-so-(in)toxic(ating) kinds of
afective-sensuous smoking embodiment and spatialities that may be life-enhancing even as
they are detrimental to one’s physical health (Tan 2013b; see also Klein 1993).
Cigarette smoking is an example of a neoliberal consumerist practice that contradicts the
neoliberalisation of self-responsibilisation. If a smoking ‘epidemic’ was conceived as a ‘sick-
ness of sovereignty’ (Berlant 2007: 12), a ‘disease of the will’ (Valverde 1998) or a ‘crisis of
antiwill’ (with antiwill gesturing towards a collective defned by its compulsions Williams
1991: 219), then healthist institutions may have been wilfully blind to how smoking is merely
an understandable reaction to a stressful existence. Moreover, Berlant’s (2007) ‘slow death’
points towards a modern capitalist condition whereby one is already gradually dying from
work-related debility/dis-ease, rather than simply from frst/second-hand smoke. Smoking,
along with other ‘spreading-out activities’ or ‘scandals of the appetite’ like sex and eating are
the only ‘few spaces of controllable, reliable pleasure [that] people’ have left (Berlant 2007:
757). Smoke breaks help with mindful exhalations that punctuate time, thereby getting
one through an exhaustingly toxic work day/environment. A way forward in multiplying
healthist discourses might be to not impute into smokers too much will or too little will.
More often than not, smokers who are trying to ‘get by’ in life are not resisting the moral
imperative of health (or non-toxicity). Neither are they cultural dupes lining the pockets
of tobacco companies and/or heartless, intentional purveyors of toxic second-hand smoke.
As much as a politics of toxicity reproduces the (e.g. healthist and purist) status quo, it can
also reconfgure some of these political relations in ways that contribute to better liveability.
Liboiron et al. (2018) call the process of afecting and being afected in a permanently polluted
world ‘toxic worlding’ (see also Langwick 2017; Nading 2020). In it, I imagine a space where
(second-hand) smoke/smoking holds the potential for spurring ethical socio-spatial-sensual
engagements among smokers and healthist institutions/non-smokers. These engagements
would be less preoccupied with detoxifying/purifying/correcting institutions/individu-
als/ environments and more concerned with creative rearrangements or modifcations that
would lend themselves to a more harmonious co-existence between stakeholders or social
groups. Meanwhile, a more humane and less toxic public health approach could begin with
making space for more smoking options, such as e-cigarettes, having more designated smok-
ing areas that are more spacious and accessible, among other more accommodative strategies.

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Urban settings. Routledge: London, np.
The Straits Times (2013a). No smoking in Nee Soon South except at designated areas, 11 Jul.
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outside designated smoking areas, 8 Jan.
The Straits Times (2017). Nee Soon South estate to get 50 designated smoking points by end-2017.
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The Straits Times (2020d). Parliament: Ban smoking near windows and on balconies in homes, says
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The Straits Times (2021a). Time to do more to stub out smoking in Singapore, 3 Jan.
The Straits Times (2021b). Rise in vaping trend worrying, 28 Feb.
The Straits Times (2021c). Vaping on the rise in Singapore: Harder to thwart illicit trade as e-vaporisers
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The Straits Times (2021d). HSA seizes biggest haul of over $2m worth of e-vaporisers, related compo-
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Today (2019). Why Singapore bans e-cigarettes, 31 Jan.
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Walker, B. (2011). Toxic archipelago: A history of industrial disease in Japan. University of Washington
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Journal of Toxicology: Clinical Toxicology, 34(6), 691–698.

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 28
FIGHTING INTOXICATION
AND ADDICTION
International drug control as a
self-perpetuating social system

Axel Klein

Faith-based agitation against “drugs” has been and continues to be a major contributor to
the doctrine-like quality of control policies such as the indiference to poor efcacy or un-
intended consequence. At its core lies an obsession with a pathologised notion of the drug
as a moralised inhuman agent (Weinberg, 2011) that is intoxicating, addictive, fuid and
ubiquitous, and posing a global threat: the “world drug problem” (UNGASS). The measures
taken in response comprise sets of practices and routine activities that have acquired some of
the qualities of a “social system” (Luhmann, 2006). That means an interlocking set of UN
Commissions and international treaties that require national governments to pursue control
measures that are monitored by international agencies with technical assistance functions.
There is a lively exchange of information inside the system, and a stringent policing of
boundaries, as, for instance, with alcohol and tobacco, two intoxicating substances outside
of the purview of the drug control agencies, but subject to very diferent forms of control
regimes (i.e., they are legal) even though often consumed in conjunction. Finally, there are
feedback loops, where the actual efect of the control measures is to exacerbate the risks that
they were supposed to reduce.
In its current form, the system provides operating principles and a cover for the distribu-
tion of material and symbolic benefts and costs. The interlocking support of privileged ben-
efciaries, I argue, is exacerbating social harm-producing practices that have long de-coupled
from the ostensible goals they claim to be striving for, such as public health, morality or
safety. Run as a social system, the primary concern is not resolving the world drug problem,
but to perpetuate itself, that is the drug control system. Solutions, be they reducing harms
or redefning the problem by rescheduling a substance as medicine, need to be developed by
“heretics” outside of the system.

Te divine warning to prohibitionists

The Athenian playwright Euripides tells in The Bacchae how king Pentheus, having refused
to welcome Dionysus into the city of Thebes, disguises himself in wig and skirts and steals
into the woods after dark, to spy on the revelries of the wine god’s drunken followers. From
a lookout high in the branches of a tree, he watches the maenads lose themselves in ecstatic

468 DOI: 10.4324/9780429058141-36

 Fighting intoxication and addiction

revelry. Suddenly discovered, he tries to fee, but a horde of women, including his wife and
mother, run him down and in a frenzy, tear him limb from limb. Wine has the power of
turning mild-mannered ladies of the court into raging amazons. Dizzying and dangerous,
the sensations it produces are so compelling that night after night, the women defy law and
propriety to drink and dance again (Euripides, 2003/410 BC).
Later, kings learn to be more accommodating and build a temple to Dionysus inside the
city walls. Thus placated, the god, now all grace and benevolence, instructs them to mix
their wine with water, and counsels moderation. Another poet has him caution: “Three
bowls do I mix for the temperate: one to health, which they empty frst; the second to love and pleasure;
the third to sleep. When this bowl is drunk up, wise guests go home”1 (Ebulus, 340 BC/2004). Pro-
tected by rituals and a refned culture of consumption, the Greeks came to value wine as the
elixir that eases sufering, brings joy and lubricates social life. Policy makers today appear
bent on repeating Pentheus’ follies. Instead of building temples where the new intoxicants
can be regulated and tamed, they have driven them into the criminal underworld that is
haunted by the hungry ghosts of the addicted (Mate, 2018).
Drugs policy, I argue, is an anomaly that requires explanation. Its idealist premise of a
“drug free world” has long been discredited as unachievable as illicit drug use persists even in
tightly controlled authoritarian countries, the collateral damage is exacting with burgeoning
populations of incarcerated drug ofenders and violent drug trafcking groups, and policy
alternatives are readily available. For decades, the Netherlands have demonstrated how the
distribution of cannabis can be organised without sufering either rampant consumption
increases or a mental health crisis.
The persistence of prohibition defes the assumption that policy formation in modern
democracies tends to adjust to emerging empirical evidence and shifting social attitudes.
For instance, the legal restrictions imposed on the basis of religion or race, prohibitions on
divorce, abortion, extra-marital sexual relations or homosexuality have all been lifted over
the past century in many parts of the world. Contrarily, the drug policy at the global level,
in spite of some advances, remains by and large mired in a set of measures that were designed
and imposed over a century ago. To explain such imperviousness to change, I suggest con-
sidering the mechanisms that have been established in pursuit of drug control as a social system
that is dedicated to the simple overarching objective of self-preservation and expansion.
For our purposes, two aspects of systems theory are salient in understanding drug con-
trol. First, the observation of a diference as a common, defning feature of everything that
is inside to determine what is system and what is environment. Second, there is the function
of the feedback loop, which in mechanical or biological systems performs a self-corrective
function to ensure stability or homeostasis (Bateson: 1971: 315). Herein lies the paradox, be-
cause the resolution of the problem would lead to the termination of the system established
in response to it. An end to the “drug scourge” would also end drug control.
The ostensible goal of a “drug free world” as advertised by the United Nations Ofce of
Drugs is instead harnessed to legitimate a series of activities by the state and often involving
violence such as the arrest of drug “ofenders”, the seizure of goods and the eradication of
crops, through the use of the enforcement capacity of the state (Keen & Andersson, 2018).
Here, the over-reliance on policing measures within drug control, and lamented as a “dis-
location” (UNODC, 2008) by senior system insiders, results in a dual paradox. The powers
of law enforcement are overwhelmingly negative “Using violence, depriving people of their
freedom” (Kotsko, 2012) and whatever the level of investment, cannot rebuild a community
(Simon, 2007). Hence, other activities are required, with diferent players and investments,
including school “education”, the establishment of wards for addicts in mental hospitals and

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 Axel Klein

so on. Before long, the objective of achieving a drug-free world is replaced by a preoccupa-
tion with managing these operations.
In the meantime, drug market participants are adapting to these interventions. Rising vio-
lence and greater health risks are used to call for further expansion of the system. The erstwhile
concern to procure the health and well-being of all mankind, as stated in the preamble of the
1961 Single Convention on Narcotic Drugs is replaced with a crusade against the consumers,
distributors and makers of drugs that has no end point or fnal objective (Gregory, 2011).
The mobilisation of state-violence against designated sections of the citizenry leads in-
advertently to the amplifcation of the very risks that early advocates for drug control frst
warned about. The substances themselves, now illicit drugs that are being produced clan-
destinely, without quality control or consumer protection are more dangerous. Just as sig-
nifcant is the impact on product strength as the “iron law of prohibition” leads to the
displacement of low potency/value products (beer, opium) by high potency/value products
(whisky, heroin) (Ciccarone, 2017).
And counterintuitively, interdictions assist the spread of consumption habits as drug sup-
pliers open up new routes for their cargo, what is known in law enforcement as the “balloon
efect”. Along the new supply routes, drug trafckers pay local collaborators in kind, creat-
ing markets in places where none were before, something known as “spill-over” (Naranjo,
2010). Far from containing and reducing the drug problem, these ostensible displays of “con-
trol” have the efect of accelerating the spread and making the drug problem truly global.
Set up in the aftermath of the First World War, the global drug control system established
a system of economic planning. It replaced market dynamics with committees of technical
experts to determine the quantities of controlled drugs that national governments needed.
Having survived the neo-liberal turn in the 1980s and 1990s, the drugs feld remains an
anomalous pocket of economic planning, and has been called a failure “because it is a social-
ist enterprise” (Friedmann, 1992).
State-led intervention in the function of drug markets has produced another transforma-
tive efect. The value of minor agricultural commodities (cannabis, coca, opium poppy) has
been so infated that they now comprise a signifcant portion of global trade. This artifce has
helped in lifting the economic and policy signifcance of the entire feld. Since all production
and distribution are sub-contracted to criminal organisations, this drugs economy erodes the
administrative and governance functions of a corruptible state and dislocates communities
with unprecedented levels of violence. Since they are outside of the law and unable to resort
to rational arbitration, all drug businesses, whether South American Cartels, or London street
gangs, are left to settle their diferences, increase their market share and protect themselves
from law enforcement by using violence (Reuter, 2009; Thoumi, 2009). Once established,
illicit drug economies also attract violent actors, organised crime or insurgent groups as se-
curity providers and regulators (Felbab-Brown, 2017).
As the consequences reverberate across society, the impact varies signifcantly between
diferent communities. Vulnerable, voiceless minorities and marginal groups bear the brunt
in terms of social deprivation, political repression and adverse public health. On the other
side are the material benefts, social and political advantages accruing to small groups of
professionals, policy makers and organised criminals. They have succeeded in constructing
the “drug problem” as a “backlash issue” where the identify politics around race, class and
gender intertwine and manifest in policy shifts around criminal sentencing, welfare reform
and the war on drugs (Courtwright, 2010). In the US, advocates of the targeted repression
of drug violations have managed to appeal to electoral majorities when combined with the
systematic manipulation of the electoral system (Alexander 2010; McCoy 2019).2

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In Europe, early opium adopters and heavy alcohol users such as Charles Baudelaire or
Thomas de Quincey borrowed images from biblical sources when depicting passage from
intoxication to addiction. ( Jay, 2011). First the temptation of the pleasure promised by the
drug lures the users into an intoxicated euphoria, from where he falls into the pit of depen-
dence, a pharmacological take on the fall of man, while the cycle of recovery and relapse
forms a kind of purgatory. For many problematic alcohol users, the attraction of Alcoholics
Anonymous lay, inter alia, in the appeal to a Higher Power, which resonated strongly with
a latent Christian experience. The recovering alcoholic in admitting the total “loss of con-
trol” makes “a decision to turn our will and our lives over to the care of God as we under-
stood him” (Schneider, 2015). Central concepts of temptation, damnation and redemption
have been excised from their religious context and given new currency in a secular setting.
At its foundation lies the most powerful mythical construct of all, the drug, as the quasi-
personifed evil through that dual function of intoxication and addiction.
This moral dimension to the understanding of the problem is captured in the preamble
to the Single Convention on Narcotic Drugs, the foundational treaty of the post-war con-
trol system which states that “addiction to narcotic drugs constitutes a serious evil for the
individual and is fraught with social and economic danger to mankind” (INCB, 1972: 13).
The function of the UN drug control treaties has been compared to religious texts in
their promulgation of abstinence from certain drugs in the way others forbid certain foods
and activities (Cohen, 2003). Ofcial communications by the International Narcotics Con-
trol Board (INCB), the Commission on Narcotic Drugs or the United Nations Ofce on
Drugs and Crime, regularly afrm the main articles of faith – those drugs pose a threat to
humanity, and that they can only be contained with international cooperation. With regular
invocations of the World Drug Problem, these are rituals attempting to “create and maintain a
particular culture, a particular set of assumptions by which experience is controlled” (Doug-
las, 1966: 143) and which belongs to the domain of the sacred.

From Christian condemnation to psychiatric evaluation

If religious heritage has been important in lending legitimacy and a cultural register of sym-
bols, narratives and tropes, many religious organisations have long been calling for tougher
controls. Arguably, these demands can be traced to the conficted relationship that Christian
churches have had with wine. It is the sacrament in Holy Communion and its cultivation was
for long the economic mainstay of monastic orders. Yet, every wedding in Canaan where
wine is a metaphor for the bounty of life is matched by condemnations of bibulous excess
and licentious living.
No such ambiguity surrounds attitudes towards other psychoactive substances. Achieving
altered states was a major component in the herbal remedies employed by traditional healers
in medieval Europe, often women. Out of body experiences, shapeshifting and the sense
of fying were attributed to the craft of witches and investigated by the Holy Ofce of the
Inquisition. Opening ofces in New Spain in 1571, the organisation saw to the systematic
persecution of people consuming of coca, peyote, ayahuasca and San Pedro cactus, hallu-
cinogens and stimulants that were embedded in the cultural and spiritual practice of newly
subjugated indigenous populations (Escohotado, 2010).
Catholicism then does recognise how these substances can efectively open alternate reali-
ties. In pre-Hispanic American cultures, such experiences that are inadequately described by
“intoxication”, were employed for self-discovery or vision quest. Under the guidance of sha-
mans, the transporting efect of mind-altering plants was conventionally used for healing the

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sick or resolving social tensions. Church leaders understood this as a rival source of spiritual
authority and cosmic wisdom. Claiming a monopoly over all matters spiritual, the clerics
integrated the substances of the New World into their binary moral prism. In the graphic
and irrefutable language of biblical certainty, these plants are attributed to the devil, and the
altered state they produce as an encounter with pure evil.3
In North America around that time, Evangelical Protestants found a diferent object to
crusade against spiritous liquors (a technological development on wine). The clergyman
and medical doctor, Benjamin Rush, who has been credited with the discovery of addiction
(Levine, 1978) was one of many activists campaigning for the prohibition of all alcohol. An
ever more sophisticated political movement with a focus on a single objective struck tactical
alliances with sufragettes and racial supremacists to achieve electoral majorities (Okrent,
2010). Similar initiatives were taken up in Britain among “clergymen and upper-class re-
formers”, before extending to other classes. Over time the position of the campaigners hard-
ened from “temperance” to “tee-totalism” (Berridge, 2013) and the goal of moderation was
abandoned as illusory.
The trend emerging at the turn of the nineteenth/twentieth century across North Amer-
ica and Europe displayed several common features. Addiction, a psycho-medical condition
that had a causal agent, became an explanatory paradigm that could satisfy popular curios-
ity about problematic behaviours, while simultaneously engendering a scientifc discourse.
Experts from diferent felds began formulating a technical vocabulary (disease, alcoholism,
dependence), devising therapeutic remedies (abstinence, psycho-social therapies, isolation)
and staking out a new professional terrain (addiction science/therapy) that legitimised inter-
ventions and held promise of a cure ( Jellinek, 1961).
Further in their eforts at restricting and directing the behaviour of individuals, move-
ment leaders augmented their appeals from pulpit and broadsheet with the coercive powers
of the state. In North America and Scandinavia, temperance activists took control of legisla-
tive assemblies to impose tough restrictions on alcohol sales at municipal, state and eventu-
ally national level (Okrent, 2010). Initially at least they were foated with popular support, as
a policy from below. But very quickly, they became absorbed into the administrative prac-
tice of the fast-expanding modern state. Counterintuitively, it is in the US where the most
wide-ranging governmental powers were appropriated, the most elaborate control agencies
established and an ideology of selective abstinence is formulated. Incubated in the hothouse
of American industrial modernity, the model has been vigorously exported and, a 100 years
on, remains the model for global approaches to controlling drugs.
Alcohol prohibition, America’s Great Experiment, so intimately interwoven with salient
features of contemporary life like income taxes, organised crime and cocktails, is a rupture
in the relationship between citizen and society at the dawn of the contemporary state. But
it also marks a moment in the continual re-ordering of cultural values. At the core of prohi-
bition lies the repudiation of any lingering notion that “intoxication”, or what in antiquity
was referred to as “divine madness”, holds spiritual or cultural beneft. The desecration of
intoxication resonates in the framing of contemporary medical discourse about alcohol that
revolves almost exclusively around costs and risks (Babor et al., 2010). When benefts do fnd
mention, they are hedonic, that is, unquantifable, frivolous and morally suspect (Coveney &
Bunton, 2003).
In accounting for regular drug use, experts shifted from a religious to a medical frame
of reference. During the eighteenth century, the colonial authorities in Latin America were
denouncing habitual coca use as a demonic practice. In the early twentieth century, cocain-
ism, by contrast, is diagnosed as a “disease of the will” (O’Malley & Valverde, 2004) that

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requires correction by medical professionals from the emerging domains of psychiatry and
psychotherapy.
From the 1920s onwards, the American Psychiatric Association has been providing guid-
ance in identifying criteria and symptoms of diferent mental health conditions. The 1934
edition of the Standard Classifed Nomenclature of Diseases for the frst time mentions
Drug Addiction. Refned over its subsequent iterations it has most recently been listed as
“Substance Use Disorder”, in edition IV of the Diagnostic and Statistical Manual of Mental
Disorders of the American Psychiatric Association.4
A further notable shift occurs in the social response. Where nineteenth-century clerics
prayed for the sinner’s soul, today’s medical practitioners are healing the patient’s mind. Since
the focus of medical professionals is the individual, the contributions of other professions
are needed to suppress the illicit manufacture and distribution that make these substances
available in the frst place.

Cultural values and secular control in the modern state

The addict is not only self-destructive but, it is feared, also poses a risk to wider society.
When riding the “high” (i.e., being intoxicated) his behaviour is unpredictable and po-
tentially dangerous. Though expedient before battle, when alcohol and amphetamines are
issued to make soldiers brave with “Dutch courage” (Kamienski, 2016), this poses a grave
risk to public order, particularly where people work in industrial settings or have access to
frearms and motor cars (Dingwall, 2006). Further, in his quest for drugs, the addict is no
longer constrained by manners, morals or law. Drugs, then, pose as a paired risk: intoxica-
tion is believed to lower the threshold of violent behaviour, while the compulsive urge of
addiction impairs rational control.
If the frst sets a challenge to the most traditional functions of the state as monopolist of
violence, the second poses an afront to civilisational values around liberty and the autonomy
of the self.
The ideal on which contemporary democracies are built is that citizens enjoy a panoply
of inalienable rights in return for which they comply with the law. Public order is no lon-
ger upheld today by terror and ignorance, but discipline and self-control exercised by the
rational, self-governing individual over his/her self. A substance that clouds the faculty of
reason or clarity of thought, therefore, threatens to subvert the social contract and comes to
the attention of the authorities.
The frst manifestations of drug control occurred in colonial settings where the laissez
faire of the nineteenth century gives way to the uncompromising dirigisme of the modern
state. In the appropriated lands of the American West and the overseas colonies the US ac-
quired after the 1895 war of conquest with Spain, drug control for the frst time intersects
with political oppression, economic exploitation and cultural eradication. Restrictions on
the sale of alcohol were imposed in the European colonies and coordinated by the Brussels
Conference Act of 1890 simultaneously, addressing the fears of white settlers while lending a
paternalistic appearance to naked imperial aggression unleashed by the “scramble of Africa”
(Ambler, 1990). Since the governance structures of the colonial states were weak (McCoy,
2019), opportunities arose for clergymen to play dominant roles. They could combine sec-
ular functions with self-appointed custodianship for the moral well-being of the colonial
subjects, including a check on “native” indulgences, be these the smoking of opium in the
Philippines or ingesting peyote mushrooms among the Comanchees (Courtwright, 1982;
Jay, 2019).

473
 Axel Klein

Colonial administration provided a platform for political agitation at intergovernmental

level, ostensibly on behalf of the un-represented colonial peoples who by the consensus of
the occupiers had not reached the political maturity to arrange their own afairs. Activists,
many, perhaps most, with religious afliations, took it upon themselves to protect the health
and well-being of native populations. This required international cooperation eventuating
in the 1912 International Opium Convention, where contracting states undertook to vol-
untarily scale back production and trade in opium and cocaine products. Initially, the newly
formed bureaucratic agencies, such as the Permanent Central Opium Board (PCOB), were
stafed by a fair quota of church men and women. Yet, after realising its objective and creat-
ing a global set of repressive controls, the force of religious activism was spent as temperance
crusaders found their fervour being tempered by the tepid routines of secular bureaucracies
(McAllister, 2000). Quite soon, moral exhortations and prayer were pushed aside by a new
regime of criminal sanctions.
In parallel with the growth of an ostensibly rational administration, prohibition agents,
police and customs ofcers became more aggressive and punitive (UNODC, 2008a). The
evolving international regime not only prevented Dionysus from spreading the gospel of
moderation, but it also blinded kings and rulers to seeing that it was their actions that were
exacerbating the problems that they had set out to contain.

International drug control as a social system

Today’s kings and their subjects, socialised by “education and prevention”, luggage and body
searches, snifer dogs and dawn raids, television adverts and urine tests, are unaware of how
surreptitiously drug control arrived in the early twentieth century. In the preceding era,
government interest in the trade of tobacco, alcohol or cofee had focused solely on revenue
generation. When governments frst gathered to discuss the trade in opium at the behest of a
Chinese state whose leaders worried about the drain on foreign exchange and the intrusion
of foreign powers, they agreed to the strictures emanating from the 1913 Opium Convention
on the assumption that these were voluntary (Pietschmann, 2007).
It is important to recall the diferent regulatory landscape at the time when across Europe
heroin was sold openly as an analgesic, cocaine until 1903 added to the most famous of cor-
dials, while saccharine was only available on prescription to protect sugar revenues and the
clandestine merchandise of extensive and violent trafcking networks (Merki, 1998).
Tougher regulations restricting access to intoxicating substances when introduced during
the First World War, in the UK, for example, by the Defence of the Realm Act, were mo-
tivated by concern over the war efort, not public health.5 Yet by the mid-1920s, all opium
and coca products were controlled in all the major countries, with a dedicated agency es-
tablished under the United Nations predecessor, the League of Nations, to monitor com-
pliance. The agreements were preceded neither by scientifc evaluation nor parliamentary
debate in any democratic nation. Instead, the requirement to “enact the necessary legislation
without delay” to “accept and deposit”, the ratifcations of the Opium Convention were
slipped into Article 295 of the Treaty of Versailles at the behest of the American delegation
(Bewley-Taylor, 2001). For powers wishing to sign the treaty and formally put an end to the
hostilities there was no negotiation. Virtually at the stroke of a pen, the frst International
Opium Convention gained near-universal adherence (UNODC, 2008b).
A ftting description for this transformation is autopoiesis, a notion borrowed from bio-
chemical theory to capture the sudden arrival and circular self-production of the social sys-
tem around the operational communication of information (Luhmann, 2006). Once created,

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 Fighting intoxication and addiction

the core function of the PCOB that was located within the newly established League of
Nations was the gathering of data: on the quantity of drugs that are required for medical
purposes, have been manufactured, imported/exported, seized and impounded.
Part of the process involves the medical authorities of signatory states to report their an-
nual requirements of controlled medicines. The successor agency to the PCOB is the INCB,
which scrutinises these and often requests clarifcations or alterations, before granting au-
thorisation. Signifcantly, the process is run solely to the reference criteria internally gener-
ated by operating procedures and takes no heed of the requirements that are external to the
system. The system therefore is solely preoccupied with the potential diversion of controlled
medicines from medical settings into recreational markets (for the so-called abuse) and has
no concern for the needs of patients in Low and Middle Income Countries with no access to
pain medication because of these control measures (Klein et al., 2020).
For drug control, the internal communication of reports is far more important than any
consideration of the impact the reported actions are having on the external environment,
including, with regard to access to controlled medicine, the criteria of patient care. Hence,
the launch of annual reports by INCB and its sister agency the United Nations on Drugs
and Crime (UNODC) are highlights of the ceremonial gathering by the Commission on
Narcotic Drugs, a UN body with a membership of 54 member states. What the very name
signifes is how the system establishes itself through the pivotal observation of a diference that
distinguishes the system from the environment. Once that distinction has been made, the
system continually reviews and evaluates all information to then determine what is inside the
system and what isn’t (Gershon, 2005). In our case, the crucial observation is the discovery,
defnition and problematisation of drugs.

Te drug fetish at the core of the system

There have been suggestions that the term drug is an invented regulatory construct, and that
in order to move forward in drug policy, it may have to be abandoned altogether (Seddon,
2016). It is worth recalling that until the late Victorian era, the word drug stood for substances
and compounds that had therapeutic applications. Whether they were medicine or poison
was a question of dosage (Porter, 1996). In contemporary discourse, the terms drugs and prob-
lem are almost synonymous. For the champions of the control system, the central question is
not what a drug is, but what it allows the system to do.
The system has grown well beyond counting of drug events and extends its tentacles into
a dazzling array of felds. A foundational text like the UNGASS 2016 Outcome Document
provides guidance on activities ranging from curriculum development for primary schools to
the pharmacological analysis of precursor chemicals to planning crop substitution for poppy
farmers. What lends coherence to the activities of schoolteachers, pharmacists and agricul-
turists is that they are all directed against what in UN parlance is the World Drug Problem. The
wide range of activities, the resources they require and, most spectacularly, the powers that
have been appropriated by the state in order to pursue them depend upon a shared under-
standing of that menace.
It consists of two peculiar types of efect: it is psychoactive and physically overpowering
(Sherrat, 1995), two more positive interpretations of the state of intoxications. And because
this is perceived at least in parts, as pleasurable, consumption becomes habit forming. Often,
they cause considerable physical discomfort, particularly, but by no means only, in the initial
stages of use. Partly because of the gratifcation and pleasure received, if only momentarily,
people continue using even in the face of adverse consequences. Consumption can spread

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so quickly in spite of eforts by the authorities, that it is often referred to, and paradoxically,
as an epidemic. At both population levels as well as in the case of individual consumers,
the relationship between user and drug has modifed conventional subject/object relations.
Drugs, then, have the quality of a non-human agent or actant (Gomart, 2002; Weinberg,
2011) a connection reaching back into the demonology and possession cults of a diferent era
(Room, 2003).
Important aspects of the control system as it stands today were constructed in the Great
Experiment of US alcohol prohibition, 1920–1933. Once the precedent had been set, alco-
holism defned as a disease, and legislation and bureaucracies established, alcohol itself was
no longer required. Instead, the class of drugs is continually expanded to more manageable
substances, where there is no pushback by powerful industries. Today, alcohol does not form
part of the World Drug Problem, associated health issues are under the mandate of the World
Health Organization not the UNODC, and wine is served in the cafeteria of the UN Sec-
retariat in Vienna.
More serious from the system perspective is the current tussle over the status of cannabis.
Legal reforms in diferent countries in recognition of the plants’ medicinal qualities, suggest
that classifcation under the control system is provisional, until the evidence base changes.
Reasonable as this proposition may appear, it underestimates the moral certitude that has
been adopted by the system in justifying the draconian measures taken by governments
against drug ofenders – from capital punishment for trafckers to mass incarceration. More-
over, with hundreds of millions of afcionados on a fast-rising upward trend, cannabis consti-
tutes the global drug that requires global cooperation through the drug control bureaucracies
(Bewley-Taylor & Jelsma, 2014).
A redefnition of cannabis as medicine would reveal as inaccurate the position that has
been held by key agencies over many decades. That would expose the system as fallible
and subject to error. Moreover, integrating cannabis into the spectrum of freely avail-
able substances threatens to dissolve altogether the very diference on which the system
is based. Developing good manufacturing standards, setting limits on THC content,
refning licencing laws, age restrictions for the protection of minors, trafc guidance,
etc., threaten to normalise the substance and to undermine the peculiarity on which the
class is based.
Alongside the normalisation of cannabis are discussions that challenge the notion of
intoxication and anti-social behaviour by distinguishing between the efects of diferent
substances. In many cases, it is alcohol the non-drug that is most often associated with
violence, while cannabis, MDMA and opiates render their consumers peaceful, harmo-
nious and placid. It is equally apparent that addiction is no logical outcome of consump-
tion, but of a complex set of variables. For many problematic users, using the drug is a
symptom of other inter-connected challenges, including health problems that cannot
be cured by conventional medicine (Klein & Potter, 2018). Further, extending the term
“addiction” to a range of behaviours from exercise to internet gaming has further loos-
ened its defnitive power.
These discussions are avoided because drug control has used the ontological basis of
drugs as evil to fend of mounting criticisms over the consequences of prohibition. The
reaction is self-referential, pointing back to the erstwhile agreements to control and the
purported need to protect the young and vulnerable. But this sidesteps the single most
signifcant characteristic of the social system in action: the feedback loop, the way that
resources are taken from the environment, transformed and send back to make signif-
cant changes in the environment.

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 Fighting intoxication and addiction

Making drugs dangerous via the drug control feedback loop

To recall, in Europe the consumption levels of the principal substances under control were
risible at the end of the First World War when the international system was formed. They
were just as low in 1961, when the control functions were transferred to the United Nations
and a new set of treaties came into force. Irrespective of ofcial prohibitions and the ac-
companying legal sanctions, levels of consumption have been rising steadily across Western
countries since, to the point where illicit drug consumption has become a rite of passage for
emerging adults and has stabilised as a culturally normalised form of consumer behaviour for
a signifcant subset of the population. The system, and with few exceptions the governments
that form a core part thereof ignore the charge of policy failure and simply repeat the claim
that drug use is dangerous and illegal.
There is far more truth to those claims today than there was nearly a century ago. The
psychoactive potency of each of the three principal product categories – opiates, coca prod-
ucts and cannabis – is far higher than it was in the 1920s. Drug market actors respond to
illegalisation by transforming the weight/value calculus of their product. Since value is ul-
timately measured in the strength, traders introduce products with maximum potency and
minimum weight.
Softer, lighter products like opium, beer, low THC cannabis vanish from the market, to
be replaced by heroin, spirits and “skunk”, i.e., cannabis with high levels of THC. One of the
frst consequences of imposing systemic controls on drug markets and suppressing cultural
rituals and events of drug use is therefore to amplify the toxicity of the product. First, there
is the upward drive-in potency; second, there is increased adulteration; third, opacity over
content and quality leads consumers to sometimes lethal misjudgements of product potency.
As the product alterations are noted by drug control agencies, they feed back into the
policy discourse on penalties and increased controls. More dangerous drugs lead to tougher
punishments. Markets respond with changes in the risk/reward calculus, including the
greater adulteration of drug products, intensifed violence against informers and the distri-
bution of ever more potent substances (Miron, 1999). All the while, demand continues to
expand, partly driven by a hard core of dependent users who fund their habits by introduc-
ing neophytes, often highly vulnerable individuals, to these secret delights. As enforcement
keeps prices artifcially high, a growing number of dependent users resort to committing
property crimes in order to supply their needs (Preble & Casey, 1969).
The drug control system, then, changes the environment from which it distinguishes
itself, not by resolving but amplifying the problem to which it owes its existence.
After the system has become operational the drugs circulating in the illicit market bear
little resemblance to the products that once were used in integrated cultural settings or med-
ical practice. Now they have high potency, are made with cheap, often toxic ingredients and
adulterated with harmful substances. To avoid brutalisation or arrest by law enforcement,
consumers retreat to remote often hazardous, unsanitary places like the so-called shooting
galleries, crack houses or public toilets (Bourgois, 1998; Briggs, 2010). The self-fulflling
prophesy of the drug control system has been to make drugs and their use more dangerous.
But the biggest transformation in the environment is achieved by a qualitative change.
The genius of the drug control system was to move the focus of policy makers and public
to distribution and production. With rising property crime and spiralling violence further
up the supply chain, drug control is now seen as a necessary policy and tool for fghting
crime. According to one former UNODC Secretary, this constitutes a policy displacement,
where public health has been pushed into the background “public security is now frequently

477
 Axel Klein

perceived as the primary, or at least the most efective, way of solving the drug problem”
(UNODC, 2008a).
Astute, though this observation may be in tracking government priorities, it is inaccurate
in suggesting that this is a recent development. In fact, prohibition was always conceived of
as mobilising the repressive power of the state under the pretext of public health, or to use
the notion of illness for social control (Szasz, 1970). Second, many policy makers are more
interested in mobilising security forces against rivals or to keep the population on its toes.
Third, it is now a well-established belief that public security and fghting the drug barons
is the very purpose of drug control, illustrating how the two distinct concepts of drugs and
crime have been merged through continuous association.6
The web of criminality through which drugs traverse from production to consumption is
the most original and magnifcent achievement of the system. It follows a simple logic, where
market participants at every stage along the commodity chain respond to enforcement by
employing violence to secure their operations. What exacerbates this trend is the dispropor-
tionate value of the drugs, itself a consequence of artifcially produced scarcity, in the remote
production areas, along transit corridors, or in retail markets in immiserated communities.
Drug economies overshadow the economic alternatives and aford the means for dealing in
extreme violence.
Participation in the drug trade becomes a precondition for holding power in parts of
Myanmar, Afghanistan, Colombia or Mexico (McCoy, 2019). At the level of local drug
markets, disputes and rivalries between market participants are outside the law or the remit
of local government planning.
What the drug control system has engineered through a system of prohibitions and
market distortions is to make drugs and drug dealers exponentially more dangerous. Shift-
ing focus onto the criminality has added a further twist to the spiral, as the drug control
system itself becomes the object of the protective measures. The third signifcant interna-
tional treaty post-Second World War, the 1988 United Nations Convention Against Illicit
Trafc in Narcotic Drugs and Psychotropic Substances, is designed entirely to increase
state powers to investigate and heavily punish their drug ofending citizens.7 Having crim-
inalised drug consumption, the responsibility for the now pervasive and multi-faceted
problems has been attached to the drug consumers, and the focus of the authorities shifted
to their suppliers. These two groups bear the brunt of the interventions, but the costs are
spread across society.
They include the powers of the state in performing invasive luggage and body searches,
mass screening in the form of urine and blood testing, and the reversal of the legal principle
by requiring drug ofenders to prove their innocence and many more.8 Less attention is paid
to the way the appropriation of powers and resources has benefted key professional groups
whose support is crucial to upholding the system.

Benefciaries – power holders and professions

If the system sustains itself by exponentially amplifying actual and collateral damage, ex-
emplifed by the so-called US opioid crises (Beletsky & Davis, 2017; Ciccarone et al., 2017;
Kolodny et al., 2015) and the massacres of alleged “drug dealers” in the Philippines (Bo Jen-
sen & Hapal, 2018), its perpetuation is only possible with the active support of key interest
groups. While the breadth of the system provides openings, for a wide range of players, think
of the virtue signalling by royal and other sponsors of drug education charities, it is the in-
terlocking support of three particular interest groups that uphold the system in its splendour.

478
 Fighting intoxication and addiction

First are the health professionals who have risen from the margins of medical science to
establish a thriving industry in the delivery of (drug) addiction treatment. As in many other
domains, the actual methods are contested between competing schools, but none have as
yet established the aetiology of addiction. Since it is not known what causes addiction, there
are also no cures, a fact acknowledged by the anodyne description of a bio-psycho-social
condition. In spite of poor outcomes, a fact underlined by the inclusion of “relapse” into
treatment models, the industry continues to fourish, while lending legitimacy and a human
face to a repressive system. Plus, they link back to the ostensible purpose of the drug control
conventions as being to promote “The health and well-being of mankind”.
Drug treatment in many countries is mandatory, as elaborated by the resource intense
inter-agency hybrid system known in the US as drug courts. In efect, the initial diagnosis of
drug abuse is made by legal fat in declaring non-medical consumption illegal. Drug consum-
ers/abusers are therefore directed into treatment by courts and families to address a “drug
abuse disorder” that has become detached from the status of addiction.
The main response to the drug problem, however, is punitive, even in places where this
is moderated by the either so-called harm reduction measures or low-level corruption. Drug
control is constructed upon a presumption that the state has the right to punish, which ex-
plains the dominant role of law enforcement in the system. Owing to the system-changing
impact of the feedback loop, a drug control strategy conceived for the protection of public
health is now led by the criminal justice system. In many ways, this has been a godsend, as
society transferred signifcant resources to newly created agencies and departments, lavishly
equipped and furnished with powers that were not deemed possible before (body searches,
urine tests, home invasion by law enforcement, telephone tapping).9
Further resources are continually transferred from drug market participants in the form
of bribes and pay-ofs. Corruption has plagued law enforcement in every country, and often
inficting system damage, be this in engendering a property seizure oriented “policing for
proft” as in many US states, to the co-option of specially trained military units like the
Mexican Flechas.10
At a more mundane level policing ofenders is mostly harmless and simple because the
presence of the drug establishes guilt and obviates the need for time-consuming detec-
tive work. Because drug consumption is culturally so deeply embedded, police ofcers can
generate a steady fow of arrests to demonstrate productivity. In conclusion, whether as
gamekeepers or poachers, law enforcement agencies and their representative organisations
constitute a vociferous lobby for, as well as the biggest material benefciary of, drug control.11
In the US, trade unions representing police and prison ofcers as well as the professional
associations for state attorneys have been outspoken opponents of both medical cannabis and
proposals for reducing penalties for non-violent drug ofences (Boettke et al., 2013).12 There
are also international networks connecting senior police ofcers, drug control agencies and
policy makers, such as Heads of National Drug Law Enforcement Agencies (HONLEA), or
police organisations like Ameripol that are dedicated to expanding drug control. Indeed,
Europol was founded as an informal forum for exchanging police information on drug
trafcking and presents an in-house analysis of organised crime threats to advance its own
institutional interests (Carrapiço & Trauner, 2013).
Involving law enforcement in deliberations about the status of drugs and appropriate re-
sponses, itself indicative of the systemic shift away from protecting public health, provides an
irreproachable foundation for decision making. By citing the ostensibly disinterested advice
from medical and law enforcement representatives, policy makers have built campaigns on
the promise to be tough on drugs. It has allowed them to appear active in addressing social

479
 Axel Klein

ills without taking on powerful interests, to create electoral majorities against a common
enemy and most ingeniously, a mechanism of blaming the poor for their own predicament.
Not surprisingly, the drug control Conventions and the control system that has been erected
around them continue to enjoy vigorous support from many national governments around
the world. From Cairo to Beijing, recalcitrant citizens can be stopped and searched, arrested
and beaten, incarcerated and tortured, in the name of drug control, with the tacit support of
international agencies.

Conclusion – the system needs to be defunded, deconstructed

and dismantled
Drug control in its current form remains a startling anomaly. It was inspired by the crusad-
ing zeal of nineteenth century evangelists, who saw in the control of frst alcohol then other
drugs social issues that could lend relevance to their declining institutions. By insinuating
themselves into the sinews of colonial empire building and the emerging twenty-frst cen-
tury state, they helped create a bureaucratic assemblage that has defed all expectations and
challenges. The current system with its UN Commissions, agencies and treaties has carved
out a socialist niche economy in the domain of “controlled medication”, where resources
are allocated by technical committee and the market has been suspended. The predictable
consequences have been an explosion of criminality, corruption at all levels of the state and
the tangled growth of bureaucratic entities. Their core interests are self-preservation and the
allocation of resources to diferent interest groups, chief among these criminal justice players
and diferent health ofcials, whose main role is to give their public health blessings to an
essentially repressive system.
The unfolding debacles from the erosion of governance across weak states, the fnancing
of civil was from Colombia to Afghanistan, to the US synthetic opioid crises or the collapse
of palliative care in Lower and Middle Income Countries (Knaul et al., 2018), have all been
cycled back into further expanding the system. Reform has therefore to come from the out-
side as in the decade long campaign to redefne cannabis from drug of abuse to medicine. It
has been resolutely resisted by the system agencies, exemplifed by the US Drug Enforcement
Administrations’ consistent attempts to prevent any systematic assessment of the medical
beneft and/or risk of marijuana.
In the beginning of the twentieth century, however, the system was erected without
the globally most widely used intoxicating, habit forming substance being included.
Eventually eforts to repress alcohol consumption petered out even in the US, but by
then the system had already been established around a string of other substances and the
powers amassed by control bureaucracies and enforcement agencies. Equally, the system
will take the gradual normalisation of cannabis in its stride, and perhaps compensate by
including tobacco. System continuity, just as its original creation or autopoiesis, was
contingent on the convergence of political and professional interests. No single sub-
stance is important in themselves, but the cultural presentation of altered states as in-
toxication and (some of ) the agents that produce it as drugs. In re-framing and managing
the risks associated with consumption as we move forward, the defunding of repressive
machineries has to be accompanied by a revision of terminology. There is already a long
discussion about the stigmatising power of pseudo-medical language such as the term
abuse (Scholten et al., 2017). It is just as important to destigmatise the items of con-
sumption and the mind-altering plant products that have for millennia accompanied the
human journey and stop using the term drugs.

480
 Fighting intoxication and addiction

Notes
1 The text continues to warn of the consequence of excess:
The fourth bowl is ours no longer, but belongs to violence; the ffth to uproar, the sixth to
drunken revelry the seventh to black eyes. The eighth is the policeman’s, the ninth belongs to
biliousness, and the tenth to madness and hurling the furniture. Too much wine, poured into
one little vessel, easily knocks the legs from under the drinkers.
2 Through inter alia (i) voter suppression as in demanding identifcation at ballot stations or by
disenfranchising convicted felons, including drug ofenders, (ii) through the partisan rezoning of
constituency boundaries and the (ii) rural bias that is inherent in the electoral college system used
for the US presidential election.
3 Pragmatism won out over zealousness in the decision on coca which though despised by the authorities
was tolerated because labourers in mines and farms found it invaluable (Escohotado, 2010).
4 As is apparent from the sheer proliferation of diagnostic labels and the difculty found in getting
consistency among psychiatrists, the text is key for unlocking health insurance funding. In recent
years, the US National Institute for Drug Abuse (NIDA) has reinforced the biological foundation
by defning addiction as a brain disease.
5 The UK Act limited the opening times of public houses to prevent alcohol induced absenteeism
among munitions workers. It stayed in place after the end of hostilities, essentially unchanged until
the 1990s.
6 Note the history of attributing criminality to intoxicating substances, and the appeal to crime
reduction as a legitimation of repression. At the beginning of Prohibition, the Reverend Billy
Sunday stirred audiences with this optimistic prediction: the reign of tears is over. The slums
will soon be a memory. We will turn our prisons into factories and our jails into storehouses and
corncribs. Men will walk upright now; women will smile, and children will laugh. Hell will be
forever for rent (Okrent, 2010:2).
7 Article 3 of the 1988 Convention enjoins the parties to “take into account the grave nature” of “pro-
duction, manufacture, extraction; preparation, …, transport, importation or exportation of any nar-
cotic drug or any psychotropic substance” and make it liable to sanctions like “imprisonment or other
forms of deprivation of liberty, pecuniary sanctions and confscation”. They are further urged to em-
ploy “discretionary legal powers under their domestic law … to maximize the efectiveness of law
enforcement”, to discourage early parole and establish a long statute of limitations.
8 Less visible because they happen in remote regions of Low- and Middle-Income Countries is the
indiscriminate use of toxic substances to destroy drug crops, the subjection of civilian populations
to military actions and killings by government “security” forces and the break-down of public
order lawlessness in many drug-producing countries (Keen & Andersson, 2018).
9 Before the global war on terror created a new set of internal enemies the most extensive appropri-
ations of police power were pioneered in combating drug trafcking.
10 An elite formation formed for the specifc purpose of combating drug trafckers which then es-
tablished itself as one of the most powerful cartels.
11 One notable exception is the organisation Law Enforcement Against Prohibition (LEAP), an advocacy
group comprising former law enforcement ofcers who are campaigning for drug policy reform.
12 According to Boettke et al., “Among the groups supporting continuation of drug prohibition,
perhaps the most infuential have been police and prison guard unions. … In 2008, for example,
the National Fraternal Order of Police (FOP) lobbied Congress to increase the penalties for of-
fenses involving particular types of narcotics, to create a registry and public database for persons
convicted of certain drug ofenses and to establish increased penalties and mandatory sentences.”

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 29
HANDLING COMPLEXITY
Constituting the relationship between
intoxication and violence in Australian
alcohol policy discourse

David Moore, Helen Keane, Duane Duncan and Emily Lenton

Introduction
Anthropological, sociological and historical research has long argued that drug use and in-
toxication are shaped by the cultural, social and political-economic contexts of consumption
(Becker, 1953; Douglas, 1987; Gefou-Madianou, 1992; Heath, 1958; Levine, 1978; Linde-
smith, 1947; MacAndrew & Edgerton, 1969; Mandelbaum, 1965; Marshall, 1979; Nicholls,
2003). In this framing, drug efects and experiences, including intoxication, arise from the
interactions between ‘drug’ (pharmacological properties), ‘set’ (individual characteristics)
and ‘setting’ (sociocultural context) (Zinberg, 1984). Criminological research has also taken a
keen interest in the relationship between intoxication and aggression (Fagan, 1990; Felson &
Staf, 2010; Miles, 2012; Tomsen, 2005), youth research in the emerging cultures and
practices of intoxication among young people (Blackman, 2017; Measham & Brain, 2005;
Measham & Moore, 2008), cultural studies in the relationship between intoxication and mo-
dernity (Alexander & Roberts, 2003; Nancy, 2016; Reith, 2005), and recent sociological re-
search in the gendering of intoxication (Hutton, 2020; Moore, 2020), media representations
of intoxication (Ayres & Taylor, 2020; Ruddock, 2020), ‘less forid’ forms of intoxication
(Keane, 2020), and intoxication and sexualities (Pienaar et al., 2020a; 2020b).
Intoxication and its efects also feature centrally in alcohol and other drug policy, but in
this context, intoxication is generally presented as a universal and singular state. Crucially,
it is constituted as a threat to health and social order, both a harm in itself and a source of
other harms. The exclusion of the multiplicity of intoxication in policy – multiple contexts,
multiple practices, multiple meanings and multiple efects – enables networks of harm to be
identifed and linked, and strategies to reduce this harm to be recommended and justifed.
Intoxication is both problematised and prioritised; thus, preventing intoxication is equated
with preventing harm, and other elements related to alcohol consumption tend to be rele-
gated to the background (Keane, 2009; Manton & Moore, 2016).
However, the style of explanation and rationales found in alcohol policy documents do
not exhaust the forms taken in policy discourse. In this chapter, we examine the accounts
generated during in-depth interviews with Australian alcohol policy stakeholders, in partic-
ular their refections on the relationship between intoxication and violence. As key actors in

484 DOI: 10.4324/9780429058141-37

 Handling complexity

the policy process, they mobilise a range of assumptions and concepts in policy development
and implementation. We fnd that the stakeholder accounts provide an instructive contrast
with the certainties evident in policy documents. Drawing on Mol and Law’s (2002) dis-
cussion of the handling of complexity in knowledge practices, we identify various modes of
explanation in these accounts, which include engaging with multiplicity as well as returns
to simplifcation.
In our exploration of the policy expert interviews, we have been inspired by Fraser’s
(2016) analysis of the way in which Australian and Canadian alcohol and other drug profes-
sionals articulate concepts of addiction. In the accounts generated by her interviews, Fraser
(2016, p. 6) argues that two simultaneous trajectories are evident:

one moving towards diference in participants’ insistence on the multitude and diversity
of factors that make up addiction problems and solutions, and the other towards unity
in their tendency to return to narrow disease models of addiction in uncomfortable,
sometimes dissonant, strategic choices.

Drawing on the work of Bruno Latour, Fraser argues that the interviewed professionals
operate in two modes treated as distinct by Latour: when ‘articulating the multiplicity and
diversity of addiction, they grope towards a vision of a “multiverse of habits”’ – that is, they
seek to acknowledge the complex practices making up ‘addiction’. However, when they
discuss possible responses to such complex behaviour, they tend to simplify: ‘in turning to
reifying disease labels of addiction they take for granted, and work within, a “universe of
essences”’, that is, ‘the kind of universe made up of stable matters of fact’ (Fraser, 2016, p. 8).
Our interviews also demonstrated two modes and trajectories, but in our case the simpli-
fcation was not that of essences, but rather an emphasis on evidence and the prioritisation of
public health benefts. In what follows, we outline our theoretical approach and our method,
before providing a brief account of how intoxication and violence are addressed in selected
policy documents. We then move to our main discussion of the handling of complexity by
policy practitioners.

Approach
In their discussion of the handling of complexity in knowledge production, Mol and Law
(2002, p. 1) pose the following questions, which are relevant to our analysis of alcohol policy:

No one would deny that the world is complex, that it escapes simplicities. But what
is complexity, and how might it be attended to? How might complexity be handled
in knowledge practices, nonreductively, but without at the same time generating ever
more complexities until we submerge in chaos?

Mol and Law consider standard forms of scientifc enquiry, in which a single order organises
the simplifcation of complex phenomena and becomes the ‘basis for action’ (2002, p. 3)
(e.g., clinical trials in medicine). When multiple orders are gathered together, the dichotomy
between ‘simple’ and ‘complex’ begins to dissolve. This is because the various ‘orderings’ of
a specifc object or topic – such as the relationship between intoxication and forms of acute
harm such as violence – render ‘reality’ in diferent ways and do not always produce and
reinforce the same kinds of simplifcation. Furthermore:

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If there are diferent modes of ordering that coexist, what is reduced or efaced in one
may be crucial in another so that the question no longer is, Do we simplify or do we
accept complexity? It becomes instead a matter of determining which simplifcation or
simplifcations we will attend to and create and, as we do this, of attending to what they
foreground and draw our attention to, as well as what they relegate to the background.
(Mol & Law, 2002, p. 11)

On the basis of this work, we can make two observations relevant to our analysis: that
knowledge production (including our own) inevitably shapes phenomena as it observes and
responds to them, and that forms of simplifcation are an inevitable part of any knowledge
enterprise. Because diferent policy knowledges produce diferent realities, the process by
which particular versions, and the simplifcations they attend to and create, come to be taken
as legitimate is contested and therefore open to change. Such a framework allows us to ask
several important questions about the politics of alcohol policy: Which simplifcations are
created to handle complexity and what do they foreground and relegate? What efects result
from these framings? Are there alternative ways of constituting intoxication, causation and
harm, and alternative forms of simplifcation, that might result in diferent framings and
therefore diferent efects?

Method
Our analysis is based on research conducted for an Australian Research Council-funded
project on the comparative treatment of gender in research and policy on alcohol and vio-
lence in Australia, Canada and Sweden. In this chapter, the main dataset we use comprises
in-depth, semi-structured interviews with Australian health or related policy stakeholders
whose work includes a major focus on alcohol policy issues. The interview dataset (n = 16,
12 female participants) was generated by frst identifying relevant national, state and local
government departments, non-government alcohol and other drug sector organisations, and
health and related agencies with a major interest in alcohol policy. Potential participants
within these organisations were invited to take part on the basis of their professional role
and/or reputation in the alcohol policy feld, and were sent individual emails with informa-
tion about the project. Participants included policy managers and policy staf from national,
state or local government health, social welfare and liquor licencing departments, and na-
tional or state non-government health, sector and related organisations delivering public
health advocacy or alcohol policy advice.
Interviews were conducted in person when possible and convenient, as well as by Skype
or telephone. For this type of professional interviewee, data gained via diferent interview
formats (i.e., face-to-face, telephone and Skype) are of equal quality (Hanna, 2012). The in-
terviews sought to map stakeholders’ training in gender issues, chart diverse views on gender
and alcohol-related problems among young people, trace the development of complex ideas
and perspectives, and understand how gendered concepts and practices are conceived and
developed in policy. In addition to general questions about the aims of alcohol policy and the
uses of research, specifc questions asked about the causes of violence in the night-time econ-
omy, whether alcohol ‘afects’ men and women diferently, and the role of gender in violent
events. The semi-structured interview schedule also included questions about the extent to
which gender and the relationship between men and violence are addressed in alcohol pol-
icy. We note that in asking about the causes of violence, we were ourselves prompting forms
of simplifcation. The interviews provided opportunities to explore the range of gender

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concepts used by participants in their policy-related work, and the complexities of relating
these concepts to policy development and implementation.
Interviews were digitally recorded, professionally transcribed and coded thematically us-
ing NVivo. Analysis used the respected inductive constant comparison method (Seale, 1999).
Initial analysis was carried out and notes made on emergent data categories. The identifed
categories were discussed by the research team and a coding frame developed (e.g., the re-
lationship between alcohol and violence, alcohol’s efects on men and women, and barriers
to addressing violence). Several interviews were double-coded to ensure coding consistency,
and the codes relating to intoxication were then analysed. The research received approval
from human research ethics committees at Curtin University (HRE2018-0103), The Aus-
tralian National University (2018/819) and La Trobe University (HEC19340).
In addition to the interviews, we also collected a set of 23 publically accessible Australian
national, state and territory government alcohol policies, strategies or related supporting
documents, which we have analysed elsewhere (Duncan et al., 2020, 2022). In this chap-
ter, we focus on two documents produced by state governments that focus specifcally on
violence in the night-time economy: Fact sheet: Strategies to reduce alcohol-related assault in
entertainment precincts (New South Wales Department of Justice & Australian Institute of
Criminology, 2012) and the Safe Night Out Strategy (Queensland Government, 2014). The
two datasets – transcripts of interviews with policy stakeholders and alcohol policy docu-
ments – allowed us to compare the forms of policy discourse circulating in each. We begin
with an analysis of the policy texts.

Analysis

Policy texts
Contemporary Australian alcohol policy discourse and practice needs to be understood in
the historical, institutional and political contexts of a long period of liberalisation in alcohol
regulation, which began in the 1990s under the infuence of national competition policy.
The broad trend has been towards increased alcohol availability, through growth in the
number and types of outlet, the range of products, and the days and hours of sale, although
there has been some reversal in recent years (Wilkinson et al., 2016). The notion of the
night-time economy, understood in terms of revitalised urban leisure zones producing both
economic value and public amenity, was key to the governmental programme of regulatory
relaxation. As Shaw (2014) has argued, the night-time economy construct identifes bars,
clubs and alcohol consumption as the core of the night-time city and of night life itself. The
implication of the night-time economy in exacerbating and intensifying violence in the city
has produced a sustained policy debate about ‘alcohol-fuelled violence’, including federal and
state enquiries (e.g., Legal and Constitutional Afairs References Committee, 2016) and a
review of the impact of liquor law reforms in New South Wales (Callinan, 2016). The high-
lighting of intoxication and violence expressed in the policy documents we studied refects
and reproduces this political and institutional context. The solutions presented in the doc-
uments also show the infuence of the ‘total consumption model’ in public health, based on
the idea that drinking problems are most efectively addressed through managing the rates
and patterns of drinking in the population as a whole (Room & Livingston, 2017).
Alcohol policy documents, especially those attached to a national strategy, have cer-
tain characteristic and generic features related to the communication of objectivity and
neutrality. As Fraser and Moore observe in relation to illicit drug policy, these texts must

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‘must establish and sustain their authority and legitimacy’ (2011, p. 500). Authorship by a
committee or other organisational entity rather than individual named authors implies that
the documents are the product of a ‘balanced, broad-based, disinterested committee acting
responsibly and beyond the corrupting infuence of the personal’ (Fraser & Moore, 2011,
p. 501). In addition, authorship by an organisational entity ‘generates authority by linking
the contents to experts and other specialist stakeholders chosen as possessing a privileged
relationship to the area of policy development’ and ensures that ‘accountability for the text
is distributed and sequestered’.
In general, although the policy documents we studied rarely made directly causal claims
about alcohol intoxication and violence, the relationship between intoxication and harm is
strongly framed in terms of the efects of alcohol on the individual. Other socio-material
forces and elements that might bear on this relationship are much less visible. It is ‘intoxica-
tion’, understood simply as the universal result of excess alcohol consumption, that works as
the primary hub around which forms of acute alcohol-related harm are clustered. In addi-
tion, references to alcohol-related violence tend to be sited within coverage of a wider range
of acute and chronic forms of harm associated with intoxication.
Two of the analysed policy texts deal specifcally with alcohol-related violence in the
night-time economy. The frst – Fact sheet: Strategies to reduce alcohol-related assault in entertain-
ment precincts (New South Wales Department of Justice & Australian Institute of Criminol-
ogy, 2012) – describes a wide range of measures for addressing ‘intoxicated and aggressive
patrons’. These measures include new rules, regulations and training for venue staf and
management, community mobilisation, media campaigns, the introduction of lock-outs,
stricter enforcement of licencing laws, increased public transport and so on. By listing these
multiple elements, which include transport and training as well as the regulation of drink-
ing, the document makes room for complexity. However, the multiplicity of measures is
corralled in service of a common aim:

to prevent or discourage potentially aggressive patrons from being able to purchase and
consume alcohol to the point of intoxication, which can impair their decision-making
ability and increase their risk of becoming involved in an alcohol-related incident.
(New South Wales Department of Justice & Australian Institute of Criminology, 2012, p. 4)

Although complexity is implied in the range of suggested measures, the reduction of intox-
ication is singled out as the target of intervention. Furthermore, intoxication per se is pre-
sented as a self-evident form of harm: ‘There is evidence […] that certain licensed premises
are engaged in operating practices that are encouraging patron intoxication and other problems
associated with alcohol consumption’ (New South Wales Department of Justice & Australian
Institute of Criminology, 2012, p. 3, emphasis added). The many factors shaping intoxicated
behaviour – chiefy gender but also age, social class, ethnicity, experience, tolerance, drink-
ing setting and so on – disappear from view.
The second policy document that deals specifcally with alcohol-related violence in the
night-time economy – the Safe Night Out Strategy (Queensland Government, 2014) – aims
to ‘restore responsible behaviour and respect, stamp out alcohol and drug-related violence
and ensure Queensland’s nightlife is safe for all’ (p. 2). The document has this to say about
alcohol (and other drug) intoxication and violence:

Everyone wants to enjoy a good night out, but too often in Queensland the occasion is
ruined by the bad behaviour of those who become unduly intoxicated through alcohol

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and drugs. Sometimes this irresponsible conduct involves indiscriminate aggression and
violence that, sadly, can lead to tragic consequences.
(Queensland Government, 2014, p. 2)

A culture of reckless intoxication and aggressive behaviour is a problem in many parts

of Queensland, and it’s time to take action to stop the violence.
(Queensland Government, 2014, p. 3)

Although a number of concepts are mobilised in the two quotations – bad behaviour, un-
due intoxication, irresponsible conduct and a culture of reckless intoxication – which, if
unpacked or elaborated, might be used to handle complexity, the simplifcation is clear:
intoxication (even though qualifed by the adverb ‘unduly’) leads to bad behaviour, includ-
ing violence. Again, as we saw in the New South Wales example, other forces and elements
implicated in both intoxication and violence are made absent. In addition, the frst quotation
further simplifes by dividing the population into two opposing categories, on the basis of
a correct relationship with intoxication. On the one hand, there is the law-abiding public,
addressed as ‘everyone’, those who seek and have a right to fun and relaxation (including
moderate drinking) in the night-time economy; on the other, there is the excessively intox-
icated minority whose bad behaviour places them outside the limits of enjoyment.
In the two policy documents focusing on alcohol and violence, a simplifed emphasis on
intoxication relegates from view the many other socio-material forces and elements that bear
on this relationship, and which might provide the basis for alternative ways of handling com-
plexity. However, the style of explanation and rationales found in alcohol policy documents
do not exhaust the forms that policy discourse takes. We turn next to the accounts of Aus-
tralian alcohol policy stakeholders, and in particular to their refections on the relationship
between intoxication and violence.

Policy stakeholder accounts

Unsurprisingly, the policy stakeholder accounts, gathered mostly by face-to-face inter-
views, provide refexive and nuanced styles of explanation very diferent from the concise
certainties of the collectively authored policy texts. The semi-structured interview format,
carried out by an attentive interlocutor, encourages participants to provide elaborated ac-
counts in which their knowledge and expertise is entangled with the construction of iden-
tity and the presentation of self. There is thus more space for complexity and questioning,
although, as we will see, simplifcations are also created in order to justify policy responses
and communicate commitment to the public health enterprise. Although the interviews
we conducted with policy stakeholders covered a wide range of forms of alcohol-related
harm, we focus here mainly on the relationship between intoxication and a specifc acute
harm: violence.
Like Fraser (2016), we identifed two general trajectories in the accounts of the rela-
tionship between alcohol intoxication and violence ofered by policy stakeholders: the frst
acknowledging complexity in the relationship between intoxication and violence, and the
second returning to the key role of alcohol in violence. Both themes are visible in some par-
ticipant accounts whereas in others only the frst theme is emphasised. For example, Sue of-
fers an account of night-time economy violence that emphasises complexity. As we see in the
extract below, she references venue density, the congregation of people in night-time econ-
omy precincts (particularly men), temperament, masculinity, (possibly) multiculturalism,

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alcohol intoxication (with the latter especially relevant to late-night violence) and extended
licenced-venue trading hours:

I would say it would be kind of the growth and clustering of lots of licenced outlets. I
think population movement into central districts, I think groups of men predominantly,
yeah, I mean, I suppose there is a whole science around temperament and all that which
is not my area. […]. I think it comes down to that, I mean even gender equality plays
into that, that kind of expectation of what it means to be a man, those sorts of things
about, you know, male aggression or expectations when you are with groups of mates. I
don’t know if multiculturalism has something to do with, I am not sure, it’s not my area
of expertise, but I think alcohol has a pretty central role in, if you are talking about en-
tertainment precinct late-night violence, alcohol, it’s absolutely part of it, you can’t say
it’s got nothing to do with alcohol, it’s just to do with the types of people and you know,
we know what the data says around proliferation of […] on-premises liquor and the late
trading hours defnitely, we have seen experiments in Newcastle and other places which
really show quite substantial reductions if you can tweak the alcohol [availability].

In Sue’s refection above, many diferent elements are assembled to paint a picture of multi-
ple forces and relations that come together in violent events. One problem she identifes in
relation to this heterogeneity is expertise. In policy practice, as in many areas of knowledge
production, the ability to speak about and address issues with legitimacy is circumscribed
by expertise based on specifc training and experience. Therefore, Sue recognises the im-
portance of psychology (temperament) and culture (multiculturalism) but in both cases, she
demonstrates restraint in incorporating these features into her explanation for violence be-
cause it would take her outside her area of expertise.
Consistent with her attentiveness to multiplicity, Sue complicates the idea of causation
in relation to alcohol and violence later in her interview, preferring the more limited claims
made by the language of contribution:

We often use the term ‘alcohol-fuelled violence’ because we’re not saying alcohol is
causing the violence as such […] but it fuels, it kind of exacerbates, it’s like that severity
and frequency thing that if you’ve got a group of people who are looking for some bifo
[physical or verbal confict] and they happen to be drunk as well, it’s probably going to
be worse than if they weren’t drunk. But not every incident is necessarily alcohol-re-
lated either. Some of those king hits, like I think there has been some where a person
wasn’t necessarily intoxicated, so that’s why you’ve got to be really careful […]. That’s
why I just don’t even use the word ‘causation’, that’s why we try to say, ‘let’s just forget
about causation because we’re never going to come to a resolution’. It’s actually ‘how is
alcohol contributing part of the mix?’

Sue folds the term ‘alcohol-fuelled violence’, which is widely used in media reports, policy
and research, into her refective account, interpreting ‘fuelling’ to mean exacerbation rather
than causation. Her reading of the phrase contrasts with critical criminological and socio-
logical analyses of the term, which regard it as a device that frames the relationship between
alcohol and violence as directly causal (Flynn et al., 2016; Moore et al., 2017). Flynn et al.,
for example, argue that the repetition of this term restricts discussion of the personal, rela-
tional, situational and sociocultural dimensions of alcohol use (2016, p. 186). Viewed from
this critical sociological perspective, Sue’s statement remains consistent with the simplifying

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discourse of alcohol policy, exemplifed in the term ‘alcohol-fuelled violence’, while also
attempting to open it up to complexity.
Stuart’s interview provides another illustration of the co-existence of the two trajectories –
of complexity and simplifcation – within the same account. He includes a wide range of
issues – intoxication, preloading, masculinities, individual personalities, price, the culture
and characteristics of venues, and liquor licencing enforcement – in the following reply to a
question about the causes of violence in the night-time economy:

Well okay, that’s a big one. There are obviously intersecting causes. So I’ve got to
kick-of with intoxication by people and so there’re issues there around the time people
spend drinking in the [licensed] venues, but that’s now complicated by the preloading
that’s taking place. We’ve also got to talk about men and their attitudes to drinking […]:
there’s undoubtedly a group or a sector of the male population […] who see aggression
as being a part of their maleness. So there’s an intersecting number of factors there in
terms of individual personalities, some people are more aggressive than others. There’s
a sense of … a certain type of male for whom that is particularly true, but there’s also
the impact of the price of alcohol that can encourage more drinking. There’s a type of
venue too that encourages or is tolerant of violence and that can be a cultural issue for
that venue, but it can also be exacerbated, or some venues can … almost encourage
violence, through their design. You know […] over-crowding, furniture, the layout of
the furniture and so on, there’s a whole lot of factors in there and also I suppose … I also
want to mention the enforcement of liquor licencing, you know, by law enforcement,
by the regulators, which I would argue is often very lax.

Stuart’s response to the ‘big’ question of the causes of violence takes the form of a list of
factors. As Mol and Law argue, a list is a form of ordering that does not claim completeness:
‘If someone comes along with something to add to the list, something that emerges as im-
portant, this may indeed be added to it’ (2002, p. 14). Although this is not to say that Stuart’s
list of factors is open to the inclusion of elements regarded as important to others but outside
the alcohol policy feld, the possibility is there in the potentiality of its open-ended form. In
addition, Stuart explicitly identifes the relationship between the items he lists as intersec-
tional. The relationship between factors such as men’s attitudes to drinking, overcrowding
and time spent drinking is not simply additional; they intersect to produce variable situations
of violence. Later in his interview, Stuart explicitly addresses the issue of intoxication and
causation in a way that echoes his references to complexity. His formulation is similar to that
ofered by Sue, although it retains the use of ‘causation’ and ‘cause’:

The way that I read the research, alcohol has been described as a contributing cause [of
violence]. I know causation is discussed with this issue, there are various perspectives
on it and whether alcohol causes violence or whether it contributes to it, I know that’s
a vexed issue, but […] I like the notion that it’s a contributing cause. So clearly […] vi-
olence is not a necessary response to alcohol and [alcohol’s] not sufcient [for violence]
because not everyone who drinks gets violent or not everyone who gets intoxicated
becomes violent. But I think for some people in some circumstances, alcohol does incite
violence.

In this excerpt (and in other sections of his interview), Stuart recognises not only the com-
plexity of causation, but also the existence of diferent perspectives that make the issue of

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alcohol and violence a ‘vexed’ rather than simple matter. Rather than expressing his knowl-
edge as factual, he talks about his beliefs and the explanations that he prefers. However,
elsewhere in his account, the public health approach to alcohol, with its focus on popula-
tion-level consumption, is presented as the efective solution to harm. His deployment of the
terminology of acute harms and chronic harms also has a classifcatory efect, gathering a
range of negative efects into the single category of harm:

I think the [public health] approach is that the best way of reducing alcohol-related
harm across the population is to reduce the drinking, the general per capita drinking
levels of a population and therefore, that will have an impact on the acute harms and
chronic harms. Obviously, the acute harms [such as violence] are coming from intoxica-
tion on single episodes of drinking and chronic harm [is] emanating from regular high
level or even regular drinking over many years.

For Stuart, it appears that the public health approach is distinguished from the other perspec-
tives he mentions because of its grounding in authoritative scientifc evidence. For example,
strategies to reduce alcohol availability are supported by quantitative research:

The research indicates that there’s […] a very strong correlation between the length of time
that venues are operating late at night and the level of intoxication, the level of violence and
the problems that are consequent … you know, drink driving, aggression, inside and outside
the venues, so yeah, we see [measures such as reduced trading hours] as positives.

The focus on regulatory changes was also a feature of Natalie’s account (e.g., earlier closing
times, lock-out laws, bans on particular type of drinks being served after specifc times and
so on). She explained her support for these strategies with reference to the ‘alcohol lobby’,
which is:

very frmly embedded in the political process and very articulate about treating alcohol
problems as individual issues: that, you know, individuals need to either be punished by
law enforcement or treated by the health system, but it’s not alcohol that’s the problem,
it’s the individual characteristics that made it a problem.

A ‘key’ strategy articulated by Natalie for countering the alcohol lobby is to make use of the
‘current research evidence that’s relevant to the policy debate’. As in Stuart’s account, the
categories of ‘research evidence’, ‘relevance’ and ‘policy’ serve to stabilise knowledge and
exclude complexity so that identifable measures that are within the realm of current public
health orthodoxy can be put in place.
Natalie’s referencing of evidence as the basis for efective action was particularly notewor-
thy because it contrasted with another section of her interview, in which she was eloquent
about what she called the ‘dickhead problem’:

The more academic way of describing it might be ‘hyper-masculinity’ I suppose, so, you
know, there’s a cohort of men who are ill equipped to resolve emotional problems with
words and who have not been kind of raised to understand that it’s not okay to just spray
your anger everywhere over everybody. Maybe sometimes, you know, you should learn
to tolerate disappointment. Yeah, I don’t know that I have a lot more to say about it,
other than it seems to be a particularly male problem, a particular type of male problem.

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Unlike alcohol availability and the evidence-based policies that can be trusted to produce ben-
efcial changes in behaviour, Natalie states that the dickhead problem of hyper-masculinity will
‘always be a problem … I don’t think we can regulate […] against that’. For Natalie then, while
men’s conduct and emotional responses are a key part of the alcohol-violence nexus, they are ap-
propriately excluded from policy responses because they are the wrong sort of problem, both too
deep-seated and too broad to respond to feasible strategies of government and control.
There is also the risk that a focus on men might divert attention from the actions and re-
sponsibilities of the alcohol industry. As Stuart suggests, ‘there’s a really strong sense of, well
I think a belief or even a fear, that if we were to focus on a group [i.e., men], then it would
take the heat of the industry and I think that’s a really strong sense in the [alcohol policy]
feld’. He also thought that most policy makers would implicitly see population-level strate-
gies as targeting men without excusing the industry. Thus, a reading of wider political and
strategic issues also frames the investment of some policy stakeholders in simplifed accounts
of alcohol intoxication and violence, despite their awareness of complexity.
Compared to Sue, Stuart and Natalie, there were several policy experts who were much
more unequivocal about alcohol’s causal role in violence and willing to give this factor pri-
macy, thereby simplifying the relationship between intoxication and violence. For example,
in answering the question, ‘What causes violence’, Richard replied, ‘I think it is over-con-
sumption of alcohol’. Steven also emphasises what he calls the ‘pretty simple equation’ of
alcohol intoxication with violence:

Well there’s clearly a connection [… between injury and assault and] the amount of
alcohol that is consumed in night-time economy destinations. There’s a very signifcant
body of evidence that shows the greater availability of alcohol [… is linked to] higher
rates of harm, particularly violence and injury as you know, indicated by arrests, emer-
gency department presentations, hospitalisations and an enormous research base that
shows that availability is about the trading hours and the levels of consumption of alco-
hol and studies that show high levels of intoxication in these night-time entertainment
precincts. It’s a pretty simple equation.

Later in his interview, Steven is even more unequivocal:

I: What are the causes of violence in the night time economy?

S: Booze. […] It’s pretty simple. It increases the risks. You know people’s behaviour changes
when they are afected by alcohol.
I: You would see alcohol as causal?
S: Absolutely and that’s what the evidence shows. An enormous body of evidence.

However, even in the strongly simplifying accounts of Richard and Steven, complexity
is brought back in, often in discussions of gender and its relationship to intoxication. For
instance, Steven modifes his earlier statement about booze simply causing violence, with a
reference to its diferential efects on men and women (which he also supports with a refer-
ence to evidence):

I think there’s a growing body of evidence that shows that alcohol makes … that men
as a consequence of consuming alcohol tend to become more aggressive. I think that’s
probably the kind of key take-out from what we know about men … the diference
between men and women and their behaviours.

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 David Moore et al.

Steven goes on to say that:

Those sort of characteristics that lead to kind of group behaviour, the kind of urging
one another on in drinking sessions and then the way that all too frequently gets out of
hand and I suppose there’s issues like that sense of entitlement that appears when people
are intoxicated or seemingly appears when people are intoxicated and that might afect
how that impacts on young women, for instance, and the sexual assaults or unwanted
behaviour from men.

Richard also brings gender into his account of alcohol efects in terms of a diferential of
harm for men and women: ‘intoxicated women are probably more at risk than intoxicated
men of being the victim of others’ unwanted behaviour’. Here Richard explicitly identi-
fes women’s vulnerability to sexual and physical violence but leaves ‘unwanted behaviour’
ungendered. Thus while gender complicates Steven and Richard’s accounts of the causal
link between intoxication and violence, they both envisage gender through what Sophie
Yates calls the ‘big G’ model (2018). This is gender as a category, an individual attribute that
usually maps onto sex. What is not brought into play is what Yates refers to as the ‘small g’
model, which conceives of gender as a process and emphasises hierarchical relations between
gendered categories. The small g model would enable attention to gendered patterns of in-
toxication, including encounters among men or women as well as between men and women.
In a diferent way from Natalie, Richard constitutes gender as a difcult space for in-
tervention. In response to a question about whether he thought men’s violence is being
addressed in current alcohol policy measures, he refects on measures explicitly targeting a
specifc category versus the general strategy of harm reduction:

Given the reliance on things like banning notices on individuals, I suspect they are far
more used to target men than women. So, I would say yes, that would be true. In terms
of other measures, I’m not … I mean I’ve seen obviously some advertising-type edu-
cation material that targets men, but because of the measures to reduce harm appear so
limited, I’m less clear about stuf that’s being done at all in that space. I mean I think, you
know, obviously the regulator is trying to enforce the existing regulation, but enforcing
regulation around serving people who are intoxicated appears very difcult, and I’m
trying to think why else venues get sanctioned for irresponsible advertising, but again
that’s not related specifcally to addressing men’s behaviour.

While recognising the potential value and logic of targeted measures, Richard identifes the
harms of intoxication as pervasive and unpredictable. Therefore the promotion of public
health as a common good requires measures that apply to and shape drinking environments
as a whole.

Conclusion
In this chapter, we have drawn on Mol and Law’s (2002) framework to analyse the handling
of complexity in Australian alcohol policy discourse: specifcally, the handling of the rela-
tionship between alcohol and violence. In doing so, we acknowledge that our own analysis,
like all knowledge production, is contingent on the ways in which we have chosen to handle
the complexity of our data. In the two policy documents that focus on alcohol and violence,
we saw how a simplifed emphasis on intoxication relegated from view the many other

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factors shaping intoxicated behaviour, which might form the basis for alternative ways of
handling complexity. In the accounts ofered by alcohol policy stakeholders, a more compli-
cated dynamic is at work. The contrasting trajectories identifed by Fraser (2016) are evident
in our data: policy stakeholders acknowledge complexity in the relationship between alcohol
intoxication and violence but, for a range of reasons, also render it in more straightforward
terms when considering responses. Notably, the simplifcations we identify all work in much
the same direction: policy responses need to reduce alcohol availability (and therefore in-
toxication) in order to reduce violence. Stakeholders also commonly invoke a specifc form
of research ‘evidence’ – usually quantitative – to support this simplifcation. In considering
this tension, we need to bear in mind that, as we noted earlier, contemporary alcohol policy
is, in many ways, a reaction to the liberalisation that occurred in the 1990s, and that the na-
ture of policy work means that the policy levers available in a specifc area may be limited.
It is also possible to see in the interview accounts general support for the well-established
public health principle that a direct relationship exists between per capita alcohol consump-
tion and harm, and a belief that this ofers the strongest strategic ground for achieving the
desired changes in alcohol policy. Such framing tends to reinforce the allocation of causal
responsibility to alcohol, authorises blanket measures that pay little attention to the range
of forces and elements co-constituting violence, and unnecessarily limits the choices for
those unlikely to contribute to violence. It also sidelines approaches to intoxication, and to
alcohol more generally, that mobilise alternative ways of handling complexity. This situation
is beginning to change, however, with policy discourses attending to the social and cul-
tural aspects of drinking being developed in the Australian Drug Foundation’s Good Sports
Program (https://adf.org.au/programs/good-sports/) and the Victorian Health Promotion
Foundation’s Alcohol Cultures Framework (VicHealth, 2019).
In ofering this analysis, our aim is not to argue that alcohol should not be the focus of
government policies and discourse but to call attention to the simplifcations evident in them
and to their efects. As we have argued, the simplifcations evident in the analysed policy
discourse foreground, for the most part, the pharmacology of alcohol and the reduction of
alcohol availability. What if alcohol policy relied on diferent forms of research that em-
phasised the gendering of alcohol-related violence (Carrington et al., 2010; Lindsay, 2012;
Tomsen, 1997, 2005) or took a more critical view of the methods, assumptions and practices
of the research it currently relies on (Buss, 2015; Moore et al., 2017, 2020, 2021; Walby &
Towers, 2017)? What diferent efects might result if the simplifcation was of a diferent
order: for example, if men’s drinking was identifed as the main issue of policy concern
with respect to violence? As an authoritative discourse that plays a key performative role in
the constitution of realities, the allocation of government resources and the governance of
health, alcohol policy deserves close scrutiny for what it can tell us about the contemporary
problematisation of intoxication.

Acknowledgements
The research was conducted with the support of an Australian Research Council Discovery
Grant (DP18010036). Chief investigators on the project are David Moore and Helen Keane.
Partner investigators are Kathryn Graham and Mats Ekendahl. Research staf working on
the project are Duane Duncan and Emily Lenton. The project has been based in two insti-
tutions over time: the National Drug Research Institute, Curtin University, and the Austra-
lian Research Centre in Sex, Health and Society, La Trobe University. The National Drug
Research Institute is supported by core funding from the Australian Government under the

495
 David Moore et al.

Drug and Alcohol Program and also receives signifcant funding from Curtin University.
We extend our sincere thanks to the interview participants who gave their valuable time to
take part in our research.

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 PART VIII

Notions of Excess
 30
ALTERED STATES
Changing conditions of excess in
European drinking cultures1

Dorota Dias-Lewandowska, Laura Fenton,

Sam Goodman and Beat Kümin

Introduction
Drawing on four distinct, yet complementary, cases, this chapter provides a historically and
culturally comparative perspective on the socially contested boundary between excess and
moderation in relation to alcohol. Beginning with late medieval and early modern Western
Europe and sixteenth- to nineteenth-century Poland, and then turning to twentieth-century
and contemporary Britain, the chapter explores how various religious, state and cultural au-
thorities have sought to defne excessive and moderate drinking, and how a diverse set of ac-
tors has negotiated their drinking in relation to these textual and visual discourses. As such,
the chapter considers the continual interplay between the defnition, regulation and practice
of excess in a range of contexts, identifying how defnitions, regulations and practices of
excess exist in a state of changing reciprocation, and reinscription over time; the case studies
illustrate how the perception of excess drives regulation, and how these regulatory eforts
themselves can serve to produce and invite excess. Further, the authors argue that contradic-
tions and double standards abound in authorities’ eforts to construct the boundary between
excess and moderation in each instance under study, suggesting that one of the consistent
contentions over the defnition of excess is this inconsistency.
The chapter starts with an examination of a fundamental transformation process in the
sixteenth century. In the Age of the Reformations, medieval Christendom fragmented into
rivalling confessions. Being a Catholic or Protestant provided one of the main sources of
personal identities and a source of ferce tensions right up to military confict within and
between groups. Often in close collaboration with the emerging states, the various Churches
sought to form theologically uniform and socially disciplined bodies of believers, demarcat-
ing themselves not just against non-Christian minorities of Jews and Muslims but also each
other. Excessive drinking became a prominent target of their campaigns. Seen as a waste of
divine resources and a pathway into sin, inebriation attracted particular censure. However,
the sale of alcoholic beverages generated income for clergy and parish communities alike,
while conviviality played a key part in social bonding among the laity. The frst case study
of this chapter thus traces the negotiation of these contrasting impulses, fnding both confes-
sional and contextual diferences in the defnition of excess.

DOI: 10.4324/9780429058141-39 501

 Dorota Dias-Lewandowska et al.

As explored in the chapter’s second case study, excessive drinking among Polish nobles
in the early modern period was seen as a social norm and a part of national identity. Thus,
clergy criticising drunkenness among the elites were more focussed on the economic con-
sequences of buying expensive foreign wines, leaving the moral aspects of sinful behaviour
in the background. At that time, Polish peasants forced by propination laws (a set of entitle-
ments that increased alcohol-related revenues for land-owning elites) to consume and buy
vodka produced by the distilleries of landowners were absent in the general debate on excess.
Starting from the second half of the eighteenth century, when the frst approaches to change
the drinking culture to a more moderate culture began, debate over excess reached a turning
point. The social norm of excessive drinking became a national problem. With the loss of
independence and an inefcient economy based on grain production, the mass consumption
of alcohol at the end of the eighteenth century in the lower classes became a serious issue.
At this point, the main actor to blame for such national misery was vodka. In the national
debate on drunkenness conducted by the Church, scientists, temperance movements and so-
cial activists, the idea that spirits were harmful was so strong that almost until the end of the
nineteenth century, it was considered less dangerous to actively promote the consumption
of beer, wine and cider.
The governance of excess shifted considerably over the course of the twentieth century
in Britain, with a diverse range of actors involved in constituting the boundary between
excess and moderation. In relation to overall consumption, the frst half of the century was
in general terms a time of moderation and sobriety. In the 1950s and 1960s, ‘binge drinking’
referred to a form of overindulgence that could last several days and which was connected to
clinical understandings of alcoholism (Berridge, Herring and Thom 2009). By the century’s
closing decade, the term was synonymous with a routinised weekly ritual (ibid). Against
the backdrop of these changes, the chapter’s third case study explores how excess was gov-
erned in British society over the course of the century. As the fourth and fnal case study
on contemporary British drinking cultures illustrates, modern breweries such as BrewDog
no longer associate excess with problematic drinking and thus attempt to disassociate them-
selves from it, but rather have sought to make the extreme a central part of their ethos and
branding. Such an approach is at odds with the advice from the UK Chief Medical ofcer,
who has advocated ever-decreasing limits on alcohol intake, and indeed states that there is
no safe amount of alcohol consumption (Press Association 2016). The result is a disjunction
in which the average drinker is caught between the encouragement towards the pursuit of
the exceptional in relation to favour, strength and style, and the knowledge of the need for
moderation and caution when it comes to volume. Excess thus becomes a fuid concept, and
moves away from the measurement of amounts alone to the character, space and intent of
the consumption too.
The chapter is thus the product of an interdisciplinary approach that seeks to bring to-
gether the conversant disciplines of history, sociology, anthropology and communications
studies. This interdisciplinarity is itself refective of the discussions and specialisms of the
Drinking Studies Network Excess Cluster, out of which the chapter developed. Though
broad in its temporal and cultural focus, the chapter benefts from a considerable degree
of productive thematic and analytical overlap as a consequence of its collaborative origins,
ofering insight into a heterogeneous feld of study. As the chapter makes clear, there is no
singular defnition of what constitutes ‘excess’, nor is there a form of regulation consistent
across the temporal span and cultural contexts that it covers; instead, as Rod Phillips argues,
‘excess’ and ‘moderation’ are mutable terms set and defned in relation to established norms
of behaviour in cultures and societies that are themselves fuid over time (2014: 23). Given

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that a full survey of the multiplicities of excess would thus greatly exceed the scope of a single
chapter, the advantage of a case study approach is that it enables the identifcation and analy-
sis of common, recurrent themes across these difering periods, and supporting its thesis with
regard to the role of various agents (particularly Church and state authorities, social/scien-
tifc elites and the individual), the concern over difering types of alcohols consumed (chiefy
ale/beer, wine and spirits), and the shifting means of regulation used to meet them. This
juxtaposition makes it possible to observe how the perception, regulation and consumption
of alcohol, all of which are subject to continuous change over the centuries, consistently
infuence the way drinking limits are created, crossed and redefned.
Each case study draws on key texts from the relevant period and secondary literature to
identify a set of concerns that have infuenced and conditioned how excess is negotiated;
these concerns are in varying degrees specifc to the context of the case, while also illumi-
nating shared tensions across the cases as a whole.
Its long-term approach, furthermore, allows the chapter to trace the cultural history of
excessive drinking from a period without a concept of ‘alcoholism’ via a phase when heavy
drinking became subject to medicalisation right through to modernity, where excess and
frequency of drinking are factors referring directly to the defnition and diagnosis of addic-
tion. Taken together, the cases illustrate the often contradictory and multi-faceted nature
of attempts to defne and regulate excess and moderation across this temporal span, and
present a picture of the trans-historical and cross-cultural signifcance of intoxication and
intoxicants to rituals of hospitality and conviviality in European societies. Last but not least,
the examples also show the recurrent importance of the type of alcoholic beverage in the
discourse on drinking limits. This can be observed not only at the level of strength, taste
or nature of the drink, but also in the context of viewing the beverage as national, local or
‘one’s own’, as compared to imported, foreign drinks. In the fnal analysis, what becomes
apparent in these studies is the semantic fuidity of the notion of excess, which may turn
from a social norm into undesirable behaviour, with the simultaneous evolution of the very
concept of excess itself.

Case study 1: Navigating boundaries of excess in Europe’s long Reformation

Building on classical tradition, medieval Europeans understood heavy drinking as disrupt-
ing the specifc mixture between the four ‘humours’ (blood, yellow bile, black bile and
phlegm) which shaped human character and physiology. Given that the Greek physician
Galen had classed ‘cold’ and ‘wet’ female bodies as inherently weak, prone to greater destabi-
lisation by beverages with ‘hot’ and ‘fery’ attributes, men – particularly those of a sanguine
disposition – could be allowed larger volumes than women. Humoral theory thus justi-
fed gender- and temperament-specifc boundaries of consumption, typically defned as the
points after which individuals started to lose control over their bodily fuids (Tlusty 2001:
Chs. 3, 7). Straightaway, this signals the importance of directions coming from authorities.
Alongside ‘scientifc’ voices, however, there were numerous other infuences on demarca-
tions between acceptable and unacceptable intake. Among them, we fnd local and central
governments as well as period notions of personal honour, which associated masculinity
with the ability to hold copious amount of drink, join in witty alehouse exchanges and pay
one’s fair share of the tap; in short, to excel at ‘good fellowship’ (Hailwood 2014). Similar
ideas circulated right across the social scale including the most distinguished companies and
environments, as documented in Archduke Ferdinand II’s record of convivial occasions at
his Tyrolean base of Ambras Castle (a Drinking Book started in 1567: Igály 2010).

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 Dorota Dias-Lewandowska et al.

The chief arbitrator of norms in pre-modern Europe, however, was the Christian Church
and its focus lay on the salvation of souls. According to Catholic doctrine, admission to
heaven involved a consideration of merit, commensurate with the extent to which humans
observed God’s commandments, performed works of mercy (e.g. giving drink to the thirsty)
and stayed clear of the seven deadly sins (among which gluttony, i.e. culinary overindul-
gence, loomed large [Dufy 2005: pt. I]). The Mireour du Monde, a fourteenth-century French
moral treatise, contrasted churches as sites for divine worship with taverns as strongholds of
the devil, while priests disseminated comparable messages during annual Easter confessions
or when admonishing congregations from the pulpit (Chavannes 1847). One of the most
notable German preachers, Johann Geiler von Kaisersberg, deplored the sin of drunkenness,
seen to be indicative of a string of other human failures and follies, in a published sermon of
1498 (Strauss 1971: 211–215). Yet at the same time, parish operations relied on convivial
occasions like ‘church ales’, distant ancestors of modern fêtes. Dedicated ofcials sold what
local women had brewed for the purpose, with the proceeds supporting the administration
and enhancement of religious activities. In the English South-West, churchwardens easily
derived over two thirds of their revenues from this source (Kümin 1996: 116). Alongside,
monastic orders produced their own beer for internal as well as external consumption. At
Freising in Bavaria, a present-day brewery boasts licencing records going back to 1040
(Weihenstephan: https://www.weihenstephaner.de/en/our-brewery/history/)! In viticul-
ture areas, furthermore, ecclesiastical institutions claimed around 10% of the vintners’
output under the title of tithes. This was way more than priests could use up on their own,
prompting the retailing of fermented beverages on sacred premises. At the Imperial Diet
of Worms in 1521, the German estates complained that ‘many clerics have turned to tavern
keeping …, put[ting] up tables for dice, bowls, or cards and invite people to play’ (Strauss
1971: 61).
The various strands of (Counter-)Reformations prompted some of Europe’s longest and
most fundamental transformation processes, starting with Hussite/Humanist critiques of
church abuses in the ffteenth century and concluding with the consolidation of rivalling
confessions by the late seventeenth (Rublack 2016). An important catalyst was Martin Lu-
ther’s insistence that the Bible should be the sole guide in spiritual matters. With regard
to our chapter’s emphasis on the signifcance of specifc drinks, this opened fresh tensions
between positive scriptural references to wine as a gift of God (for example, at the wedding
of Cana [ John 2: 1–10]) and Protestant ideals of a more ascetic lifestyle (prompting clamp-
downs on popular culture which scholars have labelled as a ‘Triumph of Lent’ [Burke 2009:
pt 3]). Luther himself very much enjoyed the odd drink, particularly beer given that he
lived outside the main wine-producing zones, classing it as a ‘little elevation’ and a social
lubricator, especially when entertaining at his Wittenberg home, where his wife (a former
nun) Katharina von Bora engaged in domestic brewing. Many famous, at times notorious,
quotations derive from slightly inebriated table talks recorded for posterity by pupils and
guests (Luther 1967). However, as a pastor, he was acutely aware of the – physical as well as
spiritual – dangers of excessive consumption. A 1539 sermon on ‘Soberness … against Glut-
tony and Drunkenness’ set out to square the circle. Luther’s proposed solution centred on the
fundamental notion of ‘moderation’, specifcally understood as staying on the right side of
the divide between acceptable ‘human’ and reprehensible ‘animal’ behaviour:

God does not forbid you to drink, as do the Turks; he permits you to drink wine and
beer; he does not make a law of it. But do not make a pig of yourself; remain a human
being. If you are a human being, then keep your human self-control. Even though we

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do not have a command of God, we should nevertheless be ashamed that we are thus spit
upon by other peoples. … If you have been a pig, then stop being one.
(Luther 1539)

Apart from clerical expectations, the passage also tells us something about demarcations from
non-Christian religions: explicitly Ottoman Turks, expected to abstain altogether, and implicitly
Jews, whom derogatory propaganda often depicted alongside a sow and thus linked to beastly
behaviour (even though their attitudes towards alcohol were equally diferentiated). While prag-
matic, Luther’s advice remained rather general, leaving case-by-case decisions of what exactly
constituted too much to the imbibers. Period evidence underlines the difculty of holding the
line, with many throwing themselves quite literally to the dogs (Figure 30.1). In an attempt to
separate themselves from such reprobates bound for damnation, radical Anabaptists frst foated
the idea of abstinence in Christian Europe (Schleitheim Confession 1527: Art. 4) but theirs re-
mained an isolated voice until the temperance movements of the nineteenth century.
At the risk of oversimplifcation, Lutheranism constituted a ‘half-way house’ between
Catholicism – whose followers participated in an extensive festive culture revolving around
saints’ feasts, church dedication days and pilgrimages (while beneftting from periodic ab-
solution of their sins through the sacrament of confession) – and the more austere Swiss
Reformation led by Huldrych Zwingli in Zurich and subsequently John Calvin in Geneva.
In the Bernese countryside, an area which had adopted the former’s teachings in 1528,
ministers embarked on concerted social disciplining. The outcome was mixed: while some
doctrinal and organisational measures met with grassroots support, parishioners resented the

Figure 30.1 Extract from Barthel Beham, ‘Country Fair’ (woodcut, c. 1530)
Source: public domain

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clampdown on conviviality (Schmidt 1995). At Neuenegg, a village adjacent to Catholic

Fribourg, young men and women regularly crossed the confessional divide to partake
in seasonal dances held just across the border, a pastime ofcially banned in their own
territory. The threat of punishment by the parochial authorities, charged with the en-
forcement of Zwinglian standards (recorded by the court e.g. on 30 July 1654, 29 July
1666, 7 May 1671), failed to discourage them, nor did patrons of the local Bear inn al-
ways live up to godly expectations. On 10 April 1659, for example, the pastor and elders
reprimanded a married woman who, instead of going to church, had headed straight for
the public house, where she overindulged to such an extent that she threw up on the
way back. Similarly, on 28 October 1680, local ofcial Peter Freiburghaus was cited for
getting so ‘full’ of drink that he could no longer sit down or walk home, while wast-
ing divine gifts by throwing wine all around him (Consistory Court Protocols 1650–;
Kümin 2007: 71, 182, Pl. VI).
Much the same story of lay-clerical and elite-popular negotiation could be told for Calvinist
regions like Scotland, the Huguenot ‘crescent’ stretching across southern France, and parts of
Eastern Europe. A classic example is post-Reformation England. Here, the moderate Eliza-
bethan settlement came under fre from ‘hotter sorts’ of Protestants who sought to bring the
established Church closer in line with Geneva (Durston and Eales 1996). Once again, drink-
ing played an important and ambivalent role. As in other Reformed areas, while communion
wine was no longer believed to transubstantiate into the blood of Christ (as in Catholicism), its
relevance to the laity arguably increased through the administration of the Eucharist in both
kinds. Many parishes provided cheap claret for the common folk but superior sweet malmsey
and muscadine for the better sorts (Craig 1993: 376); recent scholarship has noted parallels be-
tween this ‘sacred’ ritual and the pledging of healths in the tavern (McShane 2014). At the same
time, the so-called ‘Puritans’ fought a sustained battle against the allegedly corrosive role of the
alehouse, a cultural ofensive with a similarly polarising efect, in the sense that communities
tended to split into a select godly elite and a majority attached to convivial forms of popular
culture (Wrightson 1981), i.e. along lines of ‘class’. In the long run, the traditions of ‘Merry
England’ eroded, with a nadir under the nonconformist Interregnum of the 1650s, until the
restoration of the Stuart dynasty and Church of England redressed the balance in the later sev-
enteenth century (Hutton 2001). During the Enlightenment of the 1700s, attacks on drinking
then prioritised utilitarian over religious concerns; it was also the time when ‘alcoholism’ frst
gained recognition as an illness rather than a moral failure, marking the gradual rise of medical
at the expense of religious authority (Porter 1985).
Looking back over the period, Catholics and Reformed both faced conficts of interests
between religious doctrines and moral teachings on the one hand and pastoral considerations
and fnancial incentives on the other. Boundaries of excess thus varied, in terms of occasion,
social status, gender as well as confessional orientation, with the bulk of the population – and
indeed many clergymen – frmly opposed to any notion of incompatibility between Chris-
tian identity and ‘moderate’ drinking.

Case study 2: ‘Drunk as a Pole’: from a social norm to a national problem2

Stories of spectacular feasts, toasts and nobles drinking until they fell over and forcing their
companions to make toasts with glasses flled with the best Tokay wines played a major
part in the debate concerning drinking in early modern Poland. Thus, ‘to drink like a Pole’
became a phrase defning an excessive, theatrical and oppressive consumption of enormous
amounts of alcohol but at a given time and place.

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The words ‘drunk as a Pole’ supposedly derived from Napoleon, who wanted to express
his appreciation not only for the courage and morale of Polish forces, but also for their strong
heads (Moskalewicz and Zieliński 1995: 224). But already in the seventeenth century, John
Worlidge wrote:

In Poland, he is most accounted of that will drink most healths; and held to be the brav-
est fellow, that carries his liquor best; being of opinion, that there is as much valour to
be found in drinking as in fghting
(Worlidge 1678)

Thus, for contemporaries, the notion of moderation related not to consumption volumes,
but to the right timing of drinking and maintaining abstinence when necessary.
Historically, excessive consumption of alcohol was an obvious, necessary and desirable
behaviour within a culture of hospitality linked to the ideology of Sarmatism, based on the
historical legend about the descent of the Polish nobility from the ancient Sarmatians. An
ideal citizen combined strict morality with noble kindness and the attitude of a defender
of the Catholic faith and homeland. This idealisation of rural life and tranquillity was in-
terrupted from time to time by the arrival of guests who provided occasions for numerous
drinking rituals (Figure 30.2).
Although at the time Europeans viewed Poles as beer-drinking barbarians (Flandrin and
Flandrin 1999: 307–317), wine posed a rather more serious problem for native preachers and
moralists. The nobility justifed their love for wine with medical recommendations. Claim-
ing that the native beer was too cold for the local climate, they claimed that they had to
warm their stomachs with foreign, mainly Hungarian, wines (de Tende 1686: 268).

Figure 30.2 Aleksander Orłowski, ‘Uczta u Radziwiłłów’, frst half of the nineteenth century
Source: National Museum in Warsaw, photograph by Krzysztof Wilczy ń ski

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Wine consumption had already been stigmatised by the preacher Piotr Skarga in the
second half of the sixteenth century. He described it as an unnecessary luxury replacing
the drinking of good old beer (Rychcicki 1850: 253). Almost a 100 years later, Szymon
Starowolski expressed similar grumblings in his sermons on the renewal of the Republic
of Poland. These promulgated a rhetoric of doom and gloom for his homeland, the main
reason being luxury and excess, especially withdrawal from the ‘old Polish life’ and re-
placing beer with wine (Starowolski 1656: 39). Such religious voices continuously warned
against the consequences of drunkenness, yet above all the consumption of expensive im-
ported alcohols and the confict between tradition and modernity (Dias-Lewandowska
2014: 33–37).
The reign of the Wettin dynasty (1697–1763) marked the end of the ideology of Sarma-
tism and the point from which Sarmatian noblemen dressed in kontush and toasting with
Hungarian wine became synonymous with backwardness and ignorance (Dias-Lewandowska
2015). During the reign of the last king of Poland, Stanisław August Poniatowski (1763–
1795), occasional excessive drinking was no longer perceived as a social norm, but rather as
the cause of the country’s demise (Wybicki 1777–1778: 122). His diaries record a personal
pledge not to abuse strong beverages and the king considered greater sobriety among the
Polish aristocracy to be instrumental for the decrease of drunkenness in the realm at large
(Poniatowski 1870: 10). In progressive circles, moderate intake of – mostly French – wine
became the new standard to aspire to, a sobering cultural reorientation credited with a large
part in ‘superstitions and drunkenness disappearing’ (Ney 1844: 382). The most conserva-
tive members of the nobility remained faithful to Hungarian wine. Despite many reforms,
however, it proved impossible to save the country from the partitions and eventual loss of
independence.
At this point, the frst serious treaties on alcohol and drunkenness began to appear. In
his Dzieło o pijaństwie (‘Works on Drunkenness’) of 1818, Jakub Szymkiewicz contrasted the
decrease in alcohol consumption in the upper classes with its rise among the common people
and workers. He called for the creation of a ladder of restraint, with the elite, nobility and
aristocracy – who were to set an example of moderation – providing leadership at the top;
the clergy – who should heed their own calls for moderation – playing an important part
one step below; and women – whose drunkenness apparently boosted high child mortality
and domestic strive – laying social foundations at the bottom (Szymkiewicz 1818: 19–20,
278–279). The presumed increase in consumption among the lowest groups was related to an
inefcient feudal economy based mainly on grain production. Propination laws (a set of priv-
ileges boosting alcohol-related revenues for landowners), the obligation of peasants to pur-
chase certain amounts of vodka from inns owned by the nobility and the practice of paying
for work with alcohol also played crucial roles (Burszta 1950; Levin 2003). Combined with
technological advances in distilling and the rise of cheap vodka from potatoes, the problem
of drunkenness among peasants became ever more pressing (Figure 30.3).
From the middle of the nineteenth century, the focus of European debate on drunken-
ness shifted from overindulgent imbibers to contextual factors and the efects of specifc
beverages (Lucas 2004: 71). According to the foreign occupants of Polish lands, addiction
resulted from habitual drinking linked to social misery rather than occasional consumption
for pleasure, as it should be. Germans, allegedly, went through seven times as much vodka,
but without becoming drunkards (Herman 1845). In Poland, the stigmatisation of this par-
ticular beverage began earlier still. It became a public enemy, which even other alcohols
were enlisted to fght against. The idea of lesser evil – in the shape of wine, beer or cider
consumption – is particularly evident in folk literature (Zschokke 1845: 4–5).

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Figure 30.3 Aleksander Orłowski, ‘Zabawa w karczmie’, 1800

Source: National Museum in Krakow

In the discourse on excessive drinking, the blame for widespread drunkenness was at-
tributed not only to the liquor itself, but also to the actors involved in the production,
distribution and use of alcohol as a means of oppression. Especially frowned upon were the
Jewish inns. The Jews who ran them, however, because of the specifc legal and customary
conditions at the time, had few other career paths available to them. Even though the main
profts from this activity, owing to propination laws, were obtained by the nobility, it was the
Jews who, because of their direct contact with peasants, became the scape goats held respon-
sible for the problem of excessive drinking (Moskalewicz, Zieliński 1995; Dynner 2014). The
nobility however, especially in the nineteenth century, were also seen as guilty by omission
since they failed to promote sobriety and still took advantage of propination laws. The third
main culprit were the invaders, who efectively prevented the establishment of temperance
societies, thus spreading drunkenness, in what was perceived as an attempt to prevent the
Poles from taking up the fght for their independence (Chociszewski 1891).
In highly moralised tales, the main characters were often priests with the authority to
disseminate scientifc knowledge and to educate peasants on the dangers of specifc bever-
ages (Z.N. 1846: 25–26). Some anti-alcohol discourses also targeted the kind of moderate
consumption previously supported by doctors (Perzyna 1793: 261), leading to debates on
whether restraint should be total. Some groups within the temperance movement recom-
mended cofee and tea (while acknowledging the need for lower prices: Celichowski 1890),
the Promieniści society [Friends of Useful Entertainment] advocated the use of milk in cel-
ebrations (Krasińska 2013: 247) while others promoted domestic cider as a healthier and
cheaper alternative to vodka and wine (Gwiazdka 1865: 212). Eventually, even the apparent
nutritional value of wine or beer came under attack:

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 Dorota Dias-Lewandowska et al.

While looking at vodka as a scapegoat, on which one could blame the fatal conse-
quences of drunkenness […] in beer and wine, which were opposed to vodka, one tried
to fnd nutrients in order to use them as an excuse and justify the consumption of these
beverages
(Flaum 1894: 102)

In conclusion, therefore, Polish discourses on excessive drinking gradually moved from the
elite to the lower classes. In spite of the cultural changes of the late eighteenth century,
perceptions of incidental, ritualised and almost forced alcohol consumption among nobles
persisted for a long time. As late as 1882, during the Geneva Sanitary Congress, Dr Lubesski,
sought to counter ‘drunk as a Pole’ stereotypes with statistics showing lower consumption
levels than in many other European countries (The Lancet 1882: 634). In the nineteenth
century, however, the main emphasis came to be placed on the type of alcohol, the context
and the social group that consumed it. As a kind of compromise between moderation and
total abstinence, many voices condemned the strongest spirits while recommending the con-
sumption of weaker beverages.

Case study 3: Governing excess in twentieth-century Britain

The boundary between excess and moderation was a recurring site of contestation in twenti-
eth-century Britain. While much of the historiography has until recently positioned debates
over alcohol as a ‘binary confict between advocates and opponents of the liberal distribution
of drink’ (Yokoe 2019: 267), this representation misses the intricate patterns giving rise to
both excess itself and to how authorities have attempted to govern it. Though in decline as
an organised movement for social reform, some scholars have argued that the moral concerns
of the Victorian-era temperance movement continued to infuence public health discourses
on excess (Yokoe, 2019; Yeomans, 2014). A difuse ‘cast of characters’ was involved in gov-
erning excess in twentieth-century Britain, including but not limited to central and local
government, breweries, scientists, the medical profession and public health campaigners.
Their respective levels of power and infuence in constituting the boundary between excess
and moderation shifted over the course of the century. Britain in the twentieth century thus
ofers an interesting case study of a period of relatively intense change in how excess was
governed, in terms of the authorities and institutional arrangements involved, and in partic-
ular the relative signifcance of the state, the alcohol industry, and the scientifc and medical
professions in this process. These institutions were also in a situation of fux, which has, in
turn, afected how excess has been understood and governed.
In the Edwardian period (1901–1910), the decline in levels of alcohol consumption that
began in the late nineteenth century was still in play ( Jennings 2016). However, a high pro-
portion of drinking environments, in particular pubs, was designed for ‘vertical drinking’
(that is, drinking while standing up) and thus encouraged the rapid consumption of alcohol
(Gutzke 2014: 218). Public displays of drunkenness were by no means uncommon in many
towns and cities. The construction of a central licencing regime, the Central Control Board
(CCB) in 1915, to limit the impact of excessive drinking on the country’s ability to succeed
in the First World War resulted in tighter restrictions on when alcohol could be purchased,
as well as resulted in increased duties. The CCB was regarded as efective in reducing public
drunkenness (Duncan 2013: 3; Yokoe 2019: 268), and within a few years of its inception had
come to be regarded by its chairman, Lord D’Abernon (1857–1941), among others, less as a
wartime measure and more as means for addressing the causes of intemperance in a rational,

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scientifc manner (Greenaway 2003). Licencing has been a chief means by which the state
has at diferent junctures enacted and retracted its powers over the sale of alcohol, and by
extension its management of levels of consumption.3 As taxes on alcohol constitute an im-
portant source of revenue for the treasury, licencing is a mechanism that allows for a measure
of control over public drunkenness while sustaining income. However, the central state is
neither unifed nor a sole player in the governance of excess. As Jennings (2016) argues, sys-
tems of regulation are enacted in practice at the local level, involving licencing magistrates,
as well as publicans, police ofcers and others who infuence how drunkenness is managed
in local communities.
Breweries and the wider alcohol industry have also played a key role in creating condi-
tions for excess and moderation. In the interwar period (1918–1939), many Edwardian public
houses were redesigned to encourage more moderate, slower drinking and to create calmer,
more convivial atmospheres by measures such as providing food, installing better lighting
and building more spacious interiors (Gutzke 2014). This paved the way for women in par-
ticular to drink in licenced premises in higher numbers than previously (ibid), a pattern that
Langhamer (2003) argues was propelled further by conditions on the Homefront during the
Second World War. Langhamer contends that women’s reports to Mass Observation and
other sources from the time ‘paint a picture of wartime as a period during which women
made signifcant recourse to the public house as an arena for leisure and during which their
alcohol consumption increased markedly’ (2003: 424). While it has been argued that the
immediate post-war years were characterised by many women’s retreat from public drinking
spaces (Gutzke 2014), young people – including young women – began drinking in licenced
premises in increased numbers in the decades that shortly followed. Indeed, the second half
of the twentieth century was characterised by both a diversifcation in the age and gender of
drinkers, a multiplication in the types of places where drink could be sold and, in the main,
increasingly liberal licencing laws ( Jennings 2016). Of particular concern to health cam-
paigners in the late twentieth and early twenty-frst centuries has been the rise in of-sales.
Low-cost alcohol sold in supermarkets was identifed as a leading contributor to rising rates
of liver disease from the 1990s onwards. Price was identifed by campaigners as a key site for
intervention. From 2006, Scottish Health Action on Alcohol Problems, a partnership of the
Medical Royal Colleges, led a campaign for the introduction of ’minimum unit pricing’ in
Scotland, which eventually became law in 2018.
Moving beyond the state and industry, medical and scientifc expertise has been central
to the constitution of the boundary between excess and moderation in twentieth-century
Britain. The medical understandings of excess that circulated in the twentieth century have
their roots in the second half of the previous century, when ‘an embryonic group of doctors
with a clear interest in inebriety/addiction’ emerged (Berridge 2013: 70). However, medical
interest was not simply in forms of excess, like addiction and drunkenness, but also in how
to quantify moderation. In the 1860s, the physician Francis Edmund Anstie (1833–1874)
devised ‘Anstie’s limit’, a measure of moderate alcohol consumption that Kneale and French
argue is a key precursor to the notion of the ‘unit’ used in late twentieth-century and early
twenty-frst-century public health guidelines (Kneale and French 2015: 111). Like the ‘unit’,
Anstie’s limit was a measure of pure alcohol (ibid: 111).
The middle decades of the twentieth century are notable for the prominence of psychi-
atry in popularising a disease model of alcoholism. In the Victorian period (1837–1901),
campaigners involved in the temperance movement positioned excess as a moral matter
signalling drinkers’ inability to control their desire for drink, whereas in the twentieth cen-
tury, the rising prominence of ‘alcoholism’ positioned regular drunkenness as a condition

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that called for medical intervention, particularly in the form of psychiatric treatment (Thom
1999). Published in 1960, E.M. Jellinek’s Disease Concept of Alcoholism was particularly sig-
nifcant in advancing the understanding of alcoholism as a condition that was confned to
a small proportion of drinkers and that could be addressed through psychiatric treatment
(Thom 1999: 209; Jennings 2016: 169).
From the mid-1970s onwards, a public health approach emerged as a key and later
dominant player in the construction of excess. Originally a movement aimed at improv-
ing housing and sanitary conditions in cities undergoing rapid growth in the nineteenth
century, the version of public health that became increasingly dominant in alcohol policy
circles in the closing decades of the twentieth century was principally focussed on the
individual and his or her health-related choices (Berridge 2013: 165–169; Jennings 2016:
169); this version of public health has its origins in the epidemiological transition which
followed the Second World War, including increased interest in the causes and treatment
of chronic (as opposed to infectious) diseases as a result of longer life spans. The rise of a
public health approach to alcohol witnessed a ‘redefnition of the problem in epidemio-
logical…terms as arising from levels of alcohol consumption in the population as a whole
and, at an individual level, as a result of lifestyle and “risk behaviour”’ (Berridge, Herring
and Thom 2009: 599). The language of ‘prevention’ and ‘risk’ came to overtake the focus
on ‘treatment’ in how excess was understood and regulated (ibid: 598–599). ‘Problem’
drinking became an issue for the population as a whole: something everyone was at risk of,
and no longer the reserve of those with the disease of alcoholism. Any amount of drink-
ing could damage one’s health, though those who drank above amounts cited in public
health guidelines were especially placing themselves in harm’s way. Nevertheless, one set
of expert discourses does not entirely replace its predecessor (ibid), and the fgure of ‘the
alcoholic’ remains a powerful cultural trope.
For a variety of reasons, including rising levels of disposable income ( Jennings 2016: 24),
per capita consumption started to rise from the 1950s onwards (Smith and Foxcroft 2009:
10). In the closing decades of the century, changes in licencing laws and local authority
regulations lead to the transformation of the night-time economy in city and town centres,
and to what criminologists, sociologists and others have called a ‘culture of intoxication’
among young adults (Measham and Brain 2005). This culture is argued to be characterised
by ‘determined drunkenness’ (ibid), that is, by an instrumentalist orientation towards intox-
ication as part of a hedonistic pursuit of pleasure. Intoxication through drinking ‘alcopops’
and other favoured alcoholic drinks became widely understood by young adults as another
means of reaching the ‘altered state’ that had been previously sought through club drugs,
like ecstasy (Collin and Godfrey 1997; Measham 2004). The industry’s eforts to engage
younger consumers were largely successful, as evidenced by the increased consumption of
alcopops and the corresponding halt in the upward trend of illicit drug use between 1995
and 2003 (Measham and Ostergaard 2009). Hayward and Hobbs (2007: 438) point to the
‘aesthetic processes aimed at encouraging alcohol-related excitement and excess’, such as in
marketing and wider forms of cultural production, which sit uncomfortably alongside voices
condemning excess, like the ‘late night morality plays’ of television programmes like Booze
Britain. Such programmes were part of what the authors called a ‘dual narrative’: a simulta-
neous celebration and condemnation of excess (ibid: 438). The tension between a cultural
celebration of excess and a set of conficting normative concerns about the damage caused by
drunkenness was also at the heart of policy making. The New Labour government, in power
from 1997 until 2010, oversaw legal changes that allowed for alcohol to be sold 24 hours a
day, a far cry from the CCB’s imposed last orders of 9pm. As Jennings (2016: 4) notes, the

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2003 Licensing Act ended ‘450 years of magistrates’ control of licensing’ when it came into
force in 2005.
Adopting a long-term historical frame, consumption rates are characterised by recur-
ring, cyclical increases, which temporarily reverse a longer-term pattern of decline (Chartres
2004: 39). The most recent of these periods of increased consumption was the second half of
the twentieth century (ibid). During these decades, public health and other discourses en-
couraging moderation existed alongside the increased liberalisation of licencing laws, which
from the 1961 Licensing Act onward initially saw growth in the types of businesses which
could sell alcohol (until supermarkets later came to dominate of-trade sales), a relaxing of
restrictions on the times of day when alcohol could be sold and a gradual weakening and
the eventual removal of magistrates’ authority in licencing matters ( Jennings 2016). In 2001,
overall responsibility for licencing was transferred from the Home Ofce to the Department
for Culture, Media and Sport, a telling move that underscored the growing link between
licencing and the alcohol and leisure industries (ibid: 202). From the point of view of suc-
cessive UK governments, governing excess meant performing a balancing act between the
desire to generate revenue and foster conditions for the creation of proft on the one hand,
and the requirement to maintain public order on the other hand, with a public health ap-
proach having more success in the devolved administrations, principally Scotland, where, as
mentioned, Minimum Uni Pricing became law in 2018. It is to one increasingly prominent
part of the alcohol industry in the twenty-frst century – the craft brewer, BrewDog – and
its construction of excess that we now turn.

Case study 4: BrewDog, Craf Beer and twenty-frst-century excess

Readers opening up BBC News on 22 July 2010 would have been forgiven for thinking their
eyes were deceiving them, or that perhaps they had had a little too much to drink the night
before. However, what lay before them really was a beer bottle protruding from a stufed
grey squirrel. Pictured was one of just 12 bottles of ‘The End of History’, a Belgian blonde
ale produced by then up-and-coming UK brewer BrewDog. Aside from its limited edition,
everything else about this beer was calculated with excess in mind; a bottle ranged between
£500 and £700, depending on the size and type of the animal in which it came encased, and
the ABV was a deliberately tabloid-baiting 55% (BBC News Online 2010). It was, for a time,
the strongest beer in the world, and succeeded in putting BrewDog in all of the major British
newspapers; tabloids all dutifully ran stories expressing fears over the kind of irresponsible
drinking that such products would doubtless encourage.4 However, viewed in context of
BrewDog’s development over the past decade, ‘The End of History’ was less the gimmick
that BrewDog’s detractors labelled it at the time, and instead part of a pattern for a brewery
for whom excess has always been a commonplace, and, as time has shown since, a deliberate
part of their business model and brand.
‘The End of History’ was the culmination of BrewDog’s early ambitions towards no-
toriety. As Jon Henley has observed, super-strength beers and a range of publicity stunts,
including driving a tank through streets of north London, helped cement their self-declared
reputation as ‘a post-punk, apocalyptic, motherfucker of a craft brewery’ (2016). Henley
notes too that these activities have won BrewDog as many critics as they have supporters
among the public and beer writers. Jessica Boak and Ray Bailey provide a dispassionate
overview of BrewDog’s early history, noting that while their efect on the UK beer mar-
ket and culture is palpable, their style is not unique, and rather follows a pattern set by the
California-based Stone Brewing’s ‘Arrogant Bastard’ ale frst brewed in 1996, over a decade

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before BrewDog existed (2014: 209). Such similarities suggest that what BrewDog reveal
about contemporary drinking cultures is that ideas of excess need not simply be understood
as the amount of alcohol consumed, but rather a pervasive ethos of their brand identity and of
the US-infuenced British craft scene in general. Difering distinctly from the Campaign for
Real Ale (CAMRA), which began as a traditionalist movement in Britain in the 1970s, the
modern UK craft beer community is modelled on a US-style tendency towards invention
and extremes of favour, as Pete Brown and other commentators have noted (Brown 2009).
While there is a shared point of common ground between CAMRA and craft beer in their
response to the homogenisation of brewing as a result of nineteenth- and twentieth-century
industrialisation, the manner in which this opposition is manifest is vastly diferent. The no-
tion of excess seems entirely alien to CAMRA, which seeks a continuation of typically much
lighter and milder beers brewed with established methods; for craft beer, innovation and the
pushing of boundaries are key. In light of this infuence, and their own behaviours, this case
study argues that instead of viewing BrewDog’s stunts in isolation, they must be recognised
as the bedrock of the brewery’s corporate identity and market identity, as well as indicative
of the kinds of rhetorical and practical hyperbole engaged in by elements of the UK craft
brewing industry, infuencing aspects of contemporary drinking culture from style, favour,
price and promotion.
British beer culture has been often characterised by excess. While the physiological efect
and social position of beer itself is quite diferent from spirits such as vodka, or those drinks
with more apparent class-based connotations such as wine, there was a consistent concern in
the nineteenth and twentieth centuries that the working classes would be unable to moder-
ate their behaviour without regulatory pressure from the state. In the late twentieth century,
however, that responsibility began to shift, eventually coming to rest on the shoulders of the
neoliberal individual by the time that craft beer culture emerged. Shifting class boundaries and
upward social mobility in the twentieth century meant that well-known drinking subcultures
such as the ‘Lager Louts’ of the 1980s or the ‘Ladettes’ of the 1990s prompted the association
of excessive behaviour largely in relation to or as a result of quantity of alcohol consumed
by individuals (Marsh and Fox-Kibby 1992), and the resultant social disorder that arose as a
consequence.5 In the modern craft scene though, excess exists on a range of levels beyond that
of simply ABV, quantity consumed and binge drinking. BrewDog and its products exem-
plify a kind of consciously performed excess associated with craft beer, from the exaggerated
post-industrial aesthetic of their bars, the provocative names of their mainly high-strength and
highly hopped beers, the extent of their merchandising, as well as their sense of self-impor-
tance, evinced in their website’s declaration of how they ‘bleed craft beer’ (2019).
Alongside the breathless tone of founder James Watt’s book Business for Punks (2015),
BrewDog’s website afrms their tendency towards self-aggrandisement. The description for
their 7.4% ABV Jackhammer IPA is as follows:

‘PRESS THE BUTTON. IT’S IRRESISTIBLY SITTING THERE, WAITING.

DON’T HESITATE. HAMMER IT.
Start with a colossal grapefruit aroma. Pile on bitterness after thumping bitterness,
and ride the anarchy wherever it takes you. The caramel razor is sharp, but the resin-
ous bite drills straight through your taste buds. For blitzing the mediocre, raising hell
and revelling in the aftermath, Jack Hammer is the end of the line. The hopped-up,
pucker-mouthed terminal extreme of craft brewing. This beer is bitter. Very bitter. If
you push that button, don’t say we didn’t warn you…
(BrewDog 2018)

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In its adoption of such excessive rhetoric and tone, BrewDog’s declarative marketing, and
indeed, their ‘manifesto’ evokes those of movements such as F.T. Marinetti’s Futurists, with a
similar use of diction that interweaves the violent and the sensuous in pursuit of an ultimate
gratifcation (Somigli 2003). This, and their apparent preoccupation with all things termi-
nal, from the acknowledgement of Francis Fukuyama in ‘The End of History’ through to the
‘end of the line’ and Trumpian talk of button-pushing, lends their copy the competing qual-
ities of an all-caps over-excitability alongside that of postmodern nihilism (Gambino 2018).
‘Jackhammer’ is indicative of BrewDog’s penchant for combining the excessively over-
blown, and often demonstrably untrue, claim alongside a sense of existential dread. Watt
writes in Business for Punks that it is not enough to simply start a business; instead, an ‘en-
capsulating mission’ is required, and that ‘business punks’ must be willing to ‘put it all on
the line’ and face down challenges before they become ‘a fully-loaded AK47 pointed at
your neck’ (2014: 4–6). It appears that it in all elements of their business BrewDog must
always operate with an exceptional intensity, which serves to normalise their prior excesses
and require ever further extremes; such an approach, it is implied, must then must be ad-
opted in the tastes of their consumers, further shifting craft beer towards excess.6 As Helana
Darwin has noted, such behaviour afrms the acutely masculine nature of craft beer, ex-
pressed in connoisseurship as opposed to quantity consumed (Chapman 2017).7 BrewDog’s
much-publicised ‘punk’ persona can similarly be read as part of this deliberate adoption of
excess, and hyperbole within their marketing and advertising rhetoric. From its inception,
punk has been associated with a deliberately excessive aesthetic, designed to push the bound-
aries of acceptable dress, behaviour, taste and the creative arts (Hebdige 1991; Wilkinson,
2016). BrewDog ofers a postmodern reworking of this punk persona in which the associa-
tions of anarchic, excessive tendencies remain, however, the subversive meaning of punk is
lost amidst their eforts to dominate the market.
Indeed, it is arguable that everything about BrewDog is framed in relation to excess,
except, possibly, the actual drinking. For while BrewDog’s prices might not seem excessive
compared to other craft breweries (most beers cost £4–6 in their own bars, depending on
ABV) such prices are nonetheless prohibitively high for some, limiting the amount they will
consume in a visit (Worley 2017), or tacitly pricing out some demographics altogether. Sim-
ilarly, in thinking about how much craft beer drinkers consume on a regular basis, it is ap-
parent that BrewDog bars are marketed not the kinds of drinking places that are to be visited
every day, and are instead ‘destination’ bars as opposed to what Paul Jennings (2011) would
argue constitutes a ‘local’. Concurrently, BrewDog have benefted from long-standing dis-
tribution deals with ubiquitous and nationwide UK pub chain J.D. Wetherspoon and in most
major UK supermarkets, where its fagship ‘Punk IPA’ will sell for between £1.29 and 1.99
over the bar, and in six packs of 330 ml cans for £6, respectively.8 Such cheapness, especially
in supermarkets, recalls the contemporary concern over the ease of excessive drinking at
home (Seth and Randall 2011; Foster and Ferguson 2012). Indeed, one or two of BrewDog’s
stronger beers such as ‘Jackhammer’ (even Punk IPA is a fairly potent 5.6%) will easily sur-
pass the recommended daily unit allowance as outlined by the UK’s Chief Medical Ofcer
in August 2016 (BrewDog 2019).
In conclusion, in spite of their detractors BrewDog remain one of the most widely rec-
ognised UK craft beer brands. They continue to make inroads into the North American
market, as well as the UK, as evinced by the fact that their television channel, DrinkTV,
is now a fxture of British Airways in-fight entertainment, accompanied by ‘Speedbird
100’, a commemorative centenary session IPA brewed exclusively for BA and their ‘Equity
Punks’ shareholders (BrewDog 2019). The veracity of their ‘punk’ persona has always been

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questionable, but as the brewery grows ever larger and more corporate in their afliations,
it will remain to be seen whether they continue to generate outrage in pursuit of their next
publicity coup or tabloid headline, or whether it is indeed possible to teach an old dog new
tricks. Whatever happens, it appears that stufed squirrels were not the end of BrewDog’s
history of excess, but rather just the end of its beginning.

Discussion and conclusion

As the historian and sociologist Joseph Gusfeld (1996) has argued, the ways in which
drinking has been constructed as a problem that requires intervention have varied histor-
ically. Drinking and drunkenness have been understood and acted on in ways that invite
cross-cultural and historical comparison. Accordingly, our chapter has zoomed in on four
distinct but complementary case studies. Looking over the diferent historical, geographical
and cultural contexts examined above throws into relief the complex negotiation of the
boundaries of excess between authorities and drinkers. The cases discussed in this chapter
share several thematic and substantive concerns. First, the cases of Reformation Europe,
Poland and twentieth-century Britain all point to tensions and contradictions in ofcial re-
sponses to drunkenness and the resulting attempts at regulation, while the case of BrewDog
illustrates the power of marketing discourses that exceed the logic of state regulation.
In medieval and early modern Europe, the Christian Church was a key source of moral
guidance and social norms. Yet in their pronouncements on excess, both Catholics and
Protestants sent mixed messages: on the one hand, overindulgence wasted precious resources
and set imbibers on a pathway to sin, but on the other hand wine was a gift of God – in
fact an indispensable component of the most revered sacrament of the Eucharist – and the
sale of fermented drinks a major source of revenues for pastors as well as parishioners. Some
clerics ran their own taverns and an iconic reformer like Martin Luther had no objection to
the occasional ‘elevation’. Alcohol, furthermore, helped to diferentiate Christians from the
religious ‘other’, specifcally Muslims and Jews.
In early modern Poland the nobility’s culture was based on extremes. Until the end of
the seventeenth century, the Ieiunium Polonicum was one of the strictest fasts in Europe, with
the number of fasting days reaching more than 200. The Polish nobility of the Baroque era
demonstrated opposite characteristics: the strict fasts and zealous Catholicism were accompa-
nied by famboyance, sumptuousness and disregard for the clergy’s admonitions concerning
moderation. Despite scrupulous observance of fasts, the aristocratic tables were weighed
down with expensive wines and sophisticated fsh dishes, which Poland was well known for
at that time. In the nineteenth century, the discussion about excess and moderation changed
its character. Previously known for their festive lifestyle, land-owning and other elites ex-
pressed concern over the excessive drinking of the peasantry and working classes, while
simultaneously sustaining a socio-economic order that created the conditions giving rise to
drunkenness in the frst place. Nevertheless, the new social, economic and political circum-
stances forced the discussions about excessive alcohol consumption. The concern for sobriety
was also linked to the struggle for independence which would not have been achieved with-
out the cooperation of all social classes.
Similarly, tensions and contradictions underpinned the British central state’s approach
to the governance of excess in the twentieth century. As with the early modern Church,
alcohol sales provided vital tax revenue while at the same time drunkenness raised issues of
public order. During the First World War, these tensions came to a head, leading to the cre-
ation of the CCB. While this experiment in centralised control was short-lived, the tensions

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underpinning its construction persist. In the closing decades of the twentieth century, local
authorities had to balance their ambitions for economic revitalisation via the expansion of
the ‘night time economy’ with the pressures on policing and health services that public
drunkenness brought with it.
The contemporary UK craft beer scene embodies its own set of contradictions. On the
one hand, excess is integral to BrewDog’s brand identity, with ‘excess’ being redefned from
the amount of alcohol consumed to an ethos, central to the brand, their corporate marketing
communications and the implied behaviour it expects from its consumers. On the other
hand, pricing, high ABV and the fact their beer is served predominantly in ‘destination’ pubs
pose practical constraints on how much is consumed. Likewise, despite various confronta-
tions with alcohol trade body the Portman Group over their alleged support of excessive
drinking, BrewDog nevertheless observes UK licencing requirements around alcohol by
including the standard health-warnings, and unit counts on the labelling of their products.
BrewDog’s relationship to excessive drinking can, therefore, be read in a neoliberal light in
so much as while the company recognises that it sells a harmful product, the responsibility
for managing the consumption of it falls on the individual consumer.
A further overarching chapter insight is the interplay of diferent constellations of agents.
With the infuence of the twentieth-century authorities of Church and State either declining
in the case of the former, or becoming more remote and disinterested in the case of the latter,
and without the social hegemony of a nobility as found in other European countries, the
neoliberal individual is left to moderate their drinking behaviour as dictated by their lifestyle,
habits and fnancial means. In another indication of changing cultural frameworks, warnings
about alcohol’s harmful efects by the UK Chief Medical Ofcers and Public Health England
replace the moral authorities of previous contexts and periods; however, their eforts are ad-
visory rather than prescriptive, and agency remains with the drinker themselves. BrewDog’s
apparent advocacy of excess as an ethos may appear provocative and distasteful to some, but
it remains legal, and in its legality permits the brewery to absolve itself from any culpability
around excessive drinking.
A third shared theme is that eforts to construct boundaries between excess and moder-
ation are protean in nature; they can weave together long-standing religious and cultural
beliefs with more recent, emerging forms of thought and practice. Agendas, priorities and
concerns beyond the immediate scope of alcohol regulation – such as projects of nation
building and the realignment of the respective responsibilities of states and citizens – can
become interwoven with attempts to govern drunkenness. Moral concerns are not simply
replaced by medical, ‘scientifc’ ones, or vice versa. Drunken bodies emerge as a site of com-
ment and intervention from a range of perspectives, echoing disparate sets of interests and
concerns.
Prior to the scientifc advances in the early modern period, heavy drinking was under-
stood to threaten the balance of the body’s four ‘humours’, with men’s constitutions seen as
(on the whole) better suited to the intake of fery beverages than those of women. While
Church doctrine centred on the salvation of souls, bodies remained key to how contem-
poraries understood excess. In early modern Poland, religious voices warning against the
consequences of excessive drinking were particularly opposed to the consumption of im-
ported alcoholic drinks. The boundary between excess and moderation was, in this sense,
being carved out in tandem with the boundaries of the nation and national identity. In the
nineteenth century, the focus shifted to the type of alcohol being consumed by the peasantry
and working classes, with strong spirits, principally vodka, seen as particularly troublesome
for the health and well-being of these social groups. The rhetoric condemning strong spirits,

517
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accompanied by the development of abstinence societies, was, however, faced with a contin-
ued obligatory propination, which was not abolished or limited in most of Poland’s annexed
territories until the end of the nineteenth century.
In late twentieth-century British society, the version of public health to be adopted into
alcohol guidelines was not an approach that consistently emphasised the infuence of envi-
ronments and other external factors on health, but rather one that frmly placed individuals’
decision-making capacities centre stage. The 2003 Licensing Act and related earlier changes
repositioned the state’s role: not that of guardian of shared norms and standards, but instead as
a facilitator of market expansion with a background role in preserving public order. In con-
temporary craft beer culture, there has been a shift away from concerns over the potential for
violent social disorder arising as a result of excessive alcohol consumption, as characterised by
the ‘Lager Lout’ of the 1980s, and, instead, a growing concern for the health implications of
middle-class drinking habits has arisen in its place (Knight 2018). Beer, so often viewed as a
‘healthier’ (or at least more benign) alternative alcoholic drink to the much stronger spirits or
fortifed wines available until relatively late in the twentieth century, has likewise begun to
shift into an area of health concern as the average ABV percentage of popular supermarket and
draught beers increases to between 5% and 6% ABV. Similarly, the fashion for double IPAs and
imperial stouts, though served in smaller amounts of 1–2/3rds of a pint, nonetheless normalises
the presence of excessively strong beers within the mainstream of the British beer-drinking
subculture, whereas previously, those beers (typically lagers) of 8% ABV and above that were
generally available in the UK market, such as Carlsberg Special Brew and Tennent’s Super,
were thought to signify a very diferent, and far more problematic, kind of excess linked to an
association with lower class, and therefore socially aberrant, drinking habits and consequent
social disorder. It remains to be seen whether this taste for stronger craft beers inculcates a
more ‘continental’ style of consumption based on appreciation of favour, style and ingredients,
or whether the sheer economics of drinking such products acts as a self-limiting force on the
behaviours of the craft drinker, curtailing consumption, and making cost a further form of
excess to be associated with modern beer. Alternately, given the typical transatlantic infuence
of US craft beer on the UK scene, as well as growing health concerns over home drinking,
the developing trend for alcohol-free or table beers of 2%–4% ABV may yet become a popular
option in Britain too. If so, BrewDog are again at the forefront of such moves, with two beers,
‘Nanny State’ and ‘Punk AF’ (both 0.5% ABV), ofering drinkers a lighter alternative to the
heavier beers that dominate elsewhere in craft culture.
Lastly, eforts to govern excess and promote moderation must contend with the enduring
place of intoxication in wider culture, particularly in relation to festive and everyday rituals
of conviviality and hospitality. From the church ales of late medieval villages to the craft beer
outlets of the present, drinkers frequently faunt or ignore attempts to reduce their access
to alcohol, appreciating it as a social lubricant and a tool for social bonding. In mid to late
twentieth-century Britain, young people and women increasingly participated in drinking
rituals. Public health discourses emerging from the mid-1970s that presented the ‘risks’ of
drinking as an issue for everyone, and not just ‘alcoholics’, did not reverse rising levels of
overall consumption, though they had other efects. Within the craft beer subculture, the
formation of community groups whether digital, regional, local or national is facilitated by,
if not entirely dependent on, the appreciation and consumption of alcohol.
Alongside many continuities, however, the preceding contributions also point to change
over time: in line with the long-term process of state formation, regional and central au-
thorities took an ever more active role in regulation and taxation. While never totally sup-
pressed, the moral and spiritual power of the Christian Churches in Europe faced increasing

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challenges by arguments based on ‘reason’, economic motives and public health consider-
ations; in the present, such health concerns have become the responsibility of governments,
charities and even the British tabloids, who use their platform and position to regularly decry
the binge drinking habits observed in city centres, or the creeping dangers of home drink-
ing. From the predominantly oral appeals of medieval Europe via the frst mass medium of
print to the digital resources of the present, furthermore, drinkers have become exposed to
an ever more diferentiated and often discordant plurality of voices vying to infuence their
behaviour. Stakeholders now range from teetotallers to global beverage brands, technologi-
cal tools stretch to personalised advertising algorithms on social media platforms and ofcial
yardsticks involve ever-shifting ‘expert’ advice on safe drinking limits. Moreover, the pic-
ture has been made all the more complex by the upheaval caused by the COVID-19 global
pandemic, and its efects on drinking habits across the world. These too show signs of ex-
treme variation, from moves towards much greater state-mandated restriction and regulation
such as in South Africa, or concern over a dramatic increase in ‘problem’ drinking observed
in the UK as a result of social isolation or as a result of young people continuing to socialise
regularly in pubs and bars. Given the ongoing nature of the pandemic, as well as the shifting
impact that the various measures to contain it have on our lives, it is unlikely that boundaries
of excess will become clearer and less contentious anytime soon.

Notes
1 This chapter is the result of a collaboration among members of the Drinking Studies Network’s
‘Understanding Excess’ cluster. The introduction and conclusion are co-productions (hence our
names appear in alphabetical order) but each of the case studies was written by a single author: the
frst on boundaries of excess in Europe’s Reformation by Beat Kümin; the second on constructions
of excess in sixteenth- to nineteenth-century Poland by Dorota Dias-Lewandowska; the third on
the governance of excess in twentieth-century British society by Laura Fenton and the fourth on
constructions of excess by the contemporary craft brewer BrewDog by Sam Goodman.
2 The case study was written as part of research fnanced by the National Science Centre, applica-
tion no 2016/20/S/HS3/00107.
3 Licening is a key topic in the history of the governance of alcohol. See, as examples, the many
studies cited by Yokoe (2019).
4 The title was soon reclaimed by German brewery Schorschbräu, and latterly by Keith Brewery’s
67.5% ‘Snake Venom’ (Drink Supermarket 2019) [Accessed 22/6/19].
5 ‘Ladette’ gained recognition later, entering the Oxford English Dictionary in 2001 (BBC News, 12
July 2001). [Accessed 22/6/19].
6 For example, Double IPAs (IPAs of 8% ABV or above) were once a rarity however, breweries
such as Verdant, from Cornwall UK, include 21 DIPAs and 3 imperial stouts out of 88 beers
listed on their Untappd profle, representing over a quarter of their production to date. Likewise,
Pete Brown relates that at a US craft beer expo in 2008 Dogfsh brewery ran their draught beers
through tubes of raw hops in pursuit of more favour (2009: 19).
7 Darwin’s work recalls Thorstein Veblen’s remarks on the specialisation of consumption among the
discriminating individual (2009).
8 Prices correct as of June 2019.

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 31
FROM ‘PLEDGE’ TO
‘PUBLIC HEALTH’
Medical Responses to Ireland’s
Drinking Culture, c. 1890–2018

Alice Mauger

Few nationalities rival the Irish for the sustained attention their drinking customs have
received. The impression of Irishness as somehow synonymous with drunken joviality has
been bolstered by the global dominance of drink exports like Guinness and Jameson, the
international popularity of Irish-themed bars and, of course, the proliferation of alcohol-
fuelled festivities around the world every St Patrick’s Day. Given these deep-rooted cultural
associations, it is unsurprising that Ireland’s ‘drinking culture’ and attempts to change it have
long been identifed as subjects worthy of extensive scholarly investigation. For generations,
researchers have presented drink in Ireland as posing a distinctive case study, not least be-
cause of its socio-cultural and political prominence at several historical junctures. Topics of
special interest have included the rise and fall of infuential temperance movements (Ferriter
1999; Kerrigan 1992; Malcolm 1980, 1986; Townsend 2002) and socio-cultural explanations
for the alleged heavy drinking customs of the Irish, both at home and abroad (Bales 1962,
1980; Cassidy 1996; Fitzpatrick 1971; O’Connor 1975, 1978; Stivers 1976). More recently,
policy and healthcare responses to what is now termed alcohol-related harm have come un-
der the spotlight (Butler 2002, 2010, 2015; Malcolm 2012; Mauger 2019, 2021; Reidy 2014).
Since the 1890s, medico-scientifc, voluntary and state responses have converged in three
distinct phases. The frst occurred at the turn of the twentieth century, when medical accep-
tance of a ‘disease concept’ of inebriety internationally coincided with the establishment of
inebriate reformatories, the founding of a new major temperance association and attempts
to restrict public house opening hours, all against a backdrop of increased Irish nationalism.
The second phase began in the 1960s, when the re-emergence of medico-scientifc interest
in alcoholism overlapped with heightened political awareness and activity in the sphere. No-
tably, the renewed signifcance of alcoholism in this era intersected with attempts to reinvent
Ireland’s international profle as a modern and open nation with much to ofer for potential
foreign investors. The fnal instance is Ireland’s relatively recent adoption of a public health
approach to alcohol. The Public Health (Alcohol) Act, 2018, which has been overwhelm-
ingly supported by Irish medical bodies, is currently being rolled out in stages. This Act is set
to introduce inter alia minimum unit pricing, health warning labels on alcohol products and
rigorous restrictions on marketing and advertising. These measures are purportedly aimed

DOI: 10.4324/9780429058141-40 523

 Alice Mauger

at changing Ireland’s drinking culture, with politicians and medical experts now framing
alcohol as a serious public health problem.
Combining a historiographical survey of existing works with the author’s own research
on medico-scientifc and state responses to inebriety and later, alcoholism, this chapter will
explore shifting representations of Ireland’s ‘drinking culture’ during these three phases and
assess how competing discourses have infuenced attempts to change it. By drawing together
these often distinct strands of scholarship, it is intended to present a more rounded picture of
the Irish experience than has hitherto existed. While much of this trajectory mirrors the in-
ternational picture, especially contemporary developments in Britain and the United States,
this chapter will argue that Ireland makes for an interesting example of national interests
with a long historical lineage. In turn, it hopes to provide a useful comparative framework
for those examining similar concerns in other countries.
In his introduction to Drinking Cultures: Alcohol and Identity, the anthropologist Thomas
M. Wilson has underscored the importance of alcohol consumption to the ‘production and
reproduction of ethnic, national, class, gender and local community identities’ both past and
present (2). For Wilson:

drinking is itself cultural; it is not so much an example of national and other cultural
practices, in the sense that it is a performance of something that runs deeper in the na-
tional or ethnic makeup, as much as it is itself a bedrock of national and ethnic culture.
As such it is an integral social, political and economic practice, a manifestation of the
institutions, actions and values of culture.
(2–3)

Drawing on Wilson’s defnition, this chapter employs the term ‘drinking culture’ to em-
brace various aspects of drinking practices in Ireland, including who was drinking, how
much, when and where. Such perspectives are essential to deepening our understanding of
intoxication in the Irish context.1 By concentrating on the evolution of medical responses,
the chapter will consider how experts interpreted and attempted to shape specifc forms
of social behaviour, customs and beliefs around intoxication – in this case via alcohol. As
will be shown, these responses have involved engagement with temperance activity, legis-
lative reform, psychiatry and public health. While this chapter refers in places to external
commentary on Ireland’s drinking culture, it does not attempt to evaluate such research as
this would be beyond the scope of the present analysis. Instead, the focus is on examining
Irish medical responses to what was often portrayed as a national problem. Importantly, and
in contrast to many European countries, for much of the period examined, a majority of
drinking in Ireland took place in public houses and without meals. Moreover, and as will be
discussed, until the 1970s, these public houses were largely ‘male spaces’ with women either
completely excluded or confned to separate areas such as snugs (Malcolm 1998: 51).

‘Ireland Sober, Ireland Free’?

Representations of specifc drinking cultures, especially ones emphasising excessive or
harmful levels of alcohol consumption, tend to refect broader socio-cultural and/or po-
litical conditions. From this vantage point, both drink and drinking practices can assume
multiple and often metaphoric meanings. These forces are found to operate time and again
in colonial portrayals of the hard drinking practices of indigenous peoples, usually to justify
the suppression of existing customs as part of a civilising mission. This impulse formed part

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 From ‘pledge’ to ‘public health’

of the rationale for English writers’ critical commentary on Irish drinking practices since
the sixteenth century. While such accounts are undoubtedly prejudiced, Elizabeth Malcolm
warns against downgrading them to mere validations for imperialism, noting their potential
to impart valuable evidence about the place of alcohol in Irish society (1986: 3). Likewise,
while acknowledging racial bias in nineteenth-century observations of the heavy drinking
and consequent violence of the Irish people, Diarmaid Ferriter accepts such interpretations
as indicators of the degree alcohol could permeate Irish life, especially at wakes and funerals
(1999: 6). Nevertheless, there is little doubt that colonial depictions of allegedly heavy drink-
ing cultures may be exaggerated and therefore at least partially unreliable.
That is not to say that national representations are untouched by broader societal devel-
opments and aspirations. Wilson, cited above, has suggested that where alcohol and drinking
are considered problematic, both morally and from a health perspective, they may also form
part of social and political integration and order, where culture and identity can play roles
in both the acceptance and avoidance of drinking (2005: 21). Building on this idea, in her
exemplary study of alcohol and nationhood in nineteenth-century Mexico, Deborah Toner
has underlined the historical importance of discourses about alcohol consumption. These
debates, she observes:

ofer profound insights into the ways in which a society understands its cultural sense of
self, diagnoses its problems and celebrates its achievements, and constructs both internal
and external “others” against which its own identity can be defned.
(2015: 38)

This reasoning certainly applies to Ireland in the late nineteenth century as drinking became
imbued with new meaning.
Beginning in the 1870s, Irish representatives in Westminster campaigned to secure a
devolved government for Ireland, a movement known popularly as Home Rule.2 At the
same time, steeply rising alcohol consumption and high numbers of arrests for drunkenness
were generating public alarm, as well as growing concern among doctors about the health
implications of heavy drinking. Although consumption levels and arrests declined in the
1880s and 1890s, a widespread belief lingered among many that the Irish were disgracing
themselves morally, politically and culturally through their heavy drinking (Ferriter 2015:
4; Malcolm 2012: 110–111). Irish nationalist opinion was divided as to the true extent of the
problem, let alone how to tackle it. For some, sobriety held the key to political independence
from Britain, a notion frequently repeated in the popular slogan, ‘Ireland sober, Ireland
free’. But for others, draft legislation aimed at restricting weekend opening hours for public
houses symbolised the British parliament’s veiled and patronising attacks on longstanding
Irish customs (Malcolm 1980: 94–98, 1986: 271). The centrality of public houses in these
debates is unsurprising, given their importance as social, economic and political centres in
both rural and urban Ireland. While irregular, heavy drinking at fairs, wakes or weddings
was still common in the nineteenth century, from 1850, public houses were the principal
Irish recreational venues, albeit for men (Malcolm 1998: 51–53, 72; see also Kearns 1996).
These competing nationalist and imperialist discourses infused medico-scientifc de-
bates about alcohol and problem drinking in Ireland. Internationally, by the 1890s, medical
thought had come to redefne inebriety as a disease rather than a vice (Berridge 1990, 2013;
Levine 1978; Valverde 1998). As historians of alcohol have compelling shown, the disease
concept gained authority in Britain, Europe and the United States at this time not due to any
scientifc breakthrough but rather, in response to a discrete set of social factors, including the

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infuence of evangelical temperance interests and the increasing status of psychiatry and the
medical profession more generally (Berridge 1990: 999; Nicholls 2009: 67; Porter 1985: 393).
Similar forces were at work in Ireland, where the medical community broadly subscribed
to this understanding of addiction. Like their British colleagues, some Irish doctors were
heavily swayed by temperance ideology. But beyond adhering to international frameworks,
cultural and political idiosyncrasies clearly infected their opinions as to the place of alcohol
within Irish society (Mauger 2019: 17–29).
In an especially blatant assertion of the value of sobriety to the struggle for Irish national
self-governance, one contributor to the Dublin Journal of Medical Science in 1904 proclaimed:

One of the heaviest blows which a patriotic Ireland could possibly infict on its neigh-
bouring British rulers would be given by taking the pledge all round – old and young –
and keeping it! Why, we often say to ourselves, do not patriotic politicians utilise this
fact?
(The Medical Temperance Review 1904: 139)

This proposal alluded to the abstinence pledge, such as that taken by members of the Pioneer
Total Abstinence Association formed in 1898 by the Catholic priest, Fr James Cullen. No-
tably, while the Pioneer Association quickly became associated with the nationalist cause,
this was not the exclusive political ideology underpinning temperance in Ireland. From the
late 1820s, a Protestant anti-spirits movement emerged in Ireland, particularly in Dublin
and Ulster, largely in response to the drunken violence of the 1798 rebellion, intensifying
campaigns for Catholic Emancipation and high levels of spirit consumption (Malcolm 1986:
55–56). According to Malcolm, following the demise of Fr Theobald Mathew’s Catholic
temperance ‘crusade’ in the 1840s, the growth of teetotalism became synonymous with
‘middle-class, pro-British Protestants who used it to bolster their own position’ while ‘deni-
grating the customs and habits of their Catholic social inferiors’ (Malcolm 1980: 113). Yet by
the early twentieth century, some increasingly militant Irish nationalists were fnding much
in common with teetotalism, under the vanguard of Cullen’s Pioneer Association, particu-
larly the renewed belief that sobriety would invigorate the independence struggle. Mirroring
these broader societal tendencies, by the turn of the twentieth century, several prominent
Irish medical practitioners, regardless of religion or political leaning, were openly promoting
and engaging in these movements (Mauger 2019: 28–29).
Chief among this group was Dr Ephraim MacDowel Cosgrave, physician to several Dub-
lin hospitals and president of the Irish branch of the British Medical Temperance Association
(Woods 2009: 13). Cosgrave published energetically on alcohol and temperance and was an
ardent advocate for establishing inebriate homes in Ireland (Cosgrave 1982, 1897, 1901). The
origins of these institutions are widely attributed to the temperance-based Washingtonian
movement in the United States which, during the frst half of the nineteenth century, cre-
ated small private homes providing moral treatment for voluntary patients (Berridge 2004:
5). Dedicated retreats for inebriates then began to spring up, frst in Boston, New York and
San Francisco in the 1850s, and later in Chicago, Philadelphia and parts of Canada in the
1860s and 1870s (MacLeod 1967: 218, 2012: 110). By now, medical practitioners in England
were successfully working to promote comparable institutions, coming into being by stages
under a series of Habitual Drunkards (later Inebriates) Acts (MacLeod 1967). Medical sup-
port was reinforced by the Society for the Study and Cure of Inebriety, which under the
leadership of Dr Norman Kerr campaigned for a state-funded inebriate reformatory system
(Berridge 1990).

526
 From ‘pledge’ to ‘public health’

In Ireland, Cosgrave’s stance echoed renewed calls from the wider medical community
and popular press for institutions for ‘chronic drunkards’. In keeping with the disease con-
cept, inebriate reformatories were presented as a sympathetic alternative to criminalising
drunkards and confning them in prisons. Proponents hoped these new institutions would
ofer a chance to treat and even cure inebriety (Berridge 1990: 991, 2004: 4). The rise of
eugenics as a science also infuenced this campaign, refecting a deep-rooted belief that
alcohol was a major cause of degeneration (Malcolm 2012: 111; Cox 2012: 61). In several
European contexts, this was linked to rising fears about the impact of women’s drinking on
the future of the nation (Berridge 2013: 89; Dunbar 2018; Prestwich 2003). Medical opinion
highlighted the greater biological risks alcohol posed to women, both personally and to their
unborn children. These views found their way into temperance rhetoric as well as the func-
tioning of the inebriate reformatory system. Both Ferriter and Malcolm have pointed to the
idea that drunkenness in women was viewed as a greater evil, while at the same time, it was
felt that virtuous women might lead their families along a righteous path to sobriety (Ferriter
1999: 71–73; Malcolm 1980: 67–68). Perhaps moved by these arguments, Cullen initially
intended the Pioneer Association to serve female members only (Ferriter 1999: 20–21).
Of particular concern in many quarters was the practice of clandestine drinking by
women at the notorious spirits-grocers, a form of mixed trading outlet carrying a range of
household commodities and licenced to sell alcohol. Ofcial reports abounded in the late
nineteenth century of women leaving these venues at best mildly intoxicated with some
barely able to walk (Kearns 1996: 16). In 1894, Brigade-Surgeon F.E. McFarland, a retired
Consultant Physician to the Ulster Hospital for Women and Children, singled out this phe-
nomenon warning that:

The grocer’s spirit licence has done much harm, especially to women. It has already
made of them inebriates; women especially, should not be exposed to temptation. There
are times of physical weakness which render them an easy prey to drink when once the
habit is formed. Women who formerly would not be seen in a public-house cannot now
buy their necessaries without being exposed to temptation. The downfall with them
is very rapid, and the outlook for the children very bad. This law should be repealed.
(McFarland 1894: 488)

While the spirits-grocers were no longer granted licences from 1910, fears about women’s
drinking persisted, especially during the First World War. These included anxieties around
female shebeen keepers and soldiers’ wives who reportedly squandered their separation al-
lowance on drink (Dunbar 2018).
It was within this intellectual climate that the state-funded reformatories were eventu-
ally sanctioned by new legislation, introduced in 1898 (Inebriates Act 1898). Rather than
responding to medical appeals, however, it was at the repeated requests of the Unionist MP,
William Johnston, that this Bill was applied to Ireland (‘Inebriates Bill’ 1898; ‘Habitual Ine-
briates Bill’ 1898).3 George Bretherton has contended that Irish support came from diverse
groups, ranging from temperance advocates to local government bodies to clerical and med-
ical professionals and penologists (1986: 474). Yet as Beverly A. Smith has shown, the Bill
was extended to Ireland in its later stages almost as an afterthought (1989: 58). The resulting
Act sanctioned the committal of inebriates to state or charitable-funded reformatories if they
were tried and convicted of drunkenness at least four times in one year. In Ireland, this led
to the creation of four institutions. But of these four, only the Lodge Retreat in Belfast (est.
1902) accepted voluntary inmates and limited admissions to fee-paying, Protestant women.

527
 Alice Mauger

The remaining three could only be accessed by those committed through the courts. These
were the State Inebriate Reformatory in Ennis (est. 1899), and St Patrick’s (est. 1906) and
St Brigid’s (est. 1908) certifed inebriate homes for Catholic men and women, respectively.
Given the fears around women’s drinking in this period, it is unsurprising that research on
both prisons and inebriate reformatories has suggested that the legal courts were often less
sympathetic towards the women brought before them for drink-related crimes and appeared
to be quicker to send women to institutions for drunkenness than men. In fact, both the
Ennis State Reformatory and the certifed reformatories contained more women than men
(Malcolm 2012: 114).
In spite of strong medical backing prior to their establishment, the inebriate homes were
short-lived and, as in Britain, had all but wound down by the end of the First World War. A
key issue was that what medical reformers (both in Britain and Ireland) had campaigned for,
that is, compulsory powers to detain non-criminal inebriates, never became law. Moreover,
the four Irish institutions served only a very small cohort. By 1917, St Patrick’s had admitted
only 148 men since opening and St Brigid’s, 151 women. The Inebriate Retreat at Belfast,
meanwhile, had treated 209 patients and the State Inebriate Reformatory at Ennis, 274
(Fourteenth Report of IIIA 1918: 4; Fortieth Report of GPBI 1917–1918: xii; Malcolm 2012: 120;
see also Reidy 2014). In her comprehensive analysis of Irish inebriate reformatories, Malcolm
has concluded that a vital reason for their decline was the generally permissive public attitude
towards drunkenness, although this essentially applied to men rather than women. Once
established, this tolerant outlook fostered scepticism and at times hostility among local coun-
cils, nationalist politicians, the courts, the churches and crucially the medical profession, as
to the value of inebriate reformatories (Malcolm 2012: 115–116). Even within the anti-drink
ranks, Bretherton has outlined clear divisions by the turn of the century between:

on the one side, the old elite, increasingly tied to the Unionist party, arguing that
the drunkard should be locked up; [and] on the other side, a militantly nationalist
group, some of them teetotallers, taking their stand with voluntarism and Catholi-
cism, while claiming that drunkenness would no longer exist if the British were out
of Ireland.
(1986: 479)

Political disharmony was similarly self-evident in discussions about the proposed introduc-
tion of restricted weekend opening hours for public houses. This was at least partly a tes-
tament to the political clout of both Irish publicans and brewing and distilling companies
in this period and beyond. In the late nineteenth and early twentieth centuries, publicans
achieved a high degree of social, economic and political prominence, especially in nationalist
politics. Brewing and distillation, meanwhile, remained politically important well into the
twentieth century due to the high levels of employment they provided as well as the revenue
their products yielded (Kadel 2015). Echoing the sentiments of the Home Rule Party, in
1895 a review article in the Dublin Journal of Medical Science denounced the ‘grandmotherly
legislation and coercion’:

The liberty of the subject is sufciently restricted already, and the patience with which
millions of law-respecting citizens tolerate the curtailment of their personal liberty lest
a weak brother should ofend is a marvellous testimony to our inborn respect for law.
Restrictions and pledges cannot create an Utopia.
(‘Review of Norman Kerr, Inebriety’ 1895: 50)

528
 From ‘pledge’ to ‘public health’

At this stage, the licencing laws governing Ireland remained scattered across 25 Acts of
Parliament, a fact which likely motivated the House of Lords’ 1898 Commission on Intoxi-
cating Liquor. A testament to the lack of political sway the medical community held at this
juncture, only a handful of the 259 witnesses examined were medical men and those who did
give evidence were queried on their legal rather than medical knowledge (Minutes of Evidence
taken before the Royal Commission on Liquor Licensing Laws 1898: 527).
No doubt stimulated by the lacklustre performance of the inebriate homes, Ireland’s
ever-expanding lunatic asylums remained primary sites of care for the intemperate. In
fact, alcohol-related admissions became so common that by 1900, one in ten were at-
tributed to drink (Finnane 1981: 146). Paradoxically, given their medical character, few
doctors in Ireland or internationally favoured asylums for the treatment of inebriety
(Mauger 2019; Prestwich 1994). This professional apathy was heightened in the early
twentieth century as the causal connection between intemperance and insanity became
contested and alcohol was increasingly seen as a ‘stumbling block’ for the already ‘unsta-
ble brain’ (Cox 2012: 61–62; Pick 1989: 201–202). Likewise, the perceived links between
heredity and inebriety began to disintegrate, infuenced by the growing popularity of
the Freudian movement as well as research by University College London scientists that
found no marked evidence connecting parental alcoholism to mental defects in children,
and therefore shifted the emphasis away from concerns about women’s drinking (Ber-
ridge 2013: 91). It is also conceivable that the demise of the inebriate homes undermined
medical authority, given the very public support many prominent doctors had pledged
for this initiative in the outset.
By the end of the First World War, medical interest in inebriety had waned and political
barometers swung sharply towards limiting drinking rather than treating diseases attributed
to drunkenness. Among the most infamous of these tactics was the United States’ prohibition
experiment, resulting in a nationwide ban on drinking from 1920 until 1933. Following the
Irish War of Independence (1919–1921) and the partition of the island into two separate states
(1920–1922), the newly formed Irish Free State government responded swiftly to the ‘drink
question’.4 In the frst decade of independence, the state initiated an intoxicating liquor
commission, restricted pub opening hours and decreased the number of pub licences (Butler
2010: 24–28, Ferriter 2015: 5–6). That medical involvement in these developments remained
minimal signifes both declining international interest in inebriety during the interwar years
and anxieties about persistently high infant mortality rates and infectious diseases, which
remained a priority for the Irish medical community. There was also a marked decrease in
alcohol consumption and reported deaths from liver cirrhosis, following general trends in the
United Kingdom (Berridge 2013: 165; Ferriter 2015: 9).

Te Disease View and the ‘Drunken Irish’

The repeal of Prohibition signalled shifting attitudes towards alcohol and a new ‘disease
view’ of addiction began to take root. Earlier interpretations framing drink as an inherently
addictive substance were now gradually supplanted by this new concept that rendered al-
cohol harmless for most but with the potential to cause disease in a minority of vulnerable
or ‘defective’ individuals (Levine 1978: 494; see also Yokoe 2019). The disease view was
championed by the prominent epidemiologist and leader of the World Health Organiza-
tion’s (WHO) alcohol research programme, E.M. Jellinek, through whom it fltered into the
United Kingdom. The spread of Alcoholics Anonymous from the United States to Europe
by the 1950s also propelled its popularity (Thom 1999: 72; see also Yokoe 2019).

529
 Alice Mauger

This new concept of alcoholism was comparatively slow to take hold in Ireland, in spite
of some medical activity in the addiction arena. In the 1940s, the Irish Medical Association
lobbied for provision to treat ‘addicts’ in a new Mental Treatment Bill (‘Mental Treatment
Bill, 1944’ 1945: 7–8). Introduced in 1945, the resulting Act refected the Association’s in-
put. The statute stipulated that any individual who had, due to addiction, been medically
certifed as dangerous to others, incapable of managing their afairs or at risk of developing a
mental disorder could be detained in a mental hospital against their will for up to six months
or two years in certain cases (Mental Treatment Act 1945: s.2, s.189). Though it is tempt-
ing to decipher this development as a proof of the acceptance of alcoholism as a disease in
need of treatment, Shane Butler has convincingly demonstrated the lack of state support for
this measure (2002: 23–24, 2010: 29–30). Moreover, as will be discussed, it was not until
the 1960s that psychiatrists in Ireland began openly supporting the disease theory (see also
Mauger 2021). Therefore in many ways, this development merely emulated the recommen-
dations of medical temperance advocates like Kerr and Cosgrave, half a century earlier,
for compulsory powers to institutionalise non-criminal inebriates. Rather than separate,
specialist institutions, however, the Act cemented the role of psychiatric hospitals in the
treatment of addiction.
Another plausible explanation for the lacklustre medical enthusiasm for the alcoholism
model in Ireland lies in the strong infuence of the Catholic Church both in the realms of
healthcare and education and on the development of psychiatry in these decades. As Da-
vid Healy has persuasively illustrated, church intervention in the politics of social welfare,
combined with an alliance with Irish medicine, dictated the evolution of health services in
Ireland (Healy 1996: 275; see also Barrington 1987). Increasingly, most Irish doctors were
themselves Catholics, often deeply committed ones, and this likely informed their practice.
Other examples where this has occurred include Catholic disapproval of psychoanalysis or
behaviourism; opposition by the Irish Medical Association to the proposed provision of free
health services for mothers and children under the age of fve in the 1950s; and a sustained
denial of the occurrence of syphilis in Ireland into the 1980s (Healy 1996). Contemporary
church teaching, which was primarily concerned with temperance, as well a general culture
of toleration around drunkenness for many groups, may therefore have contributed to the
Irish medical profession’s delay in embracing the disease view of alcoholism.
While continuing to attract little attention in Irish medical circles, psychiatrists working
in Britain and the United States frequently documented disproportionate numbers of Irish
alcohol-related admissions to mental hospitals in these regions (Malzberg 1930, 1940; Meyer
1933; Sullivan and Glatt 1956). Alongside these studies, sociologists and anthropologists re-
inforced the impression that Irish drinking behaviour was somehow distinctive (see Mauger
2021; Stivers 1976: 5–14). Perhaps the best-known example is the work of the Harvard re-
searcher, Robert Bales, whose 1944 doctoral dissertation contrasted Jewish and Irish social
norms and attitudes towards drink (see Bales 1980).5 In 1962, Bales published his fndings
on the assorted roles alcohol performed in Irish culture. These included drinking for medic-
inal purposes, to prevent damp and cold, as a substitute for food during famine or religious
fasts, to relieve sexual tension in young rural men facing lifelong celibacy due to inheritance
practices and as an ‘overt and active and persistent aggression against the English’. Alcohol
tended not to be condemned, Bales found, and the practice of ‘treating’ or buying rounds
only served to exacerbate Ireland’s heavy drinking culture, with alcohol omnipresent at
christenings, funerals and wakes (1962).
In fashioning his treatise on Ireland’s drinking culture, Bales had borrowed heavily from
the work of two Harvard anthropologists, Conrad M. Arensberg and Solon T. Kimball, who

530
 From ‘pledge’ to ‘public health’

observed and recorded their fndings on the lives, relationships and economy of the small
farmer class and the people of Ennis town in County Clare in the rural West of Ireland in
the 1930s (1940; see also 3rd ed., 2001). Arensberg and Kimball’s resultant book, Family and
Community in Ireland, contributed greatly to the durable premise that heavy drinking among
rural males was an important ‘safety valve in the release of sexual tension’. It also supported
the image of the mother-dominated Irish family which, as will be seen, came to infuence
Irish medical discourses in later decades (Arensberg and Kimball, 3rd ed., 2001: 56–58). It
should be noted, however, that Arensberg and Kimball argued that both mothers and fathers
played a dominant and even controlling role in their sons’ lives, with the son largely subor-
dinated by both parents but especially his father (Arensberg and Kimball, 3rd ed., 2001: 52).
Aside from relying on Arensberg and Kimball’s appraisal, Bales’ depiction of Irish social life
was mostly based on texts dating from the sixteenth to nineteenth centuries, and tended to
both illustrate and strengthen popular explanations for excessive drinking in the Irish. While
the tendency in these decades was to frame alcoholism as a male problem, Bales’ emphasis
on Irish bachelors was later contradicted by research demonstrating that at the turn of the
twentieth century, both single and married Irish men and women showed higher rates of
‘alcoholism’ than their equivalents in other ethnic groups (Room 1968).6 As several scholars
have stressed, studies of this type were also undermined due to an assumption that heavy
drinking in Irish migrants was characteristic of drinking behaviour in Ireland (Cassidy 1996;
Lynn and Hampson 1970; Malcolm 1986; O’Connor 1975).
Concerns about Ireland’s drinking culture took on a renewed political urgency in the
1950s, as it became linked to declining population and increasing levels of emigration, es-
pecially by women. In 1954, a report from the Commission on Emigration and Population
Problems partly blamed the exodus on the ‘relative loneliness, dullness and generally unat-
tractive nature of life in many parts of rural Ireland’, calling for increased diversity in venues
for entertainment, recreation, education and culture, as opposed to simply pubs (173–174).
In the same year, a collection of essays edited by Fr John A. O’Brien entitled The Vanishing
Irish (1954) went further in citing rural male Irish drinking practices as a key reason for de-
clining marriage rates. For example, Edmund J. Murray contended that ‘ninety-fve per cent
of Ireland’s eligible women would marry tomorrow were the eligible men of the nation to
transfer their afections from horses and dogs and football matches and “pubs” to the nobler
activities of courtship and marriage’ (1954: 72). Likewise, Mary Frances Keating, in the same
collection wrote of ‘Marriage-shy Irishmen’, while complaining that even for those who
failed to evade matrimony:

[…] he indulges in some form of escapism after recovering from his frst panic. The
favourite forms of escape are drinking, gambling, politics and sport. He is not a good
husband or a good father, and the blame for the fact that the Irish are a vanishing race
must be laid squarely and solely on his shoulders.
(Keating 1954: 166)

While these claims colourfully depict the perceived links between drinking practices and
population decline, it was not until the following decade that political awareness of alcoholism
was perceptible.
By the 1960s, Irish politicians were becoming increasingly conscious of the claims cir-
culating abroad about an Irish predisposition to alcoholism. Critically, this recognition
occurred at a time when the country’s Taoiseach (head of government) Seán Lemass was
seeking membership of the European Economic Community. In 1962, Lemass complained

531
 Alice Mauger

of ‘persistent and irritating falsehoods’ about the ‘drunken Irish’, made worse, he claimed,
by the BBC’s tendency to constantly reproduce this caricature (Viney 1964: 8). This frus-
tration at the racial stereotyping of the Irish echoed that of nationalist politicians in the late
nineteenth century and was, perhaps, understandable, given robust attempts in the 1960s to
transition Ireland from a rather conservative and insular nation to one that could be proudly
modern and open. As one journalist succinctly put it:

Few Irishmen would disagree that the image of the “drunken Paddy” whether fction-
ally presented on British television screens or factually endorsed in the magistrates’
courts of West London, is humiliating to the Irish at home. And if Mr Lemass is also
concerned lest foreign industries are put of coming to Ireland through fears of drunken
labour and absenteeism, this too is understandable.
(Viney 1964: 8)

Possibly adding to Lemass’ irritation were recent reports that the Irish were drinking less
alcohol than the British. In 1958 the Central Statistics Ofce registered Ireland’s annual per
capita consumption as 64.3 litres of beer and 1.2 litres of spirits compared to Britain’s annual
consumption of 79.1 and 1.1 litres, respectively. The previous year, a Commission on In-
toxicating Liquor had complacently announced that drink was no longer a serious problem
in Ireland (Ferriter 1999: 190–191). Yet, these fndings failed to take account of the very
high numbers of total abstainers. The Pioneer Total Abstinence Association had gone from
strength to strength during the frst half of the twentieth century and by 1959, claimed nearly
500,000 members – in a population of approximately 2.8 million. Irish attitudes towards
alcohol in this period could therefore be described as ambivalent, or as Ferriter has phrased
it, Ireland was a ‘nation of extremes’. Overall, however, Ferriter has described the drinking
culture in this era as one of ‘toleration’, in which excessive consumption was mostly viewed
as both gregarious and entirely respectable. Importantly, though, this culture of toleration
applied to men, while women were more likely to be targeted by the Pioneers and to be ab-
stainers (1999: 2, 168, 191). Nonetheless, there is evidence that some women were drinking
heavily, and even undergoing treatment for alcoholism. For example, in St Patrick’s Hospital
in Dublin, there was a steady increase in the admission rate of ‘alcoholic patients’ from 230
in 1958 to 735 in 1968, during which time the number of women treated for alcoholism
rose from 50 to 150 (Cooney 1970: 220). As in earlier periods, there was an emphasis on the
clandestine nature of Irish women’s drinking, with the physician to St Patrick’s Hospital re-
porting in 1962 that excess drinking, especially in women, was often so well concealed that
diagnosis was made ‘on the clinical features alone’ (Martin 1962: 120).
While Ireland was not the highest annual per capita consumer of alcohol, the problem of
alcoholism, both at home and abroad, drew increasing attention. In 1958 alone, some 561
patients (5%) admitted to Irish mental hospitals had been diagnosed with ‘alcoholism’ and a
further 92 (0.7%) with ‘alcoholic psychosis’ (Report of IMH 1960: 15). In response, psychi-
atrists began advocating for state support for a national council on alcoholism, eventually
formed in 1966. The establishment of this voluntary organisation was chiefy credited to
experts at two private psychiatric institutions in Dublin, the St John of God Hospital and St
Patrick’s Hospital. Both had developed specialist alcoholic treatment facilities in this decade
and were widely held to be leaders in the addiction feld. In the same year, the Commis-
sioners of Inquiry on Mental Illness reported that they could fnd no detailed survey of the
number of alcoholics in Ireland but were aware of research in the United States and Brit-
ain highlighting disproportionate rates among the Irish there. While contesting that such

532
 From ‘pledge’ to ‘public health’

fndings signifed the extent of alcoholism in Ireland, the Commissioners declared that based
on the experience of practising Irish psychiatrists, the problem was serious and deserved
immediate attention, including extensive research activity (Report of CIMI 1966: 79–80). In
fact, it was later reported that admissions for alcoholism were continuing to rise from 1,638
(10.6%) in 1965 to 2,874 in 1969 (14.6%) (O’Hare and Walsh 1970: 13). While this surge may
partially indicate that diagnosis was increasing in step with heightening medical interest, it
is clear that by now alcoholism treatment had come frmly under the purview of psychiatry.
The 1960s also saw much broader endorsement of the disease view in Ireland. Dr John G.
Cooney, a consultant psychiatrist at St Patrick’s Hospital, was an especially avid supporter
(Cooney 1963). Cooney was responsible for setting up a specialist treatment programme
for alcohol-related disorders at St Patrick’s and published and presented extensively on the
disease view. This concept was also widely promoted by the Irish National Council on Al-
coholism (INCA), whose main objective was to educate the public on the signs, causes and
efects of the disease of alcoholism, as well as available treatments. INCA, as Butler has ob-
served, was given clear and unequivocal public policy acceptance by the 1966 Commission-
ers (2002: 38–39). Yet in spite of growing support in some circles, others pointed to social
and cultural factors in their research on alcoholism.
Among the most prominent was Dr Dermot Walsh, a practising psychiatrist who became
the Director of the Mental Health Section of the Irish Medico-Social Research Board (later
Health Research Board) in 1969. In 1962, Walsh had written of Ireland’s peculiar cultural
environment, including, he claimed, persistent ancient folk customs, superstitions and mag-
ical beliefs; centuries of war and hardship, the lasting consequences of the Great Famine of
the 1840s; and the ‘deeply ambivalent and confict-laden relationship’ between Irish mothers
and their sons. Within this setting, Walsh premised, the Irish were:

in a general sense freer in their use of alcohol than most nationalities. There seems lit-
tle doubt that drinking plays a large part in dealing with many deeper frustrations and
conficts … Alcohol, too, has in high degree the efect of inducing and enhancing the
fantasy life which is so inherently a part of Irish cultural heritage.
(1962: 65–66)

At the Medico-Social Research Board, he went on to conduct studies into the prevalence of
alcoholism in Ireland and in 1969, pronounced psychiatric admissions for alcoholism much
higher than in Britain or the United States (Walsh 1969). This assertion did not sit well with
other workers. In 1970, researchers at the Irish Economic and Social Research Institute
(ESRI) refuted Walsh’s fndings, underlining Ireland’s lower annual per capita drink con-
sumption, lower death rates from alcoholism and liver cirrhosis and lower conviction rates
for drunkenness compared to the United Kingdom, Europe and the United States (Lynn and
Hampson 1970). The debate continued, with Walsh attributing Ireland’s lower annual per
capita consumption to high levels of total abstinence. Walsh also contended that alcoholism
was not necessarily a fatal disease, that links with liver cirrhosis remained uncertain and that
lower conviction rates might merely refect more lenient societal attitudes towards drunken-
ness. ‘For the Irish’, he concluded, ‘wherever they may be, alcoholism is a serious problem’
(1970: 205).
Continuing resistance to Walsh’s fndings is evidence of the sustained professional dis-
agreement relating to alcoholism in Ireland. At the source of this dispute, the central tenet
of the disease view proved troublesome for some commentators. For them, the suggestion
that alcoholism indicated some inherent defect in certain individuals was difcult to accept

533
 Alice Mauger

in a country with rising psychiatric admissions for that disorder (Mauger 2021). It follows
that claims of an Irish predisposition due to some biological, ethnic trait might have been
perceived as posing a threat to Irish identity. Perhaps partially in reaction to this, an em-
phasis on Ireland’s drinking culture, and broader cultural infuences on Irish drinking be-
haviour, remained popular into the 1970s. In a submission to INCA, the Director of the
Irish Medico-Social Research Board, Dr Geofrey Dean, emphasised the predominance of
‘cultural factors’ in determining drinking behaviour. Among them, Dean listed the ‘rather
extreme attitude’ of the Catholic Church in its condemnation of sins involving sex; the ‘au-
thoritarian’ Irish education system, pressures to conform to cultural norms; and loneliness
caused by segregating the sexes both in school and in social activities (Dean 1973). In spite
of his initial championing of the disease concept, even Cooney was not opposed to this al-
ternative framework. According to him, modernisation was responsible for a range of new
infuences on Irish drinking habits which were leading to an increase in alcoholism. These
included greater social mobility and disposable income, the shift from dimly lit, all-male
pubs to brightly lit bars and singing lounges catering to young men and women; expense
account drinking in the cities; and the supremacy of alcohol both in business deals and on all
social occasions. By now, Cooney was espousing a ‘multifactorial theory’, suggesting that ex-
posure to a critical amount of alcohol in a favourable setting would predispose certain indi-
viduals by reasons of metabolic and/or personality factors, to develop the disease (1971: 53).
Such concerns about the growing popularity of drinking were informed by altering
attitudes to alcohol consumption and addiction across many countries in the 1970s. This
change was driven by epidemiological fndings linking rising annual per capita intake with
a concurrent growth in alcohol-related harm, including deaths from liver cirrhosis and con-
victions for drunkenness and drink-driving. As discussed, this approach was favoured by
researchers at the ESRI. Put simply, drink was now presented as a problem for ‘total popu-
lations’ rather than a predisposed minority. This new theory, which became known as the
public health perspective, gradually replaced the disease concept (Thom 1999; Yokoe 2018).
With a shift away from biological or psychological understandings of alcoholism, the culture
around drinking was therefore frmly under the spotlight. A marked adherence to this new
focus was evident in INCA’s report to the Minister for Health in 1973. By now, the Council’s
members were divided between those who still supported the disease view, usually psychi-
atrists, and other researchers, especially epidemiologists, who promoted the public health
perspective (Butler 2002: 53–55). Probably by way of compromise, the report recommended
the prevention of both alcoholism and excessive drinking by altering social and cultural at-
titudes to drink (INCA 1973: 10).

Changing Ireland’s Drinking Culture

In spite of a growing emphasis on the potentially harmful aspects of Ireland’s drinking
culture, ideological clashes between proponents of the disease view and the public health
perspective persisted in the decades following 1970. Internationally, the WHO increasingly
endorsed a preventive or health promotion model (see Thom 1999). In England, during the
1970s and 1980s, well-funded campaigns developed to promote ‘sensible drinking’, refect-
ing a shifting focus away from ‘alcoholics’ and heavy drinkers (Mold 2020). Yet as Butler
has comprehensively outlined, in Ireland, there was a continued reluctance to implement
public health alcohol policies. Among the reasons he has presented are a sustained general
cultural tolerance of alcohol alongside a lack of political commitment borne of the realisa-
tion that measures aimed at controlling and restricting drinking behaviour were electorally

534
 From ‘pledge’ to ‘public health’

unpopular. While INCA had begun to show some signs of supporting public health prin-
ciples, it remained a divided and largely dormant operation throughout its lifetime and was
eventually wound down in 1988. Moreover, the expansion of institutional care for alcohol-
ism, both within the existing public healthcare framework and outside of it, signalled an
enduring reliance on treatment rather than preventive models. In 1978, the frst of several
private rehabilitation in-patient units, the Rutland Centre, was founded by a Catholic priest,
Fr Raphael Short and enjoyed substantive state support (Butler 2002: 44–72). Meanwhile,
there is evidence that the disease model ‘both fourished and remained embedded within the
alcohol treatment system’ into the twenty-frst century (Cullen 2011: 251–261).
Perhaps as a result of the treatment model’s persistence, psychiatric admissions for alco-
holism continued to increase and by the mid-1970s made up one-half of male admissions
and one-third of all admissions (Walsh 1987: 748). These rates remained high into the 1980s
and 1990s, accounting for between one quarter and one ffth of all total admissions up until
1995 (Butler 2002: 46). Simultaneously, alcohol consumption continued to climb. Between
1948 and 1970, annual intake per person had risen by 60% from 3.2 litres to 5.1 litres (Fer-
riter 1999: 203). In 1970, it stood at 7.0 litres of pure alcohol per adult increasing to 10.1
litres by 1986 and to 14.1 litres by 2001 (Ferriter 2015: 17). Yet, these rising rates apparently
caused little concern at government level. In 1996, the Health Promotion Unit within the
Department of Health (est. 1988) published its National Alcohol Policy – Ireland report. The
document’s tone suggested that neither the public health approach, nor fears about Ireland’s
drinking culture, had yet entered the ofcial lexicon:

There is evidence that the description of the Irish as a particularly alcohol-prone race is a
myth. Indeed it is doubtful whether Ireland ever occupied a prominent role with regard
to alcohol use or misuse.
(National Alcohol Policy – Ireland 1996: 11, cited in Ferriter 205: 706)

It could be argued that such a tack was predictable, given the neo-liberal policy climate
which characterised the ‘Celtic Tiger’ era, the popular name for Ireland’s economic boom
of the mid-1990s to late 2000s. Within this environment, the state was broadly opposed to
intervening in the alcohol market via taxation or by restricting advertising (Butler 2009:
343). However, as was the case in England, this period saw the arrival of a policy commu-
nity committed to implementing such measures to reduce alcohol-related harm. This group
boasted strong medical participation, including from physicians, public health doctors and
psychiatrists (Thom 1999: 110–120). In Ireland, the policy community was formalised by
the establishment of the charity, Alcohol Action Ireland in 2003. Meanwhile, the Minister
for Health established a Strategic Task Force on Alcohol, a committee dominated by public
health advocates, which published several reports beginning in 2002.
The early 2000s also saw the emergence of new concerns around Ireland’s drinking cul-
ture as European-wide research studies began to examine binge drinking. While this con-
cept was not a new one, its meaning had now shifted from heavy drinking over several days
to a single drinking session leading to intoxication. Internationally, binge drinking became
an important social, political and media concern, especially with regard to young people and
more often young women (Berridge, Herring and Thom 2009). But the Irish, it seemed,
were particularly prone. According to one study of 35 European countries in 2004, Irish
teenagers displayed the highest level of binge drinking and were almost twice as likely to
smoke marijuana or hashish than the European average (Downes 2004: 6). Such fndings
once again pointed towards something anomalous in Irish drinking behaviour. From the

535
 Alice Mauger

twentieth-century emphasis on the quantities the Irish drank, there now came a growing
focus on the manner in which they consumed alcohol. For many, this ofered an explanation
for the age-old conundrum of disproportionate psychiatric admissions and alcohol-related
problems in Irish populations.
While by now most medical commentators tended to agree that alcohol should be targeted
as a major public health problem, the infuence of the drinks industry was regarded as one
of the ‘biggest barriers to change’ (Ferriter 2015: 21). The balance of power began to shift,
however, in 2009, when the Department of Health established a steering group to formulate
a national alcohol policy to be integrated into the existing National Drugs Strategy. This
Steering Group was chaired by the public health doctor and Chief Medical Ofcer, Dr Tony
Holohan, and its members included representatives of the College of Psychiatrists of Ireland,
the Royal College of Physicians of Ireland (RCPI), the Irish College of General Practitioners
and Alcohol Action Ireland. Its report, published in 2012, stated that the average Irish adult
in 2010 drank 11.9 litres of pure alcohol annually and that given 19% of the adult population
were abstainers, the actual amount consumed was considerably more. Moreover, the report
stated, adults in 2010 were still drinking more than twice the annual average of those in 1960.
The report also drew attention to both binge drinking in adults and drinking in young people.
While some emphasis was placed on the need to improve access to interventions, treatment and
rehabilitation services for alcohol use disorders, the strategy’s central aim was ‘the promotion
of healthier lifestyle choices throughout society in relation to alcohol’. The report therefore
recommended the introduction of a legislative basis for minimum unit pricing, restrictions on
alcohol marketing and advertising and a phasing out of drinks industry sponsorship of sport
and other large public events (Steering Group Report 2012: 7, 11, 14, 22–23, 24, 35). The follow-
ing year, the Irish government announced its intention to incorporate several of the Steering
Group’s recommendations to reduce alcohol-related harm into new public health legislation
and in December 2015, approved the Public Health (Alcohol) Bill. A staunch supporter of
the Bill, the Minister for Health, Leo Varadkar, who worked as a hospital doctor and general
practitioner prior to his political career, described it as ‘the most far-reaching proposed by any
Irish government, with alcohol being addressed for the frst time as a public health measure’.
Echoing the concerns expressed by the Steering Group and policy advocates, Varadkar drew
attention to the fact that Ireland now ranked ffth out of 28 European Union member states
for alcohol consumption and second across Europe for binge drinking (O’Halloran 2015: 8).
Medical support for the Bill was consolidated under the newly formed Alcohol Health
Alliance Ireland, a joint venture between the RCPI and Alcohol Action Ireland. Similar in
makeup to the United Kingdom’s Alcohol Alliance, its membership included medical ex-
perts, public health campaigners, NGOs, the Health Service Executive, the College of Psy-
chiatrists of Ireland and the Irish Heart Foundation (Berridge 2013: 226). The alliance was
chaired by Prof Frank Murray, a liver specialist at Beaumont Hospital, Dublin and former
president of the RCPI. Murray has been an especially avid proponent of the public health ap-
proach, publishing widely in the media and in medical periodicals. While giving evidence at
a Dáil (lower house of Irish parliament) reading of the Bill in March 2015, Murray appealed
to a lingering national sensitivity towards the ‘drunken Irish’ stereotype:

There is plenty of public discourse about alcohol and unease about our image as a nation
of heavy drinkers. This is not something of which we are generally proud. I believe the
time is right to implement radical solutions to address the awful problem of alcohol in
Ireland.
(‘General Scheme of Public Health (Alcohol) Bill’ 2015)

536
 From ‘pledge’ to ‘public health’

This concern was doubtfully the driving force behind the Bill, which could be attributed to
several factors, including the critical state of the healthcare system and the successful imple-
mentation of the 2004 ban on smoking in all enclosed places of work, including pubs and
restaurants. Yet, it is noteworthy that this viewpoint has persisted into the present century.
Speaking in the Dáil in October 2018 as the Bill passed its fnal stage, the new Minister for
Health, Simon Harris, explicitly highlighted both the government’s embrace of a public
health approach and a strong desire to change Ireland’s drinking culture:

For the very frst time in our history, we are legislating for alcohol as it afects our health
and it is right and proper that we do so. We know that we have a relationship with al-
cohol in this country that is not good, damages our health, harms our communities and
harms many families. The measures in this Bill will make a real diference to changing
the culture of drinking in Ireland over a period of time.
(‘Public Health (Alcohol) Bill’ 2018)

The Public Health (Alcohol) Act was signed into law by the President of Ireland on 17 Oc-
tober 2018. At the time of writing, and in the context of a global pandemic, only time will
tell the extent to which Harris’ aspiration will be realised.

Conclusion
As demonstrated by several signifcant studies on other regions, anxieties about intoxication, par-
ticularly those linked to addiction and alcohol-related harm, are by no means unique to Ireland
(see, e.g., Berridge 2013; Nicholls 2009; Prestwich 1988, 1994; Savelli 2011; Schrad 2014; Toner
2015; White 1996). While many of the developments outlined here largely mirrored those taking
place internationally and especially in the United Kingdom, this chapter has highlighted how the
specifc cultural meanings attached to excessive drinking in a nation internationally renowned
for this problem mapped onto these shifting frameworks, informing Irish medical perceptions
and responses. In the decades leading up to independence, political divisions and a strong tem-
perance tradition were markedly visible in medical discourses around inebriety. By the 1960s,
persistent claims about an alleged Irish susceptibility to alcoholism seemingly diluted support
for the disease view at a time when it was seen as damaging to Ireland’s international profle.
Instead, cultural explanations were sought and increasingly promoted. Recent campaigns for the
introduction of public health alcohol legislation have revealed unprecedented unity among med-
ical responses to problem drinking as indicated by the Alcohol Health Alliance Ireland’s diverse
membership. While the reasons for this cooperation are complex, it is clear that misgivings about
Ireland’s drinking culture have endured. In conclusion, one might argue that the Irish experi-
ence is at once both distinctive and commonplace, making for a nuanced example of the ways in
which political aspirations, social-cultural environment and medico-scientifc discourses coalesce
to infuence our understanding of intoxication.

Acknowledgements
I would like to say an especially warm ‘thank you’ to the anonymous peer reviewer for their
thought-provoking and valuable feedback which has helped to shape this chapter. I would
also like to thank Professor Geofrey Hunt and Dr Richard McElligott for their insightful
conversations. The research was kindly funded by a Wellcome Trust postdoctoral fellowship
(Ref: 205455/Z/14/Z) and I am indebted to the Trust for their support.

537
 Alice Mauger

Notes
1 For an excellent discussion on the cultural and historical signifcance of intoxication, see Phil
Withington, ‘Introduction: Cultures of Intoxication’, Past and Present Supplement 9 (2014), pp.
9–33.
2 Under the 1800 Act of Union, Ireland’s parliament was abolished and the country came under the
direct control of the British parliament in London. Elected Irish representatives sat in the British
parliament at Westminster.
3 As a Unionist and prominent Orangeman, Johnston was an opponent of Irish Home Rule.
4 Given space constraints, the six counties which formed the separate state of Northern Ireland will
not be included in the analysis in subsequent sections of this chapter.
5 This dissertation was published in 1980.
6 Later anthropological works further emphasised the persistence of a heavy drinking culture among
middle-aged and elderly bachelor small farmers, which was characterised by high rates of mental
illness and in particular schizophrenia. See, for example, Brody 1973 and Scheper-Hughes 1979.

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 32
‘DRINKING HIMSELF TO DEATH’
Te Chronic Drunkard in British
Mid-Victorian Fiction and Culture

Pam Lock

Introduction

Drink and the devil had done for the rest—

Yo-ho-ho, and a bottle of rum!

The pirate song invented by Robert Louis Stevenson for his popular adventure novel, Trea-
sure Island (1881–1882) afrms the association between drunkenness, immorality, and mor-
tality in the public imagination by the end of the nineteenth century (Stevenson, Treasure
Island, p. 233). The delivery of these lines—the shanty feel of the verses and the boisterous
singing of the pirates in many of its iterations—reminds the reader of the reasons for alcohol’s
continuing popularity: its role in social gatherings as a key part of the relief and conviviality
of the group and the individual. Stevenson carefully diferentiates between the moderate
drinkers (predominantly the heroes of the novel) and the drunkards (the pirate crew with the
notable exception of the amoral and often soberly merciless Long John Silver). Although it is
not Stevenson’s style to be didactic, he is interested in exploring cause and efect. His char-
acters understand and accept the physical and psychological consequences of their actions.
The pirates in Treasure Island know that drinking to excess turns them into ‘beasts’ and does
long-term damage to their bodies and minds. These are not the jolly drunkards of earlier
centuries. Like many later Victorian drunkards in fction, Stevenson’s pirates use alcohol to
help them manage the difcult and physically demanding work their ‘trade’ requires and
helps them deal with the resulting distress by ofering an oblivion in which they can forget.
The British fascination with the drunkard evident in Victorian fction was not new to
literature. The sustained popularity of bawdy tales in Britain in the Middle Ages featuring
habitual or regular drunkenness demonstrates that the drunkard has long been a favourite
fgure in the British imagination. The revelry and drunken acts in Sir Gawain and the Green
Knight and The Canterbury Tales often prompt key plot points or revelations. Shakespeare’s
Falstaf appears in multiple plays (a repetition that is extremely unusual in the author’s work)
making him one of the most famous drunkards in the world. Falstaf’s recurrence and his
‘strong appeal to our sympathies’ is therefore important to the wider public perception of the
British drunkard in his mixture of brutish corruption and comic charisma (Tolman, p. 82).
The late seventeenth and early eighteenth centuries saw a slow increase of doctors speaking

542 DOI: 10.4324/9780429058141-41

 ‘Drinking himself to death’

out against drunkenness. In the mid-eighteenth century, public opinion on drinking and
drunkenness was infuenced by accounts of the so-called ‘gin craze’, informed and infu-
enced by Hogarth’s famous pictures, ‘Gin Lane’ and ‘Beer Street’ and the related writings
of Henry Fielding on the links between crime and drink. These representations focused on
working-class drinkers, making them grotesque and dangerous to themselves and others.
Towards the end of the eighteenth century, the characters of Falstaf and John Bull were
simultaneously confated and opposed in satirical works. Satirical caricatures of John Bull
designed to ‘critique […] political power’ counted on Bull’s reputation for excessive drinking
to support a variety of positions as he became ‘accessible to a wide range of political groups
and interests’ (Taylor, ‘John Bull…’, pp. 108, 106). In these representations, beer is both the
healthful drink of the vigorous, sturdy John Bulls depicted in anti-French reform prints, and
the downfall of the misled John Bull in anti-Whig propaganda. As the nineteenth century
progressed, the ambiguity of concepts of drunkenness increased and fctional drunkards were
progressively darker and more dangerous, a warning to readers and a reminder of the fragil-
ity of the human body and mind. As Kathleen McCormack argues, ‘Victorian novels usually
punish [drunkards] severely with sickness, death, or poverty’, or at least chronic drunkards
(McCormack, p. 138). Yet, these representations enacted more than a ‘punishment’. New
medical developments in understandings of the efects of alcohol on the body and mind
led to greater attention to detail and nuance in the depiction of fctional drunkards. I have
therefore specifed the ‘chronic’ drunkard as the focus for this chapter, what we might now
colloquially call the ‘alcoholic’.1 This, combined with the rise of realism, made fction a key
player in the increasingly diverse public discourses on drinking and drunkenness.2
The frst half of the nineteenth century marked a signifcant surge of developments in
medical interest in alcohol and my frst section will focus on the place of fction in public
discussions on habitual drunkenness and other efects of alcohol during this period. As David
Clemis outlined in his chapter on ‘Medical Expertise and the Understandings of Intoxication
in Britain, 1660–1830’, the shift in public understandings of alcohol’s efects on the body and
mind was partly prompted by popular publications on new medical theories about drinking
and drunkenness. Although physicians such as Stephen Hales were writing about the dangers
of drink in the early eighteenth century, the popularity of the works by Erasmus Darwin,
Thomas Trotter, and the imported writings of American physician, Benjamin Rush, at the
end of the eighteenth century spread word of new developments in medical approaches to
the consumption of alcohol and the treatment of drunkards in Britain.3 These new medical
descriptions of the damaging efects of prolonged heavy drinking further problematised
notions of innocently ‘merry’ England and gave scientifc foundation to developing ideas
about drinking and drunkenness. The development of medical understandings of the efect
of alcohol had two key centres: the body and the mind. Physiological experiments demon-
strated in signifcantly improved detail the short-term efects of alcohol on the body such as
circulation, organ function, and brain function. Closer attention in asylums to the relation
between diferent forms of madness and the consumption of alcohol, and written accounts
of the observations of physicians working in asylums, improved medical and, in the longer
term, public understandings of the damaging efects of regular heavy alcohol consumption
on the brain.4 The study of alcohol-related diseases such as ‘delirium tremens’ also increased
the focus on physiological and psychological complaints that were thought to be entirely
caused by the consumption of alcohol.5 This new medical and public interest in the con-
sumption of alcohol, combined with the rise of realism in the 1840s, inspired a wide range
of authors to write an unprecedented number of detailed and complex ‘alcoholic’ characters
during this period.

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 Pam Lock

Some doctors also challenged the doctrine held by many Christian denominations that
drunkenness was a sin that could and should be ‘treated’ only by the church and its ofcers
(and was therefore not the business of doctors). In his introduction, Trotter states that

The habit of inebriation […] has seldom been the object of medical admonition and
practice. The priesthood hath poured forth its anathemas from the pulpit; and the mor-
alist, no less severe, hath declaimed against it as a vice degrading our nature. Both have
meant well; and becomingly opposed religious and moral arguments to the sinful indul-
gence of animal appetite. But the physical infuence of custom, confrmed into habit,
interwoven into the action of our sentient system, and reacting on our mental part, have
been entirely forgotten.
(Trotter, p. 13)

However, habitual drunkenness was still generally seen as a vice in Britain, or a mixture be-
tween vice and disease. Public discourses and popular publications commonly mixed moral
and medical approaches to maximise the impact of each. The tension between what are
commonly known in alcohol studies as the vice and disease models was one of the powerful
drivers of fctional interest in the habitual drunkard. The Brontë sisters’ characterisations of
Huntingdon and Hindley depict habitual drunkenness both as a moral lapse or sin and as a
disease to be treated by doctors. The title of George Eliot’s short fction featuring a female
alcoholic, ‘Janet’s Repentance’, demonstrates Eliot’s focus on the moral perspective despite
the medical accuracy of the portrayal. The choice of the religious concept of repentance
demonstrates an understanding of drunkenness as a sin.6 The rise and popularity of realism
from the 1840s gave authors the opportunity to move away from simplistic representations
of the drunkard as simply comic or tragic.
The rapid rise of temperance (anti-drink) campaigns during the frst half of the nineteenth
century also contributed to the dissemination of medical and religious understandings of
drinking and drunkenness. The work of temperance campaigners strongly infuenced changes
to the portrayal of the drunkard in the nineteenth century as authors of popular and temper-
ance fction entered into discourses using their fction to support, complicate, and challenge
anti-drinking messages. Although disparate in their aims and organisation, temperance groups
were usually collectively known as ‘the temperance movement’. One key distinction that ap-
peared in the mid-century was the distinction between those groups advocating moderation in
various ways (which were predominantly middle-class) and those promoting total abstinence
from alcohol, often known as teetotalist groups (which were predominantly working-class in
leadership and had strong links to the labour movement). The temperance movement’s role in
the improved public understanding of the potential harm of regular drunkenness was not only
through lobbying of parliamentary and medical representatives but, more widely, through
their publications and public events (lectures, plays, parades, festivals, etc.). Temperance cam-
paigners made extensive use of the potential of the decreasing costs associated with press and
publications facilitated by cheaper printing processes and the increasing proportion of literacy
across the population which also promised greater incomes and audiences.7 The boom of the
temperance press led to the creation of ‘temperance fction’; poems, short stories, and novels
designed to demonstrate the dangers of drink and the advantages of sobriety. These fctions
frequently accompanied the articles, reports, and drunkard’s confessions that made up the bulk
of the content of temperance newspapers and magazines. In the early days, this new genre was
quite crude and often overlapped with other moral guidance and conduct fction. Reliant on
simple moral stories, early temperance fction was designed to horrify its middle-class audience

544
 ‘Drinking himself to death’

to reassure them of their choice of sobriety, or set an example to its working-class targets to
encourage reform and sobriety.8 According to Brian Harrison, much of the temperance move-
ments’ efort was ‘wasted’:

Mayhew saw a man who had vigorously praised Cruikshank’s Bottle drunk three hours
afterwards, and Kohl observed that a quarter of the audience watching a temperance
drama were drunk; while such spectacles might have been popular, they probably had
little efect on daily conduct.
(Harrison, p. 356)

Annemarie McAllister challenges Harrison’s over-generalisation of this example. Her recent

research demonstrates that the social and celebratory elements of temperance gatherings were
extremely popular, ofering attendees (mostly ‘converted’ temperance supporters) an enjoy-
able alternative to the social life of the pub and the bottle, and not simply a stopping point
between pubs.9 However, popular writers such as Charles Dickens, George Eliot, Anthony
Trollope, and Wilkie Collins challenged teetotal campaigners. Although they acknowledged
and wrote about the dangers of regular or chronic drunkenness, they defended the right of
the majority to drink moderately. By the 1850s and 1860s, the temperance movement had
responded to this challenge in two key ways. The development of a more sophisticated ap-
proach to fction, bolstered by relatively lucrative temperance fction prizes to attract higher
quality works, and the advocation of temperance principles by well-respected physicians,
encouraged by essay prizes and support for popular and well-circulated monographs. Tem-
perance fction became a route for new authors, particularly female authors like Clara Lucas
Balfour and Hesba Stretton, to get published and to earn a living from their writing. Ellen
Wood (author of one of the triumvirate of popular sensation novels, East Lynne (1860)) pub-
lished her frst novel, Danesbury House (1860), via a temperance prize awarded by the Scottish
Temperance League which went on to become one of the most popular temperance novels
of the century, and persuaded her reluctant publisher to fnally take her frst popular novel.
Hesba Stretton’s children’s story, Jessica’s First Prayer (1866), outsold Alice in Wonderland.
The didactic purposes of characterisations of the drunkard in these various types of fction
were also infuenced by the increased availability of printed publications and the increase in
literacy which led to larger readerships from a wider social spread. The increase in the num-
ber of periodicals led to opportunities for specialisation so that these didactic messages could
truly be targeted at specifc audiences. In temperance fction, for example, some stories were
specifcally aimed at potential members, to aid their conversion, such as ‘A Word in Season, or,
the Sailor’s Widow’, which appeared in one of temperance campaigner, Joseph Livesey’s early
temperance magazines as an inspirational story for both father’s considering abstinence for the
sake of their children, and children encouraged to promote temperance in their parents, while
other fctions were written with the aim of maintaining the temperance convictions of existing
members such as Wood’s Danesbury House which included aspirational encouragements for the
Scottish Temperance League’s predominantly middle-class readership.
This chapter is divided into two sections to fesh out the history of the fgure of the ha-
bitual drunkard from two essential approaches. The frst section focuses on fction’s place in
the public discourses on new medical understandings of the drunkard in the frst half of the
nineteenth century. The second section focuses on gender and class, particularly the increase
in social mobility to address the function of the fgure of the habitual drunkard in exploring
new theories around identity. Having examined descriptions of predominantly male drunk-
ards in the frst two sections, I will pay particular attention to the fctionalisation of female

545
 Pam Lock

drunkenness in this section. Although I will address class frst and gender second, the inter-
sectional nature of these categories means that there will be considerable overlap between
the two discussions. The combination of these two sections aims to give an overview of the
fctional drunkard as a nexus for anxieties about class, gender, and change while at the same
time standing as a cautionary fgure with a didactic purpose.

Vice or Disease? Fictional Interactions With and Challenges to New Medical

Developments on Habitual Drunkenness
In the frst half of the nineteenth century, new terms were coined or appropriated by physicians
such as ‘habitual drunkenness’, ‘chronic drunkenness’, and ‘delirium tremens’. These came into
prevalent use to identify regular heavy drinkers in medical terms. The common modern term
‘alcoholism’ was not coined until 1849 by the Swedish physician Magnus Huss and it took several
decades to become popular, only gaining its current dominance in the twentieth century. As
such, I will avoid using this modern term unless justifed by the context.
Following the frst popular medical treatises on drinking and drunkenness by Erasmus Dar-
win, Thomas Trotter, and Benjamin Rush, popular monographs and articles by physicians and
physiologists on the efects of alcohol and the treatment of habitual drunkenness became in-
creasingly common. Key players in the frst half of the century included surgeon and phrenol-
ogist Robert MacNish (1802–1837), the physiologist and temperance activist, W. B. Carpenter
(1813–1885), and physician James Miller (1812–1864). Their writing continued to be infuential
throughout the century, particularly because of their promulgation by temperance campaigners.
This section will focus on this frst surge of change, between the beginning of the nineteenth
century and about 1860. Articles were published on the benefts and dangers of alcohol as a
medicine, a food, and a poison by national medical journals such as The Lancet and the BMJ.
Temperance-specifc journals were established such as the early and short-lived Temperance Lancet
(1841–1842), the National Temperance League’s The Medical Temperance Journal (1869–1892), and
the British Medical Temperance Association’s The Medical Pioneer (1892–1897).10 The common
use of alcohol as a medicine, and as a mixing agent in the popular opiate laudanum, complicated
these discourses.11 As a result, as Lilian Shiman notes, ‘[t]he medical profession was a target for
much temperance propaganda [in the hope that they] would be persuaded to desist from recom-
mending spirits as medicine except where absolutely necessary’ (Shiman, p. 12). Debates on the
dangers of habitual drunkenness entered the popular sphere through newspapers and periodicals
of all persuasions. From the mid-1840s, articles detailing the autopsies carried out on ‘drunk-
ards’ were common in local and national newspapers as well as temperance-specifc publications.
These gruesomely described the drunkard’s ‘fatty’ and ‘enormous’ livers, their ‘unhealthy’ intes-
tines, and ‘infammation’ of the brain resulting from their habitual use of alcohol.12 I argue that
fction was the other key publication that captured, translated, and engaged with debates about
the advantages and dangers of drinking and drunkenness. The following gives an overview of
the key authors involved in these debates and the extant literary and historical research that links
these to the wider cultural discourse.

Early Medical Approaches to the Chronic Drunkard: Te Brontës, Eliot,

Dickens, and Collins
The Brontë sisters were at the vanguard of the development of the fgure of the drunkard
in mainstream fction. Their particular educational and personal backgrounds led them to
create some of the earliest psychologically complex characterisations of chronic drunkards

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in the nineteenth century. There was, of course, a parallel continuity of the traditional
tragi-comic male drunkard. William Thackeray’s Vanity Fair (1848) published in the same
year as Anne Bronte’s The Tenant of Wildfell Hall (1848) includes the famous comedic ac-
count of Josh Sedgley’s disastrous hangover, which prevents him from proposing to Becky
Sharp. Likewise, Charles Dickens provided his readers with a rich array of happy drunkards
throughout his writing career. The drinkers in sacrosanct pubs like the ‘Maypole Inn’ in
Barnaby Rudge (1841) and the ‘Three Jolly Fellowship Porters’ in Our Mutual Friend (1864–
1865) are not dangerous drunkards but convivial companions enjoying a regular but usually
moderate serving of beer and shared punch. Dickens’s dangerous drunkards are always vic-
tims of their circumstances, usually working class, sometimes violent but always out of their
own control and a part of a minority to be pitied. These difered from the careful physiolog-
ical and psychological depictions that entered usefully into medical debates on drunkenness
of authors such as the Brontë sisters. In Dickens’s case, they were about the socio-economics
of debates about drinking and drunkenness and a deliberate part of his regular attacks on the
temperance movement.
The Brontë sisters’ novels marked a signifcant milestone in the depiction of the drunk-
ard. They had an unusually good understanding of the scientifc, medical, and religious
implications of drunkenness because of the emphasis on Natural Theology in their home
schooling by their father, Patrick Brontë (1777–1861). Paul Jennings notes that Patrick was
an early promoter of temperance. As early as 1827, Patrick chaired a public meeting in the
vestry calling for the ‘Suppression of Whisht Shops’ and by the 1830s he was president of
the Haworth Temperance Society ( Jennings, p. 139). As a result, the sisters would have been
very familiar with the development of anti-drink teachings and fction through the pam-
phlets commonly used by temperance campaigners. We know from the family diaries and
letters that parishioners sufering from the efects of personal or family drinking sometimes
visited the house for aid from the curate and that these conversations were often witnessed
by the sisters. The children’s juvenilia show an interest in the links between drink and
trauma.13 As the sisters began writing their frst novels for publication in the mid-1840s, their
brother Branwell’s damaging relationship with intoxicants (especially alcohol and opium)
was peaking so their experience of chronic drunkenness was not only personal but raw.
Anne euphemistically mentions in her diary paper of 31 July 1845 that Branwell had had
‘much tribulation and ill health’ and that ‘we hope he will be better and do better in future’
(Barker, p. 132). She mixes the medical with the moral by the loaded comparative adjective,
‘better’. Anne’s combination of this conventionally moral phrasing with her reference to his
tribulation and ill health complicates the implied meaning of ‘do better’ and ‘be better’ re-
vealing her mixed feelings about his illness. In other words, she associates his problems with
both ill health and lack of moral efort.
The sisters took difering approaches to habitual drunkenness in their work. Excepting
the brief characterisation of John Reed in Jane Eyre (1847) and the ‘mob led by drunken
working-class Methodists’ in Shirley, Charlotte tended to give most attention to female
drunkenness in minor characters (usually nurses but including the famous ‘madwoman in
the attic’ Bertha Mason); Anne and Emily wrote two of the most famous drunkards in
Victorian literature. Anne’s Arthur Huntingdon in The Tenant of Wildfell Hall (1848) and
Emily’s Hindley Earnshaw in Wuthering Heights demonstrate the overlap between contem-
porary religious and medical theories about the ‘cause’ of chronic drunkenness complicating
the vice:disease binary (McCormack, pp. 137–148, p. 144). They represent a challenge to
notions of the innocence of youthful excess in men and the possibility of a ‘cure’ for the
chronic drinker. Anne demonstrates her understanding of recent nature-nurture debates in

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the press in Helen’s fears that Huntingdon’s drinking is inherited. Helen removes their son
(illegally) from the family home and works to develop an aversion to alcohol in him while
they are away in an attempt to protect little Arthur from the infuence of his father. Anne
also challenges physicians like Robert Macnish and J. C. Lettsom who advised that drunk-
ards should slowly reduce their drinking, rather than stop suddenly. Macnish compares the
urge to drink as ‘more insatiable than the longings of a pregnant woman’ and describes sud-
den cessation as ‘dangerous’ and less ‘likely to be lasting’ (Macnish, pp. 157, 162). In Tenant,
Lord Lowborough tries to quit drinking by slow steps and moderation, but is always tempted
back into excess. Only when he swears immediate and total abstinence does he successfully
stop. When Arthur is unable and unwilling to reduce or stop his drinking, Helen comes
to the dramatic realisation that she cannot fulfl the ‘saviour’ role expected of her as wife.
She becomes a very early and insightful example of a representation of what we would now
commonly describe as ‘co-dependence’.14
Further, Emily and Anne’s characterisations of Huntingdon and Hindley challenged no-
tions of ‘cure’ in both medical treatises and temperance guides. Grotesquely physical in their
nature, the deaths of the two characters demonstrate the sisters’ understanding of the links be-
tween heavy drinking, delirium tremens, and apoplexy. Huntingdon and Hindley’s deaths are
attributed to an irrepressible urge to drink. Anne declares in the Preface to the Second Edition
that her novel is deliberately didactic to ‘reveal the snares and pitfalls of life to the young and
thoughtless traveller’ (Brontë, ‘Preface’, Tenant, p. 39). Huntingdon describes a physical urge to
quench ‘an infernal fre in [his] veins’ (Brontë, Tenant, p. 227). Sadly, the action is ironic for,
instead of quenching the fre, he is feeding it. Roy Porter notes that Carl von Brühl-Cramer
described excessive drinking as analogous to ‘the power of fevers to create unslakable thirsts’ in
his infuential 1819 disease model of habitual drunkenness.15 The association of chronic drunk-
enness with an infernal fre persists through the nineteenth century. Charles Lamb describes
the ‘frst steps’ to sobriety as ‘not like climbing a mountain but going through a fre’ (Lamb, p.
3). John B. Gough’s confessional account of his struggle with an ‘appetite’ for alcohol describes
a ‘dreadful burning sensation’ in his stomach ‘as if the fres of the pit had been kindled there’
(Gough, pp. 249–250). The metaphor and this selection of contemporary religious, moral, and
medical examples demonstrate the common mixing of the medical and moral in descriptions
of habitual drunkenness. In contrast, Hindley’s drinking is one of a range of suicide attempts
following the death of his beloved wife. His suicidal urge to ‘drink[…] himself to death delib-
erately’ is reminiscent of suicidologist Karl Menninger’s (1893–1990) work on alcohol and sui-
cide (Brontë, Wuthering Heights, p. 190). Menninger refers to this as a wish for ‘suicidal comfort’
in reaction to ‘great anxiety’ (Menninger, p. 146).16 Emily’s realistic and detailed descriptions of
Hindley’s death of apoplexy following a series of extended periods of heavy drinking demon-
strate the popular understanding of this possibility. I argue that these deaths demonstrate the
sisters’ pessimism for the fate of their brother.
As described in more detail in the next section, there was a surge in representations of
fctional female drunkards in the 1850s. These constituted two types: the drunken wife as
a drain on her husband and community such as Dickens’s unnamed drunken wife in Hard
Times (1854), Collins’s Rebecca Murdoch in ‘The Ostler’ (1855), and the pitiful, damaged
woman drinking to escape such as Aunt Esther in Elizabeth Gaskell’s Mary Barton (1848)
and George Eliot’s Janet Dempster in ‘Janet’s Repentance’ (1857). Although the former type
sometimes demonstrates the developing understanding of links between physical and mental
deterioration and heavy drinking of this period, the latter type is more interesting in medical
terms. Although Eliot’s Janet’s Repentance occasionally falls into temperance tropes such
as the confessional sequences with the preacher, Mr. Tryan, as Steven Earnshaw argues,

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it is ‘the frst serious treatment of a habitual female drunkard’ (Earnshaw, p. 148). Janet is
the victim of domestic abuse at the hands of her drunken and violent husband, the lawyer
Robert Dempster. Janet’s compulsive drinking and the typical external triggers such as her
‘cruel’ husband are complicated by her own shame and self-hatred. As Steven Earnshaw
points out, the temperance narrative’s ‘encounter with hell’ is ‘usually done to show that
drinking is bad and will more or less literally lead straight to hell, [however] it is not the same
as the religious-philosophical self-despair Eliot identifes with Janet’ (Earnshaw, p. 150). By
making it clear that Robert Dempster’s behaviour is the direct cause of Janet’s drinking,
Eliot complicates the addiction narratives of doctors and temperance advocates. Janet’s urge
to drink is prompted by the desperation of her circumstances. Although she struggles to start
with, Janet stops drinking as soon as her husband’s power over her is diminished by his illness
and then removed by his death. There is not a distinct physical need as described by Macnish
and Carpenter. This is unsurprising, given that her partner, the writer G. H. Lewes, was in a
public battle with famous physiologist, W. B. Carpenter, in the mid-1850s after Lewes wrote
a blistering attack on Carpenter’s medical temperance treatise, The Physiology of Temperance
and Total Abstinence (1853). In the following decade, temperance fction was to become in-
creasingly sophisticated and infuential on other, more popular genres.

Temperance Fiction and Sensation Fiction

In 1859–1860, the spectacular sales of Collins’s The Woman in White (1860) and accompany-
ing press commotion launched in the public imagination the new genre which would come
to be known as ‘Sensation Fiction’.17 As Pamela Gilbert observes, ‘The new genre [Sensa-
tion Fiction] was distinctively transgressive in that it was thought to appeal directly to the
‘nerves’, eliciting a physical sensation with its surprises, plot twists, and startling revelations’
and was to become ‘one of the most distrusted—and most popular—forms of the period’
(Gilbert, p. 2). In the same year, a slightly more modest but nonetheless popular temperance
novel was published by the Scottish Temperance League, Ellen Wood’s Danesbury House
(1860). Wood, ever sensitive to the tastes of contemporary readers, brought the thrills of
the emergent sensation novel to the melodrama inherent in temperance fction to create the
bestselling temperance work of the nineteenth century. This novel falls into a sub-genre of
its own that I term ‘temperance sensation’. Wood’s characters die dramatically in their droves
as a result of their own or others’ drinking. The novel represents a study of inheritance and
upbringing in its account of the (mis)adventures of the Danesbury family and their friends,
relations, and workers. Mr. Danesbury’s children are ‘divided’ between two vastly contrast-
ing mothers. The frst Mrs. Danesbury, a water drinker and temperance advocate is tragically
killed in a carriage accident (symbolically caused by a drunken gatekeeper) on her way to
save her baby, accidentally given laudanum by his tippling nurse, but not before instilling
her strong morals in her elder children. The second Mrs. Danesbury is an impatient, careless
mother who drinks regularly for relief and pseudo-medical reasons, whose bad infuence
leads her children to drink from an early age. The older children fourish and grow up to
become a good infuence on their families and communities; the younger children fall into
dissolute ways, ruin their father fnancially and emotionally, and die gruesomely as a result
of their habitual drunkenness. The frst Mrs. Danesbury’s baby, William, strengthens and
complicates this educational divide. Born to the frst Mrs. Danesbury but predominantly
raised by the second, he almost shares the sad end of his younger brothers but is saved (at
the eleventh hour of course) by the aid of his older siblings. Thus, Wood demonstrates the
intricate relationship between nature and nurture that many physicians of this period were

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exploring in their own writing. James Miller, whose Alcohol: Its Place and Power was pub-
lished a couple of years before Danesbury House by the same temperance association, bemoans
the dangers of this association of drunkenness in parents and the habits of their children in
terms of generation:

And the worst of it is, that the disease so induced does not terminate with him or her
who produced it. If, unhappily, children be born, they will inherit the evil of their pro-
genitors: studented in body, and often in mind.
(Miller, p. 122)

Although ‘popular’ sensation fction authors such as Wilkie Collins and Mary Elizabeth
Braddon tended to support moderation rather than temperance or total abstinence, they also
recognised the dangers of habitual drunkenness. In The Woman in White (1860), Sir Percival’s
downfall is escalated by his increasingly erratic drinking. Likewise in Braddon’s Lady Aud-
ley’s Secret (1862), another villain, Luke Marks, sufers his slow death from the injuries he sus-
tains in the pub fre set by Lady Audley partly as a result of his tendency to drunkenness. He
is comatose and only rescued from the fames by the moderate and therefore alert Robert. In
both cases, this again echoes Miller’s medical writings on the ‘efects of alcohol’ (Miller, p.
163). He describes ‘subdivisions’ of behaviour according to increased doses of alcohol, larger
doses resulting in ‘anger and contention; rioting and revenge; assaults and housebreakings’
and still larger doses making the drinker ‘ripe for sudden bloodshed, murder, rape’ (Miller,
p. 163). Alcohol: Its Place and Power was owned by Collins and although I am not suggesting
that he or Braddon shared Miller’s advocation of abstinence (their work encourages the use
of alcohol and other stimulants for refection and cogitation), they were similarly concerned
about the efects of regular heavy drinking and used new medical understandings about its
efects on mood and mental control to accentuate their villains’ malevolent characteristics.
These authors exemplify the important place of fction in topical discourses on drinking
and drunkenness in their interaction with contemporary medical and popular writers. The
focus on individual characterisation in a work of fction powerfully demonstrates the issues
with generalisation in the conclusions of some medical and temperance writers. Their char-
acters enact the interplay of the moral and medical and demonstrate the individuality of a
condition like habitual drunkenness which complexly arises from and afects the body and
mind. Most importantly, at a time when there was pressure to ‘fx’ the drunkard, they ques-
tion the possibility of a ‘cure’ when faced with the multiplicity of ‘cause’.

Gender and Class

Until Anne Brontë’s Tenant, little was written on drunkenness among the landed and middle
classes. The assumption was that drunkenness was only a problem for the working and under
classes. That is, although there was no question that the more ‘respectable’ classes did drink and
sometimes heavily, many writers argued that this was acceptable because they were able to con-
trol themselves, unlike the lower classes.18 Developing from the madness of the ‘gin craze’ in the
eighteenth century, the rhetoric about the dangers of working and underclass drinking to society
and order was a key driver of representations of the drunkard in the nineteenth century.19 As Jean
Charles Sournia comments, the concern in the eighteenth century was

rather surprisingly […] based on social rather than medical grounds: drunkenness was
upsetting social order in that the lower classes, thought to be the sole indulgers in

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alcoholic excess, were becoming unruly. Drink was seen as a primary cause of poverty,
crime, immorality, and violence; lower class drinkers were frequently described as irre-
sponsible and ignorant.
(Sournia, p. 20)

As James Nicholls observes, “Defoe complained that ‘now so far are the common people
infatuated with Geneva [gin], that half the work is not done as formerly’” (Nicholls, p. 37).
The class-centric ‘moral panic’ whipped up by such commentators in the eighteenth century
gave a strong foundation to the controlling patriarchal messages of such writings in the nine-
teenth century. This was partly prompted by increases in social mobility which threatened
traditional hierarchies and associated power dynamics. Some sections of the temperance
movement used this rhetoric as a warning for middle-class members to encourage them to
be abstinent for fear of losing their social position to drink.20 Other temperance groups, par-
ticularly those with working-class roots and a focus on total abstinence (teetotalism), took
advantage of this widespread rhetoric to promote their campaigning against drink as a way
for working-class members to secure respectability and thereby climb the social ladder.21

Class Matters
The working and under classes were the most likely to be portrayed as drunkards in Vic-
torian fction.22 It is clear from her preface to The Tenant of Wildfell Hall that Anne Brontë’s
decision to depict upper class drunkards was deliberate because she saw a gap that needed to
be flled for the sake of truth and to warn young men and women about the dangers of drink.
She describes Huntingdon as an ‘extreme’ example but afrms that ‘I know that such char-
acters do exist’ (Brontë, ‘Preface’, Tenant, p. 40). George Eliot’s Janet Dempster retains her
respectability because of her class and her husband’s wealth. They do not need to scrimp and
save for drink and she is not left in debt after his death. Where the drunkard’s impact on the
family and the community was clearest in fction (and in contemporary newspaper reports
such as sanitary and crime statistics) was when the cost of ‘the bottle’ in time and money
could be considered deadly, and when poverty speeded up the physiological efects of heavy
drinking. In his lecture ‘Drunkenness as an Indirect Cause of Crime’, John Taylor makes the
direct link between poverty and the ‘sum spent by the working classes upon intoxicating li-
quors’, quoting Porter’s description of this as ‘voluntary taxation’ and without which he sug-
gests that ‘abundant means would be at their disposal’ (Taylor, ‘Drunkenness…’ pp. 9–10).
Popular illustrator and caricaturist, George Cruikshank’s gradual conversion to temper-
ance in the 1840s was partly inspired by his father’s death from delirium tremens and partly
by his worries about his own increasingly extreme drinking bouts. This led him to produce
one of the most infuential anti-drink stories of the century, The Bottle (1847). A few years
later, he signed the pledge. Told in a series of illustrated prints with dramatic accompanying
descriptions, The Bottle charts the short and disastrous history of a family after the husband
introduces his wife to ‘the bottle’ for the frst time and encourages her ‘just to take a drop’
(Plate 1). Initially merry, the story quickly takes a darker turn. The husband loses his job,
their clothes and furniture are sold to ‘supply the bottle’ (Plate II), and the family are forced
to resort to begging. Their youngest child dies of starvation and the husband kills his wife
with the bottle that is the source of their misery (naturally) after which he is left ‘a hopeless
maniac’ (Plate VIII). The Bottle was swiftly followed by a sensational sequel: The Drunk-
ard’s Children (1848). This second series chronicles the downfall of the remaining children
into vice, crime, and premature death. Cruickshank’s publications were so popular that, by

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October of the same year, The Bottle had been turned into a play by T. P. Taylor and a va-
riety of theatrical versions were performed as temperance entertainments for the rest of the
century. Although his fame as Charles Dickens’s illustrator no doubt added to the success of
the series, Cruikshank’s conversion disgusted his friend and caused them to permanently part
ways. In particular, Cruikshank’s temperance versions of classic fairy tales in George Cruik-
shank’s Fairy Library (1853), prompted Dickens to publish a public objection titled ‘Fraud
on the Fairies’ (1853) in his own popular periodical, Household Words (1850–1859). Dickens
opposed teetotalism because of his basic objection to universal abstinence (i.e. the idea that
everyone should stop drinking alcohol). He saw drinking as an important source of relief
and conviviality for the majority of the population, particularly the working and middle
classes. In one of several vitriolic anti-temperance articles, he argues: ‘Because Bill Brute,
the robber in Newgate, and Mr. Brallaghan of Killalloo, resident down the next court, make
wild beasts of themselves under the infuence of strong liquor, therefore Jones, the decent and
industrious mechanic, going to Hampton Court for a summer day with his wife and family
is not to have his pint of beer and his glass of gin and water’ (Dickens, ‘Demoralisation…’,
p. 1). The feeting characterisation of these working-class men—‘Bill Brute’ representing
the criminal classes and ‘Jones’ the ‘industrious’ skilled worker—is a direct response to the
equally extreme caricatures of Cruikshank and other temperance writers’ in their focus on
the drinking of the working classes.
However, Dickens was equally concerned about the dangers of chronic drunkenness. The
gruesome description of the life of a drunkard and his ruined family in ‘The Drunkard’s
Death’ in Sketches by Boz (1836) bears a striking similarity to Cruikshank’s approach in The
Bottle and The Drunkard’s Children. A man falls to the temptation of drink and becomes a
burden on his wife and children. Unable to earn a good living between them, his wife dies
of starvation and disease, his sons turn to crime and end in death or custody. At frst, his
daughter attempts to support him but, after he drunkenly betrays his son to the authorities,
she disappears and he is left to support himself. At the end, he throws himself in the river
and then symbolically changes his mind after he enters the water and tries to return to land
but is swept away by the rushing waters of the Thames. The diference between these two
fctions is subtle but key to the diference between representations of pro-moderation and
pro-abstinence rhetoric. While Cruikshank’s tale focuses on the titular ‘bottle’, implying
that its introduction to any household leads inevitably to the downfall of the family, Dick-
ens’s tale suggests that some drunkards are impelled by ‘misfortune and misery’ and ‘by far
the greater part have wilfully, and with open eyes, plunged into the gulf from which the
man who once enters it never rises more, but into which he sinks deeper and deeper down,
until recovery is hopeless’, placing the onus on the circumstances of the individual rather
than the intoxicant per se (Dickens, ‘Drunkard’s Death’, p. 555). This focus on the individ-
ual continued to manifest itself in his fction for the rest of his life. Sarah Gamp in Martin
Chuzzlewit (1842–1844) follows the traditional stereotype of the drunken and careless nurse.
Most famously, the grotesque Krook in Bleak House (1852–1853) whose drinking ends with
his spectacular death from spontaneous combustion was carefully researched by Dickens as
outlined by Gordon S. Haight and Brooke D. Taylor.23 Finally, Jenny Wren’s drunken par-
ent, Mr. Dolls, named by her as ‘the bad child’ is kept by her earnings as a dolls’ dressmaker
in his last complete novel, Our Mutual Friend (1864–1865). Dolls, unable to see the long-term
repercussions because of his immediate need for drink, betrays his daughter’s confdence for
‘sixty three pennyworths of rum’ (Dickens, Our Mutual Friend, pp. 696–697). Dickens’s con-
clusions that habitual drunkenness was a symptom of, rather than a cause of, poverty corre-
sponded with other socio-political observers of the time such as Friedrich Engels. However,

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his single-minded attack lacked the gradation of fellow social commentator Henry Mayhew’s
accounts which both agreed that habitual drunkenness was a symptom of poor living condi-
tions and, at the same time, acknowledged that drink contributed to the misery of the lower
classes by re-directing time and money away from necessities and personal improvement.
Dickens’s prominent and infuential voice in the 1840s and 1850s maintained the focus on
the drunkenness of the lower classes while at the same time safeguarding his aim to make the
members of the temperance movement ridiculous.
The impact of the realities of increasing social mobility on the individual also trou-
bled both conservative and liberal writers. To generalise, the conservatives worried that
it demonstrated the perils of rejecting the place ordained for a person by God; the liberals
regarded the vulnerability of those attempting to better themselves as a failing of society
and government. Anthony Trollope refects on this in his An Autobiography, outlining his
inner confict between his belief in the God-given rights of the upper classes to their so-
cial position and his feeling of ‘injustice’ at the ‘misery’ of the working classes (Trollope,
Autobiography, p. 292). His characterisation of industrialist, Roger Scatcherd in Dr. Thorne
(1858) exemplifes another trope of the second half of the nineteenth century, the socially
mobile drunkard. Stimulated by drink and ambition, stonemason Scatcherd makes his name
and his fortune in the new railway boom, as a leading engineer.24 Initially, he efectively uses
alcohol as a stimulant to allow him to work the long hours required for his success (and is
admired by his peers for his capacity for both) but the efects of regular heavy drinking on
his body and mind combined with his feelings of alienation brought on by his new social
status, lead to a tragic decline. On his deathbed, as Dr. Thorne begs him to stop drinking to
save his life, Scatcherd proclaims his feelings of isolation and despair: ‘What gratifcation can
I have except the brandy bottle?’ (Trollope, Dr. Thorne, p. 124). Scatcherd leaves a legacy of
both the railways he has built and an inheritance which allows his niece, Mary Thorne, to
marry into the Squire’s almost bankrupt family (although she marries for love). Trollope thus
allays his conservative conscience by enabling Mary’s marriage and returning the money
and lands that the Squire has sold to Scatcherd to his son. At the same time, his sympathetic
portrayal of Scatcherd reminds the reader of the vulnerability of men moving across class
boundaries. Trollope continued to muse on the relationship between alcohol and social
mobility in his later fction. The suicides of Julius Mackenzie in ‘The Spotted Dog’ (1870)
and Augustus Melmotte in The Way We Live Now (1875) are both attributed to alcohol and
a change in social class. Mackenzie is a scholar, brought low by his own drinking and that
of his drunken wife; Melmotte takes his own life fearing arrest after a disastrous 36-hour
drinking binge. Unlike Scatcherd, Melmotte (a fraudster) and MacKenzie (who destroys the
book he is supposed to be editing) leave destruction and distress behind them. It is not clear,
however, whether Trollope was simply working through a series of possible conclusions or
developing his ideas on this subject with time. His return to this sort of character, and his
diferent approaches in these writings, demonstrates how much of an interesting enigma the
‘social mobile drunkard’ was to him.
I fnish this section on class with Hardy’s portrayal of the ultimate fctional Victorian
drunkard, Michael Henchard in The Mayor of Casterbridge (1886). Hardy’s depiction fol-
lows a surprisingly similar line to Trollope’s drunkards, though in a more Hardian manner.
Henchard, a haytrusser and regular heavy drinker, becomes intoxicated at a country fair
on smuggled rum concealed in furmity (a traditional wholesome spiced wheat and milk
drink) and auctions his wife and child to a sailor for fve pounds.25 When Henchard awakes
the morning after the drunken auction, he is unable to fnd his family and swears a 21-year
pledge to abstain from alcohol. The drunken and morally questionable transaction which

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catalyses Henchard’s transition from husband and father to businessman forms a foundation
for the making and re-making of non-biological family ties, a process that Henchard repeats
in the novel.26 Unlike his fellow socially mobile characters in the texts mentioned above,
it is this period of sobriety that spurs him on to success. Henchard moves to Casterbridge
to become a successful grain merchant and Mayor of the town. However, on the very day
that marks the expiration of his pledge, he returns to drinking and, precipitated by a series
of drinking bouts, quickly declines in status and health until he is once again a haytrusser,
working the very land that was once his own. I consider this to be a deliberate return to his
original character, in part refecting his discomfort in his new position and in part Hardy’s
fatalistic philosophical approach. Henchard dies, flled with regret and seeking anonymity as
set out in his famous will, reversing his long search for reputation and wealth.

Te Female Drunkard
In fction, male drunkards are the majority. Like the common rhetoric on class, male drunk-
enness was also frequently represented as a cause of poverty, crime, and violence (rather than
a result of poverty as Engels and Dickens argued, for example); the time and money spent
in the pub deprived their wives and children of money and care. In Danesbury House, when
the ‘Danesbury Operatives’ are introduced, the narrator describes the contrast between the
cottages of the men who pass their wages to their wives to allow them to create ‘pleasant
dwellings’ and those who ‘drank their wages away’ and so ‘huddled with their wives and
families into the downstairs rooms’ (in order to let the ‘two upper rooms’) (Wood, p. 65).
This sort of rhetoric demonstrates the intersections between anxieties about the lower classes
detailed above and gender dynamics. The female drunkard is diferent from the male drunk-
ard; her gender matters and a drunken woman continues to be regarded as somehow ‘worse’
than a man in the same condition. Her drunkenness is the most despicable and irresponsible
of all and the least curable. However, class is also key. Depictions of the female drunkard
are predominantly confned to the lower and under classes. Middle- and upper-class female
drunkards are rare and generally more respectable or forgivable.
The female drunkard is a feeting and shadowy character, even at her most outrageous.
She is usually depicted as a comparison with another character (such as Dickens’s juxtaposi-
tioning of the drunken unnamed wife and the saintly Rachael in Hard Times) or described
by others in the story (such as the mothers in Sarah Stickney Ellis’s Family Secrets (1842) and
Hesba Stretton’s Jessica’s First Prayer (1866)). However, she is key to understanding the gen-
dered social norms of Victorian Britain and the women who challenged them. Women bore
the ultimate responsibility for drinking and drunkenness in the family. Engels argued that
‘[i]t is morally and physically inevitable that, under such circumstances, a very large number
of working-men should fall into intemperance’ given the ‘comfortless’ home and working
conditions in the newly industrialised towns (Engels, pp. 102–103). The comfort of the home
was considered a female responsibility, so Engels’s comment implicates women as well as em-
ployers in male drunkenness. Lady Bell describes the consequences of a drunken and careless
wife in her refections on her philanthropic work with factory hands in At the Works (1907).
She gives an example of a newly married couple:

The wife, a fretful, delicate, rather silly woman, had begun drinking very soon after
their marriage. The husband, a respectable, upright, domestic sort of man, a good cit-
izen and a good workman, gradually found that the money was being frittered away
and his home neglected. Finally, depressed and wretched, he took to going out of his

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uncomfortable home and remaining at the public-house, and began drinking himself.
He said he did not care for it, but he liked ‘forgetting about things,’ and he took abso-
lutely the only course open to him which gave him at once change of scene and material
warmth and comfort.
(Bell, p. 248)

Bell places the blame for the husband’s drinking squarely with the ‘silly’ wife in the exhausted
and pitiful ‘fnally’. His lack of pleasure in alcohol and the contrast between his ‘uncomfort-
able’ home and the ‘warmth and comfort’ of the pub emphasises the wife’s responsibility for
him taking up drinking to ‘forget[…] about things’. Drunken mothers also feature heavily in
melodramatic accounts of working-class living conditions. Harriet Beecher Stowe, writing
about her experiences in Manchester in Sunny Memories, describes driving past gin shops and
seeing ‘Mothers go there with babies in their arms, and take what turns the mother’s milk to
poison’ (Beecher Stowe, p. 134). Temperance campaigner and speaker, Mary Bayly, dramat-
ically wrote ‘the efects of this vice [drunkenness] upon herself, her husband, and her family,
are terrible in the extreme. No tongue can express what the child of a drunken mother
sufers’ (Bayly, p. 136). Temperance articles and tracts encouraged young women to join
the cause arguing that, in the words of the ‘Young Woman’s Tract’: ‘The abstinence cause
is calculated, when espoused by young women, to dignify the female character’ (‘Young
Woman’s Tract’, p. 7). However, as I shall describe later in this section, this notional female
responsibility for personal and familial sobriety was challenged by some infuential authors.
Anne Brontë’s Helen Huntingdon writes in capitals in her diary: ‘he may drink himself
dead, but it is NOT my fault’ (Brontë, Tenant, p. 279).
Fictional depictions of the dangers of female drinking to the sanctity of the home were
exemplifed by Sarah Stickney Ellis’s writings on a woman’s role in the family and society.
The popularity of her early works, The Women of England series (1839–1843), boosted sales of
her later collection of more specifcally temperance-related tales, Family Secrets (1842). Like
much temperance fction of this period, the families featured are predominantly working
class. These stories dramatically featured grotesque drunken mothers stealing money and
clothes from their children to feed their mortifying habit and greedy drunken husbands,
depriving their families of their money and time (usually represented as food, clothes, care,
and instruction) and shaming them morally. In ‘The Favourite Child’, the main character,
Maria, describes her mother’s descent into drinking:

[H]er husband was a hard man, and stinted her of many things she had been used to.
I believe he meant well, but they got to harsh words one against another, and so my
mother took to drinking to drive away her grief, and then he left her.
(Stickney Ellis, p. 270)

Maria’s mother’s drinking worsens due to her husband’s treatment (implied domestic vio-
lence) and then he leaves as a result of her drinking. Their resulting poverty and her need for
drink leads Maria’s mother to steal from her sick and starving daughter to pay for her habit.
The chain of blame created demonstrates a symbiotic relationship between alcohol and do-
mestic violence with the child as the ultimate victim.
However, other authors used drinking to demonstrate the vulnerability of women in
Victorian society. Elizabeth Gaskell’s Aunt Esther in Mary Barton (1848), although she is
abandoned by her soldier-lover when he is sent to Ireland, only turns to drink after losing her
child. When her child becomes ill, she is unable to run her shop and the doctor’s bills rapidly

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reduce her savings to nothing. Although she becomes a prostitute to support herself and her
new habit in the end, Gaskell makes it clear that she had worked hard to try to save herself
from fnancial and moral ruin. As such, she is represented as pitiful rather than disgusting:

Such as live like me could not bear life if they did not drink. It’s the only thing to keep
us from suicide. If we did not drink, we could not stand the memory of what we have
been, and the thought of what we are, for a day.
(Gaskell, p. 145)

For her, drinking is an escape from her reality, her grief, and her memories but she defends
her love for her soldier and her little girl.
In the 1850s, there was a signifcant increase in representations of the fctional female
drunkard in popular mainstream novels. This coincided with a surge in the development
of the women’s rights movement and agitation for changes to the Married Women’s
Property Act and the related divorce laws. In 1854, Charles Dickens contrasted the so-
ber and decent weaver Stephen Blackpool in Hard Times with his beastly and unnamed
drunken wife. Written to support Lord Cranworth’s bill to amend the divorce laws,
Dicken’s portrayal of Blackpool’s wife is deliberately disgusting and chief among her
bad habits is drunkenness. 27 As Dayton Haskin notes, Dickens and his allies in this cam-
paign ‘did not envisage a remedy for the plight of women […] The reformers’ concern
was the prohibitive expense of divorce for men’ (Haskin, p. 211). Dickens outlines his
primary purpose for ‘No. 2’ of Hard Times (Chapters 9–15; published 29 April 1854) in
his ‘Working Memoranda’:

Chapter X
open Law of divorce. Stephen Blackpool and Rachael
(Wolverhampton black ladder)
Finds his bad wife at home ‘Come awa’ from th’ bed! ’Tis
mine! Drunk agen? Ah! why not’28

The heading, ‘open Law of Divorce’, specifes that he plans to ‘open’ the topic in Chapter
10.29 Dickens’s frst description of Blackpool’s wife in his notes is simply that she is ‘bad’,
but when he creates a mnemonic by outlining a brief conversation between Stephen and his
wife, Dickens demonstrates what he means by ‘bad’ in two examples: Stephen’s attempt to
ban her from the marital bed (to which she is no longer entitled or welcome): ‘Come awa’
from th’ bed! ‘Tis mine!’; and her defant drunkenness: ‘Drunk agen? Ah! why not!’. This
conversation, slightly amended and developed, appears in the fnal text. This is the reader’s
frst introduction to his wife and he discovers her symbolically lying on the hearth in his
cottage, extremely drunk:

‘Heaven’s mercy, woman!’ he cried, falling farther of from the fgure. ‘Hast thou come
back again!’
[…] After an impatient oath or two, and some stupid clawing of herself with the hand
not necessary to her support, she got her hair away from her eyes sufciently to obtain
a sight of him. Then she sat swaying her body to and fro, and making gestures with
her unnerved arm, which seemed intended as the accompaniment to a ft of laughter,
though her face was stolid and drowsy.

556
 ‘Drinking himself to death’

[…] ‘Back agen?’ she screeched, after some minutes, as if he had that moment said
it. ‘Yes! And back agen. Back agen ever and ever so often. Back? Yes, back. Why not?’
[…] ‘I’ll sell thee of again, and I’ll sell thee of again, and I’ll sell thee of a score of
times!’ she cried, with something between a furious menace and an efort at a defant
dance. ‘Come awa’ from th’ bed!’ He was sitting on the side of it, with his face hidden
in his hands. ‘Come awa! from ’t. ’Tis mine, and I’ve a right to t’!’
As she staggered to it, he avoided her with a shudder, and passed—his face still
hidden—to the opposite end of the room. She threw herself upon the bed heavily, and
soon was snoring hard. He sunk into a chair, and moved but once all that night. It was
to throw a covering over her; as if his hands were not enough to hide her, even in the
darkness.
(Dickens, Hard Times, p. 70)

Dickens develops on his original mnemonic, elaborately describing the ‘bad wife[‘s]’ inhu-
man, physical repulsiveness, her disconcerting emotional instability, and her threateningly
disjointed speech. Dickens is carefully emphasising the cost to Blackpool of being inextrica-
bly bonded to his wife, emotionally and fnancially, as part of the book’s role in agitation for
changes to the divorce laws. Dickens’s attention to these ‘costs’ demonstrates his focus on the
demonisation of the ‘bad wife’ to serve the androcentric purposes of his ongoing campaigns
for freer access to divorce for men.
The following year, Dickens published a short story by Wilkie Collins which explored a
more dangerous version of the drunken woman in the Christmas edition of Household Words,
The Holly-Tree Inn. Ostensibly, a sort of ghost or supernatural story, ‘The Ostler’ (1855), is a
warning against associating with strange women from out of town. The protagonist, Isaac,
has a dream about a woman threatening him with a knife. A few years later, he rescues and
marries a psychologically disturbed female stranger, Rebecca Murdoch, who is about to
commit suicide with laudanum.30 Soon after their marriage, the wife withdraws to ‘seek the
deadly self-oblivion of drink’ (Collins, p. 15). Despite his famous promotion of the precepts
of polygamy, the key objections to Rebecca’s drinking are sexual accusing her of making
‘acquaintances of the most dangerous kind’ and keeping ‘company with drunkards’ (Collins,
p. 15). The link between family respectability and female drunkenness is confrmed when
she arrives for his mother’s funeral ‘infamed and shameless with drink’ (Collins, p. 17). The
embodied implications of ‘infamed’ suggests a parallel between passion and drunkenness.
The combination with the mention of shamelessness, emphasises the immoral implications
of her intoxication. The introduction of a new knife to the house, resembling the one from
the dream, is decidedly phallic and he becomes ‘afraid […] to sleep in the same room with
her’, instead, walking about at night, dozing in the parlour or sitting up with his sick mother.
After escaping their home, he is haunted by her in his dreams, demonstrating the long-term
damage a drunken wife can cause to a sensitive husband like Isaac.
In 1857, George Eliot wrote against these androcentric stereotypes by creating Janet
Dempster, the heroine of ‘Janet’s Repentance’, a ‘scene’ from her frst collection of fction,
Scenes of Clerical Life. Also written in support of agitation for changes to the divorce laws,
Eliot supported Barbara Leigh Smith’s appeals to better protect wives against domestic abuse
and to enable wives separated from their husbands to earn and retain their own money
and property (inspired by the work of Caroline Norton, whose writings detailed the in-
justices sufered by her at the hands of a drunken husband she could not legally escape).
The eponymous Janet, driven to drink by her drunken and abusive husband, is nonetheless
beautiful, graceful, and intelligent, spending much of her free time doing good works in

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the community. Only her husband’s abuse leads her to drink, in an attempt to ‘arm herself
in leaden stupor’ (Eliot, p. 333). She escapes him after he casts her from the house. After
her husband’s death from delirium tremens, Janet is fnally released from his control and
increases her charitable works demonstrating the positive possibilities of divorce for women
trapped in unhappy or brutal marriages. Janet can repent without fearing long-term shame
because she is intelligent, beautiful, and kind but most of all, she is middle-class. In her de-
piction of Janet, Eliot shows an awareness of the tropes of fctions about female drunkards
and challenges the generalisation of depictions such as Collins and Dickens. Janet bears some
similarities to Aunt Esther in Mary Barton, in that her drinking is justifed by traumatic
family circumstances. However, instead of Esther’s stereotypical release through an early
‘merciful’ death, Janet is helped to achieve a ‘cure’ through the support of her community
and religion, represented by her friend Mrs. Pettifer and the Rechabite curate, Mr. Tryan
and the release from her abusive husband through his early death.
Nonetheless, temperance fction continued to push the notion of female responsibility for
the sobriety and good morals of the family and wider community. This is exemplifed by
Ellen Wood’s 1860 Danesbury House (as discussed above in Temperance Fiction and Sensation
Fiction above). By prioritising upbringing as the pivotal impact on these children via their
two diferent mothers, Wood continues to confrm the importance of the female role in the
family in the fght against habitual drunkenness, contradicting Anne Brontë and George
Eliot’s challenges. Published a few years later, Hesba Stretton’s equally popular, Jessica’s First
Prayer, begins with a description of Jessica refusing new clothes from a potential benefactor
because ‘[i]f you was to give me fne clothes like your little girls, mother ‘ud only pawn them
for gin’ (Stretton, p. 85). The precious child’s straight forward attitude to her inability to
accept desperately needed help because of her mother makes her plight all the more pitiable
and the mother all the more monstrous.
Towards the end of the century, more melancholy and pitiable fctional female drunkards
appear. Inspired by Zola’s novels and George Gissing’s own tragic relationship with his frst
wife, Nell Harrison, whose damaging drinking destroyed their relationship and her life,
Gissing published The Nether World (1889) and The Odd Women (1893). In The Nether World
(1889), Mrs. Candy’s body is ‘vitiated by the drugs’ from Mrs. Green’s beer-shop, and, by the
end of the novel, she cares ‘only for beer’ despite her collection of temperance pledges over
the freplace (Gissing, p. 76). In The Odd Women, the female protagonist’s sister, Virginia,
becomes a secret drinker, slipping into railway cafes and grocers for a tipple while running
errands and becoming increasingly strange and ill as the story progresses.31 Gissing’s tippling
women demonstrate his anxiety for women making themselves vulnerable while seeking
or managing unsought independence. His odd women, unable to fnd a husband because of
the unequal gender split of the population in the fnal decades of the century, seek solace in
drink to replace the families they were denied.

A Final Refection
The elements of the fctional drunkard exemplifed in these sections are, of course, inter-
dependent. Class, gender, religion, and new medical developments intersect in fction, and
it is the resulting points of tension that make the most interesting and innovative character-
isations of the drunkard. Just as Trotter, Macnish, and Miller wrote specifcally about the
diferent impact of drunkenness on women and men and of their concerns for the morals as
well as the health of the working and underclasses, so certain types of authors wrote at these
points of intersection. The study of the fgure of the habitual drunkard in fction is essential

558
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to our understanding of mid-Victorian anxieties for the individual, the family, the com-
munity, and the nation. This precarious fgure, sometimes comic, usually tragic, is always
extreme and therefore useful to exemplify social issues, both highlighting problems (in the
case of Dickens’s Hard Times) and portraying possible ideals (in the case of Danesbury House).
For some, the habitual drunkard is a warning to defend tradition and enforce social norms
and boundaries. For others, it is a nexus of imaginative experiments with the possibilities
ofered by increased opportunities to transgress such boundaries and assert individuality.
Either way, the fctional chronic drunkard not only warns us to drink ‘well’ or not at all, but
also reminds us of the fragility and value of human life.

Notes
1 As Steven Earnshaw points out, this is not the only proper approach to the habitual drinker and
for more information on the notion of diferent approaches to identity and drunkenness, I recom-
mend his book, The Existential Drinker (Manchester: Manchester University Press, 2019).
2 The Penguin Dictionary of Literary Terms and Literary Theory describes the aims of realism
as a literary movement as ‘The portrayal of life with fdelity’. This relatively new imperative to
portray ‘real’ life led to shift of focus away from the aristocracy, or at least encompassing other
socio-economic groups. J. A. Cuddon (ed.), Dictionary of Literary Terms and Literary Theory (Lon-
don: Penguin 2014), p. 590.
3 Erasmus Darwin, Zoonomia (Cambridge: Cambridge University Press, 2011); Thomas Trotter, An
Essay, Medical, Philosophical, and Chemical on Drunkenness and Its Efects on the Human Body (Phila-
delphia: Anthony Finley, 1813); Benjamin Rush, ‘Inquiry into the Efects of Ardent Spirits on the
Human Body and Mind’, reprinted in Quarterly Journal of Studies on Alcohol, 4 (1944), 324–341.
4 See, for example, Benjamin Collins Brodie, Psychological Inquiries: In a Series of Essays (London:
Longman, Brown, Green, and Longmans, 1854) and James Miller, Alcohol: Its Place and Power
(Glasgow: Scottish Temperance League, 1859).
5 For a useful account of the medicalisation of the treatment of habitual drunkenness, see Clemis
(cited above) and Iain Smith, ‘Doctoring in a Whisky-Injured Nation: The Medical Response to
the “Alcohol Question” in Scotland, 1855–1925’, unpublished thesis, University of Glasgow, 2018.
6 As discussed with Steven Earnshaw, verbal communication, June 2015.
7 Indeed, the very ‘weight’ of this publication has necessitated that I be very selective with the
amount of temperance fction included in this chapter. To do justice to the representation of the
drunkard in temperance fction would require a separate chapter or a larger work.
8 For example, an early example from one of Joseph Livesey’s periodicals, ‘A Word in Season, or the
Sailor’s Widow’, tells the story of a tippling man instantly converted to abstinence by the tears of
his ‘beautiful child’ after hearing a servant tell of the drunken death of her son, Jemmy, stating,
‘We none of us can tell how much we all owe you for making us acquainted with the story of poor
Jemmy: and I shall not fail to comply with your request to drink no more brandy’. Anon., ‘A Word
in Season, or, the Sailor’s Widow’, Livesey's Moral Reformer, 23 (Feb. 1839), pp. 217, 219–220.
9 See, for example, Annemarie McAllister, ‘The Alternative World of the Proud Non-Drinker:
Nineteenth-century public displays of temperance’, The Social History of Alcohol and Drugs, 28:2
(Summer 2014) 161–189.
10 For more information on temperance periodicals, see Annemarie McAllister, ‘Temperance Peri-
odicals’, in The Routledge Handbook to Nineteenth-century Periodicals and Newspapers (London: Rout-
ledge, 2016), pp. 342–354.
11 Lilian Shiman notes that the ‘popular belief in the need for alcohol in maintaining good health
is not surprising when we fnd that the medical profession itself held similar views. Nineteenth-
century doctors were dependent on alcoholic beverages for many of their cures. Lilian Lewis
Shiman, Crusade against Drink in Victorian England (New York: Palgrave Macmillan, 1988), p. 35.
An extreme example of this can be found in James Kneale, ‘Dr Granville’s Thunderbolt: Drink
and the Public in the Life of One Nineteenth Century Doctor’, Social History of Alcohol and Drugs,
28:2 (2014), 120–141.
12 Anon., ‘Fatal Afray in the Dark’, Morning Post (30 Mar 1847), p. 7; Anon., ‘Manslaughter at St.
James’s Back’, Bristol Mercury (9 Mar 1850), p. 6.

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13 For more details, see Emma Butcher, ‘War Trauma and Alcoholism in the Early Writings of Char-
lotte and Branwell Brontë’, Journal of Victorian Culture, 22.4 (2017), 465–481.
14 For more on this, see Pam Lock, ‘Death and the Alcoholic: Public Discourses in Anne Brontë’s
The Tenant of Wildfell Hall’, Social History of Alcohol and Drugs (2015), 29–47.
15 Roy Porter, ‘Introduction’, pp. xii–xiii. Porter refers to Ueber die trunksucht und eine rationelle Heil-
methode derselben (1819). Thomas Trotter, An Essay, Medical, Philosophical, and Chemical on Drunken-
ness and Its Efects on the Human Body, ed. by Roy Porter (London: Routledge, 2013).
16 See also Pam Lock, ‘Hindley’s “Reckless Dissipation”: Making Drunkenness Public in Emily
Brontë’s Wuthering Heights’, Brontë Studies, 44:1 (2019), 68–81.
17 Although, as Annemarie Beller’s research on ‘instances of emergent sensationalism’ reveals, this
boom did not come out of nowhere. Anne-Marie Beller, ‘Sensation fction in the 1850s’, The Cam-
bridge Companion to Sensation Fiction, ed. by Andrew Mangham (Cambridge: Cambridge University
Press, 2013), pp. 18; 8.
18 See, for example, G. H. Lewes’s attack on total abstinence in which he states:
So long as the Temperance advocates confne themselves to efecting a reform among the
poorer classes, […] they are doing righteous work, and may be pardoned their outbreaks of zeal,
their passionate foolishness, their bitter animosity, and all the “wild and whirling words” with
which they rival Methodists and Emancipationists.
He specifes that ‘very few of [his middle-class readers] are likely to be among the intemperate; to
them the Teetotal arguments are impertinent’. G. H. Lewes, ‘The Physiological Errors of Teeto-
talism’, Westminster Review (1852), 96–97.
19 For more information, see James Nicholls, ‘A new kind of drunkenness: the gin craze’, The Politics
of Alcohol (Manchester: Manchester University Press, 2009).
20 For example, the popular Scottish Temperance League were led by middle-class members, and
published their ‘moral suasian’ for the moral improvement and entertainment of a specifcally mid-
dle-class audience, with the aim of changing parliamentary law to discourage and encouraging a
ban on the consumption of alcohol.
21 As Annemarie McAllister has observed, there was a notable, though permeable, class divide be-
tween these groups as teetotallers tended to have a greater working-class leadership and mem-
bership, whereas moderate groups tended towards the middle classes. See Annemarie McAllister,
Demon Drink? Temperance and the Working Class, Chapter 7 (e-book).
22 Patrick Colquhoun’s 1814 ‘Map of English Society’ defnes the under classes as ‘paupers, vagrants,
gypsies, idle persons supported by criminal activity’. Patrick Colquhoun ‘Map of English Society
in 1814’, A Treatise on the Wealth, Power, and Resources of the British Empire (London: Joseph Maw-
man, 1814).
23 See Brooke D. Taylor, ‘Spontaneous Combustion: When “Fact” Confrms Feeling in Bleak House’,
Dickens Quarterly, 27:3 (2010); Gordon S. Haight, ‘Dickens and Lewes on Spontaneous Combus-
tion’, Nineteenth-Century Fiction, 10:1 (1955), 53–63.
24 This character capitalises on the ‘railway mania’ that started in 1845. In the second half of the
nineteenth century, £3 billion were spend on building railways in Britain creating 16,000 miles of
track. Figures taken from the national archives: https://www.nationalarchives.gov.uk/education/
resources/victorian-railways/.
25 The wife-selling scenario that begins the novel may seem unlikely to a modern audience but, as
Norman Page notes, it was not unusual during the time in which the novel is set, before changes
to the divorce laws in the 1850s, and not unknown in the 1880s when Hardy was writing. Norman
Page, Wilkie Collins: The Critical Heritage (London: Routledge, 1995).
26 As Tess O’Toole argues, it is ‘an attempt to reconfgure family relations that sets its plot in mo-
tion; the opening episode of the novel […] portrays a dramatic dissolution of family structure, a
willed unmaking of the marital and paternal ties forged by law and by biological procreation’. Tess
O’Toole, Geneaology and Fiction in Hardy: Family Lineage and Narrative Lines (Basingstoke: Palgrave
Macmillan, 1997), p. 19.
27 Lord Cranworth unsuccessfully submitted bills to change the divorce laws in 1854 and 1856. The
Matrimonial Causes Bill was introduced for second reading in the House of Lords, which received
royal assent on 28 August 1857.
28 Charles Dickens, Hard Times [manuscript]. Planning Notes, Victoria and Albert Museum, MSL/1876/
Forster/163.

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 ‘Drinking himself to death’

29 This formula is repeated in the notes, indicating the frst appearance (or opening) of a central
subject or theme.
30 Laudanum is usually a mixture of opiates and alcohol.
31 For more information on women’s secret drinking during this period, see Jen Wallis, ‘A Home or
a Gaol? Scandal, Secrecy, and the St. James’s Inebriate Home for Women’, Social History of Medicine,
31:4 (2018), 774–795 and David Beckingham, ‘Private Spirits, Public Lives: Sober Citizenship,
Shame and Secret Drinking in Victorian Britain’, Journal of Victorian Culture, XX:XX, 1–16.

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 33
TEA, ADDICTION AND LATE
VICTORIAN NARRATIVES OF
DEGENERATION, C. 1860–1900
Ian Miller

In August 1895, Theresa Galleway, age 41, collapsed on the foor of her Dudley home sufer-
ing from a ft. Theresa’s daughter, Alice, discovered her but decided not to send for a doctor
as her mother appeared to recover. Later that evening, Alice left her mother alone in bed but,
upon returning an hour later, found her dead. It was the task of the Deputy Coroner, Mr
Child, and local doctor, J.D. Price, to establish what might have caused Theresa’s untimely
death. Investigations revealed that Theresa had sufered regularly from ‘fainting fts’ seem-
ingly worsened by consuming excessive amounts of tea. Upon fnding the brain healthy,
the medical men began to doubt the evidence about fts. Instead, they decided to examine
Theresa’s heart, which they found to be grossly enlarged, and her stomach, which was dis-
tended with fuid, probably tea. Child and Price concluded that the stomach’s condition
had interfered with the action of the heart, causing death. A bemused member of the jury
enquired: ‘Do you wish us to understand that death was due to tea drinking?’, to which Mr
Child afrmed: ‘Any fuid might have caused the distension of the stomach, but in this case,
it appeared to be tea’ (Berrow’s Worcester Journal, 1895).
The seventeenth century saw the beginning of a long-term shift towards British domina-
tion of the global tea trade, accelerated by the formation of the British East India Company.
Tea became increasingly useful to state revenue (Rappaport, 2017). Throughout the nine-
teenth century, tea production was a key British colonial venture, the temperance movement
advocated the less intoxicating drink as a welcome alternative to alcohol, and middle-class
tea parties became fashionable. Tearooms opened across most British towns and cities. The
British developed a proftable tea industry, creating ferce competition between Chinese and
Indian traders (Forrest, 1973; Moxham, 2003; Ketabgian, 2007; Rose, 2010; Sharma, 2011;
Rappaport, 2017; see also, among others, Pettigrew, 2001; MacFarlane & MacFarlane, 2003;
Grifths, 2007; Hair & Hohm 2009; Saberi, 2010; Ellis, Coulton & Mauger, 2015). Compe-
tition ultimately lowered the costs of tea in countries such as Britain and Ireland (Liu, 2020).
Yet, the circumstances surrounding Theresa Galleway’s death suggests that tea could be
considered deeply problematic for health, addiction and well-being. This essay explores how
and why, in the closing decades of the late nineteenth century, the consequences of excessive
tea drinking caused anxiety and debate.
In the nineteenth century, new nutritional sciences emerged, transforming how scientists,
physicians and the public understood food and drink consumption. Early modern dietetic

564 DOI: 10.4324/9780429058141-42

 Tea, addiction and late-Victorian narratives

theories had typically viewed a person’s bodily responses to food as dependent upon their
individual constitution, and as variable from person to person. In contrast, Victorian nutri-
tional chemistry ofered new, empirical understandings of diet and moved towards estab-
lishing standardised nutritional rules that, ideally, most people should follow (Kamminga &
Cunningham, 1995). Meanwhile, Western society rapidly urbanised and more efcient
global trading systems developed. Westerners now had access to all manner of new foods
from around the globe. However, this did not necessarily mean good health. Urbanisa-
tion dislocated consumers from the rural sources of food production areas, creating new
consumer cultures. Particularly in Britain, jingoistic popular culture often celebrated free
trade as having brought innovations such as cheap tea while at the same time scorning alien
cultures of consumption (Trentmann & Flemming, 2006). Set against this backdrop, con-
cern mounted about the nutritional well-being of the poorer classes who, it seemed, could
not be trusted to purchase the foods which nutritional scientists considered healthy. By the
end of the century, working-class urban life was associated with dyspepsia, nervousness and
under-nutrition (Miller, 2011).
The essay demonstrates that concerns about tea addiction became central to late Victo-
rian debates on working-class nutrition and consumption. It focuses on Britain, Ireland and
America, countries where excessive tea drinking came to be seen as a signifcant problem. In
Britain and America, discussion focused primarily on the bodily implications of urbanisation
and industrialisation. In contrast, Irish debates were pre-occupied with the rapid process of
dietary change that had followed the devastating Great Famine (c. 1845–1851) and discour-
aged peasants from over-depending on potatoes as a dietary staple (Miller, 2014). In Amer-
ica, tea was less popular than cofee, partly due to the country’s proximity to Caribbean and
Latin American cofee plantations. Nonetheless, alarm about tea addiction briefy emerged
in the 1890s. Accordingly, the chapter focuses primarily on Britain and Ireland, with some
cross-Atlantic cross-comparison due to the ties of language, lineage and, especially in the
Irish case, high levels of post-Famine emigration.
In an era when modern understandings of food, diet and nutrition were at a relatively for-
mative stage, the late Victorians asked: Which foodstufs were safe? Which were addictive?
What were the potential consequences of excessive consumption for physical and mental
health? Which substances were suitable for consumption and which should be classifed as for
medicinal use only? While alcohol was quite clearly addictive, socially disruptive and mor-
ally ruinous, tea occupied a more ambiguous space in the late Victorian dietetic imagination.
Tea did not cause as many social problems as alcohol. Nor was it as obviously associated with
vices such as violence and prostitution. But, when consumed in particular ways, it emerged
as a potentially threatening substance.
Despite this pronounced historical concern about tea addiction, tea has not featured heav-
ily in the literature on addiction, having been overshadowed by cofee, alcohol and illicit
drugs (Courtwright, 2001). Erika Rappaport’s monumental study of tea and empire focuses
relatively briefy on the perceived health problems associated with drinking too much tea
(Rappaport, 2017). An otherwise thorough study of cafeine states (inaccurately) that ‘tea has
rarely, if ever, appeared on anyone’s list as a substance that ought to be put beyond the pale of
law or morality’ (Weinberg & Bealer, 2001). Historians who have discussed the relationship
between tea and health typically focus on mid-century adulteration debates rather than the
inherent addictive properties within tea itself or contemporary perceptions of its toxic, so-
cially perilous nature (Rappaport, 2017). Most historians have instead explored the civilised
middle-class tea party and the symbolic uses of tea drinking as a marker of middle-class
social civility and polite society (Fromer, 2008).

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However, middle-class tea drinking ideals difered profoundly from the realities of
working-class consumption. Rather than daintily sipping tea from small tea-cups in polite
company, the less afuent preferred stewing cheap, unhealthy concoctions of tea all day long
on their stoves, often consuming little else but a few slices of processed white bread. Hence,
while navigating questions about the potentially addictive, dangerous nature of tea, the late
Victorians were forced to fnd ways to continue upholding tea as a healthy, civilised drink –
indeed, one with signifcant economic value – while at the same time condemning its misuse
among certain groups. As with many other aspects of Victorian life, the key message that
emerged was to demonstrate moderation and avoid excess. The chapter makes clear that tea
drinking was a morally, physically and emotionally ambiguous past-time. Yet, excessive tea
drinking also served as a metaphor for social relations, an example of excess and reckless pas-
sions among the poorer classes, a problem feared by the middle classes for its revolutionary
potential. Reformers presented excessive tea drinking as the frst step on a slippery slope to-
wards more serious problems such as chronic alcoholism, whether drunk to excess or preco-
ciously administered to babies. But this interpretation, with its emphasis on personal blame,
concealed pressing social issues such as inadequate wages to buy sufcient and wholesome
food such as milk, oatmeal, potatoes and perhaps even meat.

Tea, Nerves and Degeneration

In the early nineteenth century, occasional comments were made about the lack of proper
nourishment in a cup of tea. However, most commentators happily described tea drinking
as one of life’s pleasure (Cottager’s Monthly Visitor, 1830). The tone of discussion changed
dramatically later in the century as tea became more widely available to a broader range of
consumers. Throughout the nineteenth century, the quantity of tea purchased in the United
Kingdom rose from around 24,000 lb per year to 225,000 lb. The introduction of lower
duties in the 1850s contributed to tea’s ever cheapening cost. In Ireland, per capita consump-
tion of tea rose from 0.5 pounds to 2.2 pounds between the late 1830s and early 1860s and
continued to rise throughout the remainder of the century (Burnett, 1999). As mentioned
above, cofee was more popular in America, although tea’s popularity nonetheless increased
towards the end of the century (Courtwright, 2001).
In the 1860s, dietary surveys undertaken across Britain and Ireland revealed a notable
rise in tea consumption across all social classes, but especially among the poor who had
previously not been able to aford tea. In his well-received surveys, Medical Ofcer for
the Privy Council, Edward Smith, warned that tea contained little nutritive material and
could not compensate for proper nourishment (Sixth Report of the Medical Ofcer of the
Privy Council, 1863). It was in this decade that warnings about excessive tea drinking be-
gan to be voiced. Annual health reports submitted to the British government warned that
working-class communities, especially those in the north, were in a state of physical degen-
eration, partly in consequence of over-depending on tea as a dietary staple. A key clue was
that people seemed much shorter in height than the previous generation (Third Report of
the Medical Ofcer of the Privy Council, 1865). The public greeted these messages with
mixed responses. After all, this was a time when the temperance movement was at its height
and when respectable middle-class tea parties were in vogue.
In 1872, pioneer of occupational medicine, John Thomas Arlidge, then employed as a
pottery inspector in Stafordshire, warned that tea injured the nerves, potentially creating
hereditary problems likely to be passed down to the next generation. Aldridge was par-
ticularly scornful of working-class women relying on tea as a principal dietary staple with

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only a few slices of bread and butter. He conceded that some women had been driven to
this diet through poverty and desperation, but still thought that housewives could advan-
tageously improve their budgeting skills and replace tea with nutritious food. The British
conservative newspaper, the Spectator, immediately voiced its displeasure by asserting that it
did not believe a word of Aldridge’s scaremongering comments. Tea drinking, the Spectator
argued, only injured a few people, often those with particular constitutions, the sedentary,
those with ‘hysteric tendencies’ and women ‘worn out with other excitements’. ‘There is no
proof that it is injurious to the mass of the people’, insisted the Spectator, ‘who take very little
in actual quantity…whose nerves are strengthened by labour and who are constantly in the
open air’ (Manchester Times, 1872).
Aldridge’s arguments are worth refecting on momentarily as they reveal much about
how physicians viewed the relationship between food intake, bodily health and also social
well-being. Evidently, Aldridge preferred to blame women for the resultant health problems
of consuming too much tea. The gendering of tea consumption is notable. Women were
generally, but not exclusively, blamed for the excessive tea drinking problem. This ftted in
with the trend of blaming mothers for faulty child-rearing and perceiving women as a less
rational, more impulsive sex inherently prone to compulsive disorders (Appignanesi, 2019).
Of course, such perspectives ignored the fact that many women chose to provide male and
younger family members with nutritious food as part of a family economy that made sense
in the context of poverty and resourcefulness. Simultaneously, these narratives blamed in-
dividual housewives instead of fully considering the harmful socio-economic environments
that encouraged high dependence on unsuitable foodstufs.
In addition, Aldridge’s emphasis on nerves refects late Victorian tendencies to concen-
trate on the physiological symptoms of addiction, rather than their behavioural precursors
and efects (Foxcroft, 2007). Aldridge viewed morbid conditions of the nervous system as a
direct cause of personal and social degeneration. In the 1820s, M.P. William Cobbett had
argued that tea ‘has badness in it’, disrupting sleep and weakening nerves, adding that tea
drinking among the poorer classes caused laziness and encouraged girls to gossip rather than
work (Cobbett, 1833). But in the late nineteenth century, nerve damage was considered far
more insipid and threatening. By then, evolutionary theory had begun to dominate medical,
scientifc and social thought. It now seemed plausible that entire species, even humans, could
degenerate to become the weakest, rather than fttest, in the battle for survival. Neurologists
and psychiatrists came to believe that pathological heredity could pass from one generation
to the next. It was this notion of change over time that marked the crucial diference be-
tween old and new hereditarian concerns over tea. As Janet Oppenheim argues, in the early
nineteenth century, a nervous temperament was just passed on. However, late century nervous
degeneration was more frightening and disgraceful. Once set in motion, it seemed to be an
irreversible process, dragging entire families into an inexorable downward spiral of declining
physical and mental powers. Collectively, nervous pathology could bring entire societies and
civilisations down (Oppenheim, 1991; see also Pick, 1989).
This feeds into broader arguments on addiction made by Susan Zieger who suggests
that addiction appeared so ominous in the late nineteenth century as it was a dangerously
individualised form of self-medication completely beyond the control of physicians. Addic-
tion rested somewhere between immorality and disease. It was not illness per se, but could
easily transmute into physical, mental and moral decay. Despite its non-disease status, late
Victorian physicians nonetheless presented addiction as a pathological illness which only
they should set out to remedy. Moreover, throughout the nineteenth century, the standard
terminology changed from inebriety to addiction while the immorality of the addict was

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increasingly framed as racial defect in the infuential discourses of degeneration and, slightly
later, eugenics. Rather than being just an unwelcome personal habit, addiction was now
demarcated as a sign of inherited biological defect. Particularly in the 1890s, Zieger argues,
both medical and mainstream discourses represented inebriates and other addicts as social
parasites, unproductively sapping life from the social body. Addiction was a problem for
both national and physical bodies and could rarely be separated from other social ills (Zieger,
2008). Those addicted to specifc substances seemed so overwhelmingly involved that they
had transformed into diferent people, alien to their own society and their own previous
identities. Initially applied to alcoholism, the stigma of addiction did not remain confned to
them for long (Alexander, 2008).
In relation to tea, blame was placed frmly on the working classes for their new-found
habits, who found themselves accused of carelessness and recklessness. One key allegation
was that the poor over-consumed tea not out of necessity, but for its mentally exciting and
exhilarating efects. Doctors feared that such decadent behaviour had a potentially shattering
efect on the nerves and, as Edwin Brown argued in 1863 to the Midland Scientifc Associ-
ation, risked ‘lowering the vital energies of the nation’. Brown made the relation between
personal and national behaviour clear when informing his audience that the Chinese were
now ‘degenerate representations of their ancestors who, prior to their being a tea-drinking
nation, carried fre and sword over large portions of Europe and Asia’ (Derby Mercury,
1863). At a time of Empire-building and rising global infuence, the argument was resonant:
Britain itself was under threat from reckless forms of tea consumption.
As degeneration narratives infltrated the fn de siècle, physicians and the public take warn-
ings about excessive tea consumption more seriously. In October 1883, the Dean of Bangor,
Henry Edwards, spoke at a meeting on establishing cookery classes in elementary schools.
Controversially, the Dean announced that, if he had his own way, there would be much
less tea drinking. The Dean believed that oatmeal and milk had once produced ‘strong,
hearty, good-tempered men and women’. However, excessive tea drinking had now ‘created
a generation of nervous, discontented people who were forever complaining of the existing
order of the universe, scolding their neighbours and sighing after the impossible’. The Dean
insisted that good cooking would much improve this situation. Moreover, he argued that
‘over much tea drinking, by destroying the calmness of the nerves, was acting as a danger-
ous, revolutionary force among us’. For the Dean, tea addiction was the frst step towards gin
addiction. The root of the problem was ‘an ignorant wife’; the end result was ‘ruin, intem-
perance and disease’ (Berrow’s Worcester Journal, 1883).
Like Aldridge before him, the Dean framed excessive tea drinking as both a personal
and national problem, one in which women were especially complicit. Even if a man had
succumbed to excessive tea drinking, blame was still placed on his wife’s insufcient house-
wifery skills. The Dean invoked contemporary themes of physical and national decay while
cautioning that the extent of the problem posed a national threat. The personality changes
seemingly induced by tea addiction afected social and political outlooks. Indeed, the Dean’s
statement attracted so much attention due to its invoking of revolution. It pinpointed tea as
the very cause of infamed personal passions that could too easily mutate into political revo-
lutionary zeal. All of this stemmed from deliberately induced nervous exhilaration.
The Dean received signifcant national publicity. He responded to a food of angry letters
sent to the Daily Telegraph (many penned by tea retailers) by stating:

I have been amused by the criticism which my protest against the above excess has
provoked. Angry tea traders have sent me earnest remonstrances. Your own article

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 Tea, addiction and late-Victorian narratives

of the 10th inst. is severe, but hardly fair, as it attributes to me sentiments that I never
uttered. I claim the right of explaining…I have never denounced good tea or moderate
tea drinking. I said in my condemned speech, ‘Tea and bread and butter are very good
in their proper place and proportion’. I did protest against the bad housewifery which is
undermining the physique of many Welsh workmen.

The Dean reiterated that his concern was with bad housewifery, not tea drinking as such, and
concluded with ‘let me add, I have no objection to any moderate tea drinking’ (Western
Mail, 1883).
The Pall Mall Gazette also published a number of letters on the Dean’s speech, including
one by Berkshire reverend, Charles W. Stubbs, who believed that

as much superfuous money is expended on tea and sugar as would maintain four mil-
lion subjects in bread. If it is considered what a fatal enemy excessive tea drinking is to
the human body, how much it impairs the vigour of the constitution and debilitates the
mind, the pernicious infuence of it will be more apparent.

Stubbs described tea as a ‘pernicious commodity that tends to our very ruin’. Stubbs was
particularly contemptuous of recent calls to lower tea duties (Pall Mall Gazette, 1883).
Evidently, the Dean was forced to navigate the business interests of tea traders, natu-
rally inclined to condemn commercially damaging publicity, as well as the responsible,
usually middle-class, tea drinkers considered unlikely to fall prey to over-consumption
and nervous disorder. Discussion of the problem was undoubtedly class-fuelled. In many
ways, excessive tea drinking served as a metaphor for ideas about the civilised middle and
upper classes, and the passion-fuelled, reckless lower classes whom degeneration theory
warned might out-reproduce the more civilised, ‘advanced’ members of British society.
As the root of the problem was the careless working-class housewife in need of domestic
education as a remedy.
This is not to say that all critics placed blame on the individual or familial level. When
providing evidence to an 1894 government enquiry into the Merioneth slate quarries, Win-
ifred Ellis made a point of commenting on the ‘incessant tea drinking’ and neglect of tradi-
tional foods such as porridge which she believed destroyed stamina, caused indigestion and
enfeebled both body and mind. As she explained,

tea has such a charm for some people that they are sensitive about putting away the cups
and saucers when they are not actually in use. Tea often serves as breakfast, dinner and
supper, the only accompaniment being bread and butter and sometimes tinned meat.
(Birmingham Daily Post, 1894)

It is notable, however, that Ellis, unlike many of her contemporaries, refrained from pro-
viding moral judgement on the miners. Her argument insisted that locals worked in dense,
foggy and unwholesome atmospheres that caused thirst, weak appetite and enfeebled diges-
tion. In her words,

it is not fair to attribute to quarrymen the fact of being possessed of an unnatural and
excessive craving for tea drinking. Tea allays thirst. It is a necessary stimulant, though
not much more, but it helps the assimilation of nourishing food.
(Departmental Committee on Merionethshire Slate Mines, 1895)

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Evidently, Ellis was more sympathetic to the occupational and structural problems that en-
couraged many workers to depend heavily upon tea as a dietary staple. Ellis rejected ideas
that excessive tea drinking stemmed from some innate, internal immoral desire for exhil-
aration. Nonetheless, Ellis still perceived excessive tea drinking, whatever its causes, as in-
jurious to the nerves, as an addictive social practice with portentous implications for future
generations.

Tea, Minds and Bodies

During the 1880s and 1890s, the British Medical Journal contributed considerably to debates
on excessive tea drinking, posing various questions. Was tea really evil? Was concern over its
excessive consumption just a medical fashion? Were the nerves really as aggravated by tea as
claimed? Was excessive tea drinking itself the real problem or the absence of nutritious foods
to accompany tea? Was ‘tea drunkenness’ as physically and morally dangerous as alcoholism?
(British Medical journal, 1886). In 1883, the BMJ was quick to report on the Dean’s speech
and, like many contemporaries, predicted ‘little less than our general physical and moral
decadence as a people and nation if we persevere in our addiction to the pleasures of the
tea pot’ (British Medical Journal, 1883). Five years later, the journal stated, ‘the habit of tea
drinking is becoming more and more thoroughly national in the British islands’ for rich and
poor alike. The journal argued that these problems were less common in middle-class ‘real
society’ which enjoyed civilised afternoon teas. However, the working classes consumed
their tea too hot, over-stimulating their hearts (British Medical Journal, 1888).
Of particular concern was the destruction of tea’s favour during the process of infusing tea
in boiling water. Many physicians believed that this left high proportions of dyspepsia-causing
tannin in the drink. According to the BMJ, ‘indigestion is unknown among tea drinkers in
the East and it is, in all probability, only the result of our defective use of the leaf ’ (British
Medical Journal, 1892). Tannin was the issue which physicians typically worried about, al-
though theine (or cafeine) was often mentioned. In 1908, prominent physician Sir Lauder
Brunton, in a discussion of the efects of tannin, described the tell-tale signs of tea-induced
mental degeneration – diminished self-restraint, nervousness, undue sensitiveness, timidity,
uncontrollable emotions – accompanied by physical symptoms, including giddiness, head-
ache, ringing in the ears, severe neuralgia and tremulousness (Observer, 1908). Further de-
bate was sparked by Surgeon Major W.T. Black in 1888 when the BMJ published his letter on
the masses of poor teeth which he had regrettably encountered at recruiting stations. Black
blamed this on excessive tea consumption (British Medical Journal, 1888). His somewhat
speculative letter received a lukewarm response. The New York Times ridiculed the debate. It
consulted six eminent New York doctors who all expressed astonishment that such a ‘ridic-
ulous and untenable’ theory was being taken seriously (New York Times, 1888).
Excessive tea drinking was considered of such importance that it featured regularly in
turn-of-the-century government enquiries. Vanessa Heggie has argued that the Inter-De-
partmental Committee on Physical Deterioration, established in 1904, was primarily con-
cerned with diet, exercise and alcohol (Heggie, 2008). Certainly, witnesses at the Committee
were very much concerned with tea’s impact on national health. Dr R.J. Collie, Medical
Inspector for the London School Board, claimed that children lucky enough to reach adult-
hood if raised on tea were pale, anaemic, prone to disease and had a half-starved appearance.
Most of those raised on tea, he argued, could be found from the age of three onwards in
children’s wards sufering from tuberculosis. He described one group as ‘open-mouthed,
stupid-looking children, the result of adenoid overgrowth brought about by insufcient

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feeding’ (Inter-Departmental Committee on Physical Deterioration, 1904). Mrs Bostock,

Health Visitor for the Manchester and Salford Ladies Health Society, observed that many
working-class mothers started feeding tea to their babies as early as fve months old, entirely
undiluted with milk (Inter-Departmental Committee on Physical Deterioration, 1904). Dr
Alexander Haig warned that the poorer classes were essentially swallowing large quantities
of uric acid (Inter-Departmental Committee on Physical Deterioration, 1904). Of course,
there was a distinct diference between over-depending on tea and being addicted to its tan-
nic properties. However, contemporaries often presented the weaning of the young on tea
as the frst step towards a lifetime of addiction and nervous degeneration, inevitable conse-
quences of poor nutritional feeding at the start of life. It seems evident that most British de-
bates shied away from discussing the broader political and socio-economic determinants that
encouraged poverty, presenting the root of under-nutrition as resting in personal domestic
behaviour. The solution was to encourage behavioural change in working-class families.
In Ireland, too, excessive tea drinking was blamed for a spectrum of social problems.
Nineteenth-century journalists and physicians were fxated with the amount of tea that the
Irish poor could consume. In 1900, Michael McDonagh, writing for the British monthly lit-
erary periodical Nineteenth Century, reported one encounter with a Kilkenny peasant during
which he was:

Invited by a peasant to a cup of tea, the liquor being black and strong through lengthy
stewing, and giving the writer a sensation of dizziness in the head, although the peasant
seemed to relish it highly. ‘If I do but get the cup o’tay’, said he, ‘I’m content. It rises the
heart in me when I’m poorly’. M’Donagh asked, ‘Do you drink much of it?’. The reply
was ‘I be at it mornin’, noon and night. Oh, it’s mighty refreshin’, and he smacked his
lips after drinking the second cup.
(Reprinted in The Star, 1900)

In the 1880s, the Irish press debated the Dean of Bangor’s speech, not least because parallel
concerns about the nature and extent of tea drinking were coming to the fore in Ireland. The
Irish Times newspaper wrote that the Dean’s outburst carried important warnings for Ireland.
Tea, so the newspaper’s readers were informed, was an unsuitable principal food of adults and
was physically harmful to children subsisting upon nothing else but the substance, as was sus-
pected to be the case among Ireland’s lower classes. ‘Tea-making to excess among this class
is a form of laziness which produces – there can be no doubt about it – mischievous results’,
explained the newspaper, continuing by lamenting that ‘it takes too much the place of solid
food’ (Irish Times, 1883). Reports emerged of washerwomen, kitchen girls and mothers
flling the out-patient departments of Belfast’s hospitals complaining of headache, nausea,
loss of appetite, physical distress after eating and chronic dizziness (Belfast Newsletter, 1887).
A key diference in Ireland was the tendency to link national decay and excessive tea
drinking to post-Famine dietary change (Miller, 2014). In the decades after the Famine, the
Irish poor enjoyed an increasingly diverse diet facilitated by a burgeoning consumer culture.
However, by the 1890s, the Irish poor seemed far less healthy than they had been while
subsisting on potatoes. Labourers themselves noticed this decline, suggesting that the poor
could be sometimes active agents in these debates. At the Royal Commission on Labour
(1893–1894), Mr Lynch, a labourer from Delvin, Co. Westmeath, insisted that ‘the children
are spoilt in their youth from not having milk. The people are killing themselves with tea.
The men don’t work so well in consequence. Stirabout and milk used to be a grand thing for
them’ (Royal commission on Labour, 1893–1894). Similarly, a farmer named Mr Ramage

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maintained that, ‘I think the modern food is deteriorating the men’s strength’ (Royal Com-
mission on Labour, 1893–1894). Mr L. Ward, a ploughman, stated that, ‘They were stronger
men in the old days. Now they are more prone to heart disease and other ills which I believe
is owing to the modern diet’ (Royal Commission on Labour, 1893–1894). It seemed to some
that nutritional health had been compromised due to the diminishing popularity of the po-
tato. The post-Famine Irish body was characterised by weak physical calibre. As in Britain,
fears emerged that the Irish poor nonetheless threatened to perpetually reproduce, tarnishing
the physical vitality of future generations.
Concern peaked in the 1890s when ofcial investigations were pursued into a nationwide
rise in asylum admissions. An ofcial enquiry directly linked the problem to the inability of
the poorer classes to purchase nutritious food, heightened levels of vexation and worry caused
by economic depression and a consequent derangement of physical and mental functions
(Townend, 2002). However, most asylum owners blamed rising admissions frst and foremost
on the widespread reliance on poor-quality Indian tea, stewed rather than infused. This, it
seemed, was creating peculiar forms of dyspepsia that was debilitating nervous systems nation-
wide. Diet, they suggested, had unquestionably contributed to increasing insanity levels, and
that large numbers of asylum patients now bore the scars of scant, improper food: ‘the insanity
of malnutrition’ (Alleged Increasing Prevalence of Insanity in Ireland, 1894).
In 1894, Thomas Drapes, resident medical superintendent at Enniscorthy District Asy-
lum, published an article on the matter in Journal of Mental Science. Drapes observed that what
was most puzzling, and worrying, about the alleged increase of insanity was that admissions
were rising at a time when the population level was rapidly declining due to emigration.
Drapes confrmed that nearly all of the superintendents of Irish asylums thought that tea
had impacted indirectly on Irish mental well-being when consumed as a substitute for more
nutritious food. He warned that ‘we see its efects in the number of pale-faced children,
who are brought up on it instead of the old time-honoured, but now nearly abandoned,
porridge and milk’ (Drapes, 1894). Little surprise that in 1905, the Bishop of Ross described
the tea-addicted body as a ‘jerry-built house that tumbles down at the frst shock. Hence,
the decayed teeth, poor blood, weak hearts, delicate lungs that give way under any severe
strain’ (Irish Independent, 1905). Notably, Scottish lunacy inspectors also viewed excessive
tea drinking as a major cause of rising insanity cases, stating that decoctions of tea had ‘an
unsettling efect on subjects mentally unstable from birth, at adolescence or at the climac-
teric’ (Observer, 1908). As outlined above, Arlidge had depicted the problem of excessive
tea drinking in terms of race. Since at least the Famine period, Irish emigrants to Britain
had been associated with excess and unruliness (see, among others, Swift & Gilley, 1989).
Despite being white and European, the nineteenth-century Irish were often portrayed as a
‘Celtic’ race, set apart from the British ‘race’, and defned heavily by excitability, efeminacy,
irrationality and, as Joanna Bourke suggests, heightened levels of mental health issues and
psychological excitability. Debates on tea drinking often confrmed stereotypical and racial-
ised views of Irishness (Bourke, 2000). (See also Curtis, 1997 [1971]).
In America, cofee was more popular than tea (Pendergrast, 2010). However, from the
1880s, the ‘English fashion’ increased in popularity. One Chicago newspaper reported in
1887 that:

I foresee from tea drinking a harvest for physicians. The ladies will acquire a taste for
it from the adoption of a silly fashion which is the outgrowth of this absurd spring of
English manners. They will eventually use it extensively at all hours of the day.
(Sedalia Weekly Bazoo, 1887)

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Of particular interest was the peculiar case of Peter Phelan, reported internationally. In
1899, Phelan was admitted into Bellevue Hospital, New York, in a critical condition, drift-
ing in-between mentally clarity and delirium. It transpired that Phelan had been known
to drink up to 30 strong cups of tea each day. When interviewed, local doctor, George F.
Shrady, stated:

The case is a very unusual one. It may be, however, that Phelan’s condition may be due
not so much to the tea itself as to the fact that he tried to substitute it for food. His case
should not, however, deter anyone from drinking tea in moderation. Properly made and
taken in moderation, tea is not only harmless, but positively benefcial.
(Evening Times, 1899)

Phelan was a 40-year-old assistant stage carpenter at New York’s Broadway Theatre until
he sufered a nervous collapse. Reportedly, he had developed cravings for tea as ferce as the
alcoholic’s craving for alcohol. Phelan had mostly replaced food with strong tea. However,
one day he found himself unable to leave his bed. He tried to cure himself by drinking even
more tea but found this frustratingly difcult to digest. Upon hearing that Peter was ill, his
mother transported him to her home where physicians attended him. However, they were at
a loss for a diagnosis. At this point, Peter was transferred to Bellevue Hospital where doctors
diagnosed him as a ‘tea drunkard’ (Evening Times, 1899). They learnt that he had become
fond of tea as a child and been allowed to drink as much of it as he liked. As a young man,
he became accustomed to drinking six to eight cups a day. Gradually, this increased until the
age of 40 to 30 cups a day. He reported that he was receiving good attention but complained
that he convince the staf to ofer him a cup of tea (Evening Times, 1899).

Tea Drunkards?
The invoking of ‘tea drunkenness’ in journalistic coverage of Phelan raises questions about
precisely how toxic, addictive and exhilarating the Victorians thought tea could potentially
be. For more conservative elements of society, the ‘sin’ of seeking gratifcation of the desire
for artifcial stimulation was the same, regardless of whether it was sought in tea, alcohol or
drugs (Health Reformer, 1875). But the majority of doctors framed excessive tea drinking
as a health or moral problem rather than sin, albeit a problem with signifcant moral impli-
cations. Some were in no doubt that tea was an insidious poison. Slow poisoning was an
important Victorian concern, as demonstrated in debates about arsenic (either deliberately
slipped in meals or workplace exposure) and other prominent poisoning controversies (Wat-
son, 2003; Burney, 2006; Whorton, 2010; Stratmann, 2016). Could it have been that tea was
yet another substance working its toxic way through unsuspecting bodies? In 1899, a London
coroner concluded that furniture dealer, C.H. Holmes, had died from a dyspepsia-induced
ft brought on by excessive tea drinking. Holmes believed that tea had slowly destroyed the
nervous system, eventually causing heart disease (Guardian, 1899). However, associating tea
with poison implied that people such as Holmes were unwitting victims of their appetites
for tea.
As mentioned above, most physicians insisted that excessive tea consumers knowingly
and deliberately consumed excessive quantities for its decadent, exhilarating efects. They
likened tea to alcohol and framed excessive tea drinking in terms of addiction. The new-
found association of tea with nervous pathology was particularly problematic for temperance
advocates. Indeed, their very success had rested largely upon upholding tea as a suitable

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alternative to alcohol (Rappaport, 2017). When an inquest was held on a London man, John
Charles Fairman, in 1862, the coroner was pleased to hear that Fairman had been a temperate
man but regretted discovering that he had habitually consumed at least three quarts of tea per
day, against the advice of his wife. The coroner, upon fnding Fairman’s heart to be twice the
size as it should have been, concluded that ‘excessive tea or cocoa drinking is as dangerous
as intoxicants’ (New York Times, 1902). Perhaps the most extreme argument on this matter
was made in 1903, one Chicago Professor announced that whiskey for breakfast was far less
injurious than tea or cofee, although his colleagues swiftly announced their intentions to
continue drinking non-alcoholic beverages for breakfast (Turner County Herald, 1903).
Meanwhile, in Philadelphia, eminent surgeon, Charles D. Green, warned in 1877 that:

While we have been turning our eyes up on the more obvious and vulgar evils attendant
upon the free use of alcohol, we have been blind, have been overlooking the sneaking,
insidious action of a bland peaceful seducing liquid, which has been sapping the founda-
tion of manhood and honesty. Alcohol sends a few to the jail or to the madhouse, but tea
acts through the nervous system on the conscience and turns us into a nation of sneaks
and thieves. Look at the Chinese, the Japanese! Nations of sneaks and thieves!
(Daily Gazette, 1877)

For Green, tea had far more deep-rooted consequences than alcohol. Being drunk might
lead to short-term problems such as violence and crime. Yet, for him, the infuence of tea
reached far more insidiously and permanently into the body, causing entire races to take on
degenerative qualities. The implication was clear: it wouldn’t be too long before the Ameri-
can race went the same way as the Asiatic races had supposedly done.
The BMJ similarly portrayed excessive tea drinking in terms of addiction, a substance which
needed to be replaced with an alternative product if the working classes were to wean them-
selves of (British Medical Journal, 1887). In 1906, one American doctor advised women to
take up smoking instead (New York Times, 1906). Nineteenth-century Britain had a number
of retreats for alcoholics, most of which limited the amount of tea provided. Staf reported that
the cravings for tea could be just as ferce as for alcohol. Occasionally, they admitted patients
sufering only from tea addiction. One staf member at St. Veronica’s Retreat reported of a
tea-addicted patient: ‘She would go into a state of coma. She would lie about just like any
woman who was drunk, would do no work, neglect her house, her children, her husband,
everything’ (Report of the Departmental Committee on Treatment of Inebriates, 1893–1894). Similar
arguments were made in Ireland, particularly in relation to the most impoverished areas such
as Connemara where, in 1910, one School Inspector reported that ‘the use of tea is now carried
to such dangerous excess that it ranks before alcohol as an enemy of the public health’. As an
alternative, the inspector recommended consuming soup (Irish Independent, 1910).
The framing of excessive tea drinking as dangerous addiction raised questions about
whether tea drinking should be banned outright, or at least regulated. Controversially, in
1872, Arlidge argued that the reforming zeal of the temperance movement should also be
directed towards repressing ‘tea-tippling’. ‘Bitter and strong is the agitation at the present
period against beer and other intoxicating liquors as the root of all evils’, insisted Arlidge,

but in my opinion there is room for agitation against tea drinking, as carried on in the
way spoken of, for I am convinced that a deterioration of health among the working
classes, and a lowered vitality in the rising generation are consequences of the abuse of
the beverage in question.

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Arlidge viewed tea as potentially dangerous and addictive as alcohol. If anything, the tem-
perance movement had created a vacuum in which new liquid beverages had been sought.
As tea ruined digestion and enfeebled the heart, Arlidge frmly believed that tea ought to be
classifed as a narcotic poison (Medical Times and Gazette, 1872).
By the end of the century, some social reformers were going further. In 1895, Dr J.E. Cooney
wrote in the Windsor Magazine that both alcoholic drinks and tea were abused, and could be
safely abolished as beverages, being made available for medicinal uses only. Cooney believed
that tea was a ‘useless, expensive and noxious drink’ which spoiled nature’s beverage – water
(Reprinted in Yorkshire Herald, 1895). Evidently, this formed part of a process of determining
which substances were safe and which were far from and formed part of a broader process of
deciding whether or not certain substances should be banned. The Victorians saw alcohol as a
grave threat. Historians have argued that anti-alcohol campaigns were a form of moral regula-
tion (Yeomans, 2014). In the late nineteenth century, the ‘spectre of the drunkard’ also became
entangled with a discussion about degeneration. Moral and medical concerns about alcohol
abounded; yet, this clashed with, and ftted uneasily into, a capitalist system geared up to cater
to an expanding consumer market. Put more bluntly, alcohol made too much tax revenue to
ever be banned or classifed as for medicinal use only (Berridge, 2013; Hands, 2019). A sim-
ilar argument could be made for tea. In the face of trade interests, themselves entangled with
political and economic interests, physicians could only issue grave warnings and encourage
moderation. In this context, health advice focused intently on drinking moderately and, for the
most part, veered away from the idea of banning tea outright.
Those concerned about tea consumption developed the idea that tea caused its own type
of drunkenness. ‘Tea drunkenness’ was characterised by exhilaration which impacted gravely
on the nervous system. Like alcohol, tea needed to be consumed in moderation and with due
care paid to quality (Aberdeen Weekly Journal, 1895). In 1895, a group of New York doctors
announced that at least 10% of the patients at the city’s main dispensary were sufering from
the efects of ‘tea drunkenness’, which they believed to be ‘almost more distressing than that
of alcoholic indulgence’. One Brooklyn doctor, James Wood, announced that 10% of pa-
tients applying for treatment at New York’s chief dispensary were ‘tea drunkards’ sufering
from headache, vertigo, insomnia, heart palpitations, mental confusions, nightmares, nau-
sea, hallucinations, morbid depression of spirits and even suicidal impulses. Wood described
excessive tea drinking as ‘almost more distressing than that of alcoholic indulgence’. These
patients typically drank up to 15 pints of tea each day and were predominantly of Irish origin
(Southern Star, 1895; Newcastle Weekly Courant, 1895).
Phelan’s aforementioned case provides particular insight into how physicians perceived
the efects of extreme tea drunkenness. The doctors described his condition as follows:

His face and body were safron hued and his lips, gums and eyelids white. He was
scarcely able to move and when he did his respiration was like that of one who had run
up a steep hill. The lifting of his hand made his breath come fast.

The Evening Times described Phelan as looking like a ‘wax manikin’. It was only after sev-
eral days of hospitalisation that Peter was able to provide the doctors with his health history
(Evening Times, 1899). Phelan’s case was problematic as it coincided with the United States’
Church Army’s opening of its frst tea saloon in New York (Evening Times, 1899). The Army
sought to convert New Yorkers from liquor and beer to tea. Its saloon sold fne tea at a
cheaper cost than beer. Reportedly, over 200 people patronised the new saloon in its frst
three hours of operation (Evening Times, 1899).

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Regardless of whether tea drinkers were ‘drunk’ or not, many doctors undoubtedly
feared that excessive tea drinking was a frst step on the path to full-blown alcoholism. Once
the nervous stimulus provided by tea started to wane, alcohol was the next obvious place in
which it might be found, that is, if the dyspeptic pains caused by tea had not already driven
suferers to alcohol for pain relief (British Medical Journal, 1889). In that sense, addictive
liquids were placed on a spectrum of addiction. If the key goal was to achieve nervous ex-
hilaration, then it seemed logical to presume that over-use of tea might eventually lead to
misuse of alcohol, a far more potent substance. Both excessive tea and alcohol consumption
symbolised to Victorians a lack of restraint, especially among the poorer classes, and an un-
willingness to shy away from activities feared to be impacting collectively upon the nervous
system, creating a ‘nervous society’ destined to degenerate.

Remedying the Problem

Bad publicity inevitably disgruntled the tea trade. As part of its marketing campaign, Maza-
wattee tea advertising portrayed Ceylon as the source of healthy tea. The Mazawattee Tea
Company was founded in 1887 by the Densham family and was one of the most advertised
tea frms. The company became famous for its adverts showing an aged, bespectacled and
toothless grandmother drinking her favourite brand of tea. It specialised in selling tea from
Ceylon rather than China (Rappaport, 2017). One of its advertisements, distributed widely
in the early 1890s, featured an imaginary conversation between an interviewer and a doctor.
The doctor discussed ‘a mania of late years for low price tea’ with the result being that Britain
had ‘been so fooded with rubbish that many of you don’t even know what the taste of good
tea is’. The doctor blamed the public for attempting to obtain fne tea at cheap prices. For
the fctional doctor, drinking tea was not so much the problem, but the consumption of the
wrong types of tea, for this was causing health to deteriorate across Britain. In this account,
Chinese tea, not tea itself, was the problem.
The company insisted to readers that cultivating tea in Ceylon was an important initiative
as it promised to alleviate the health problems currently rampant across working-class com-
munities. ‘China tea has greatly deteriorated’, explained the doctor, but ‘on the other hand,
there is a large proportion of soft, mellow tea sent from India that is far more palatable and
contains no more tannin than the China growths’. The doctor continued by making much of
Mazawattee’s trained team of tasters who checked the quality of tea coming into the British
market. He concluded that, ‘our great aim and ambition is to elevate the public taste for tea’
and to ‘be the indirect means of changing a frown into a smile at many a British tea table’
(Church Times, 1892).
Of course, the advertisement needs to be situated within its context of building trade
within the British Empire and of helping fend of long-standing competition with China. It
provided an image of British Empire plantations helping produce a pure, healthy, civilised
and perhaps British brew. This process was also boosted by developments in transport which
had increased the speed of exchanges around the world (Rappaport, 2017). However, at
the same time it somewhat cynically played upon contemporary socio-cultural anxieties
and completely refused to acknowledge any problems in advertising that was causing issues
of dependence and ill-health among the impoverished. According to the fctional doctors,
consumers themselves were at fault for choosing to buy the wrong tea, even if the ‘correct’
tea was more costly (even more cynically, advertisements for Charles Forde’s Bile Beans for
biliousness presented their products as the only cure for excessive tea drinking, a means of
helping unfortunate women wean themselves of their habits) (Derby Mercury, 1900).

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Some innovators attempted to produce products that would remove the tannic acid. One
of these, distributed in powder form, was named Nu-Tea. It claimed to treat tea leaves at a
high heat to eliminate the tannin (Hampshire Advertiser, 1891). In 1892, one aspiring entre-
preneur developed an ‘anti-tannic teapot’. However, the BMJ, while admiring the objectives,
ridiculed the pot for being ‘based upon fanciful belief rather than real scientifc principles’.
The teapot heated the leaves before boiling water was poured on them. On this occasion,
the BMJ added that ‘no tea drinker who respects his stomach or understands the favour of
tea would ever drink tea mixed with milk and sugar, which is merely a sort of tannin broth’.
As an alternative, the BMJ advised using a Japanese teapot containing a porcelain strainer
(British Medical Journal, 1892). In America, one physician produced a new cereal-based
drink – nervine cofee – replete with advertisements warning that tea and cofee were just
as addictive, destructive and dangerous as alcohol (Western Kansas World, 1898). And, of
course, the introduction of the tea bag in the early twentieth century encouraged tea to be
consumed in moderation, going some way towards allaying Victorian fears of the physical,
emotional and moral dangers of excessive consumption.

Conclusion
In the late nineteenth century, tea was prominent in broader discussion of addiction, de-
generation and class diference. The late Victorians were forced to consider the potentially
addictive, health-threatening nature of tea while navigating the interests of tea traders, gov-
ernment interests in taxation and the status of tea as an emblem of status and civility in
middle-class life. Discourses of degeneration framed working-class tea consumption as a
dangerous pursuit, one which threatened the vitality of the nation as a whole. Excessive tea
drinking was a metaphor for the perceived recklessness and fervour of the working classes
which they so feared. Yet alarm about excessive tea drinking also had non-metaphorical
aspects. The poorer industrial classes were indeed under-fed and under-nourished. Their
conditions of poverty undoubtedly encouraged many to forego nutrition, particularly
self-sacrifcing women prone to providing other family members with more nutritious food
items. Debates on excessive tea drinking mostly faded away after the start of the twentieth
century. Potential reasons might include new technologies such as tea bags which helped
ration the strength of consumed tea, improved awareness of nutrition among working-class
communities due to the prevalence of health advice aimed at mothers from the voluntary
sector and, potentially, stronger interest in other forms of addiction among doctors.

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Sixth Report of the Medical Ofcer of the Privy Council, House of Commons, 1863 [3416], vol. 28.
Smith, E. (1861). On the Uses of Tea in the Healthy System. Unknown Publisher.
Southern Star (5 January 1895), p. 2.
Stratmann, L. (2016). The Secret Poisoner: The Victorian Age of Poisoning. New York, N.Y.: New York
University Press.
Swift, R. & Gilley, S. (eds). (1989). The Irish in Britain, 1815–1939. London: Pinter.
The Star, (12 July 1900), 4.
Third Report of the Medical Ofcer of the Privy Council, [3484] 1865, vol. 26, p. 481.
Townend, P.A. (2002). Father Mathew, Temperance and Irish Identity. Dublin: Irish Academic Press.
Trentmann, F. & Flemming, J. (eds). (2006). Food and Confict in Europe in the Age of the Two World Wars.
Basingstoke: Palgrave Macmillan.
Turner County Herald, (14 May 1903), 1.
Watson, K. (2003). Poisoned Lives: English Poisoners and their Victims. London: Hambledon Continuum.
Weinberg, B.A. & Bealer, B.K. (2001). The World of Cafeine: The Science and Culture of the World’s Most
Popular Drug. London: Routledge.
Western Kansas World, (2 April 1898), 3.
Western Mail, (16 October 1883), 4.
Whorton, J. (2010). The Arsenic Century: How Victorian Britain was Poisoned at Home, Work and Play.
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Yeomans, H. (2014). Alcohol and Moral Regulations: Public Attitudes, Spirited Measures and Victorian Hang-
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Yorkshire Herald, (6 August 1895), 6.
Zieger, S. (2008). Inventing the Addict: Drugs, Race and Sexuality in Nineteenth-Century British and Amer-
ican Literature. Amherst: University of Massachusetts Press.

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 34
CONCEIVING ADDICTION
Historical constructions of
chronic intoxicant use

David Clemis

Addiction as a Historical Problem

From the earliest refections on their use, the power of intoxicants to alter cognition, emo-
tional states, and comportment has been both celebrated and a cause of anxiety. There has
been much less ambivalence expressed in the nearly equally long-standing concern that
some people seem incapable of discontinuing the use of intoxicants even while acknowledg-
ing the harms arising from their consumption. Concerns about the problems of excessive,
chronic use of intoxicants are present throughout history and across the societies in which
they have been widely consumed. Despite the persistence and ubiquity of those concerns,
however, historians have not been inclined to speak of the history of addiction as they might
speak of the histories of famine, disease, violence, or other perennial afictions. Although
the essential psychoactive properties of alcohol have not changed and its metabolisation and
general efects on the human body have not substantially altered over time, addiction has
not been conceived as a discrete, historically constant phenomenon. Indeed, as modern de-
bates about its nature, causes, and meaning attest, while there is much shared concern about
consequences of excessive, chronic, harmful intoxicant consumption, there is no consensus
on what constitutes “excess,” “chronic” use, or “harm.” For the historian, then, the history
of intoxicant addiction is not simply a story of the evolving responses to a particular, fxed
aspect of the human condition, but rather it is the history of conceptions or constructions
of human responses to intoxicant use. As various scholars have observed, addiction has been
examined through several distinct lenses, and the range of problems associated with it have
been connected or distinguished in a variety of ways.1 Moreover, intoxicant addiction is
not a singular problem, but rather a cluster of variously connected problems whose causes,
nature, and imagined solutions are informed by other diverse historically shifting social,
cultural, political, and economic factors.
This selective survey of conceptions of addiction across a considerable range of historical
periods seeks to reveal something of both the range of factors and interests that have in-
formed various historical conceptions of addiction, while at the same time identifying the
persistence or reoccurrence of key ideas or forms of thinking on this matter. The framing
of this historical survey is informed by and engages with recent debates amongst modern
clinicians, theorists, and researchers about the nature and construction of addiction. Several

DOI: 10.4324/9780429058141-43 581

 David Clemis

scholars have ofered typologies of modern conceptions of addiction variously framed by

medical/scientifc essentialism; social constructionist and cultural studies perspectives; or,
more recently, science and technology studies and posthumanism.2 Elements of these various
recent perspectives, along with their values, and logics, can be identifed in earlier med-
ical, legal, and moral thinking about chronic, excessive consumption of alcohol. But this
historical examination and refection upon this subject is not simply an exercise in locating
analogues and antecedents of current concepts in addiction studies. Rather, it is hoped that a
genuinely historical approach may be stimulating and lend critical perspectives to contempo-
rary debates. Questions about moral agency or self-control, the nature of harm, the meaning
of dependence, together with cultural, scientifc, epistemological, political, and economic
framings of addiction, all feature largely in modern debates over the nature and meaning
of addiction. In refecting on these matters, it may be useful to consider various historical
understandings of chronic intoxicant use in relation to conceptions of the soul and body, the
nature of personal identity, and the problem of free will.
This chapter references selected instances in the history of conceptions of chronic in-
toxication to provide some sense of the range and possibilities of such thinking. In societies
where there is widespread use of intoxicants, thinking about their excessive, chronic use is
pervasive but often multifaceted because of the range of the economic, political, medical,
moral, and legal dimensions to the problems associated with chronic intoxicant use. Accord-
ingly, various conceptions of addiction within a given society may be diverse and sometimes
in tension. Distinct social interests or identities, as well as particular professional authori-
ties, generate difering perspectives on the matter. Thus, broad societal understandings of
addiction are informed by, and are composites of, various ideas and values emanating from
these distinct perspectives whose interaction and mutual responses often inform one another.
Charting the formation and interaction of such thinking is an important but vast task but
beyond the scope of this paper. Since the aim here is to historicise conceptions of addiction
in order to give some sense the range, possibilities, connections, and diferences of those
conceptions, this paper is principally concerned with understandings of the idea of addiction
as it appears principally in medical and legal discourses across time. The focus here is on the
examination of conceptions of intoxicant addiction over the broad course of Western his-
tory, with some reference to other regions. The principal focus is on alcohol consumption,
given the rich documentation of its ubiquity and very long history of continuous use.
Much recent scholarship on the history of addiction has been concerned with medical,
institutional, and public health policy responses in the nineteenth and twentieth centu-
ries. 3 Jose Cree and Rebecca Lemon have each recently produced studies of the usage of
the term addiction in the early modern period, when it is shown to have frst gained cur-
rency in English. These scholars explore how religious and literary texts articulate early
modern conceptions of addiction in terms of conceptions of the self and the relations be-
tween the individual and others (especially God or the Devil, but also lovers, friends, etc.).
In this context, addiction is a notion of wide but also subtle application.4 Jessica Warner has
suggested that something like the modern idea of addiction emerged in English religious
discourse in the seventeenth century.5 Warner acknowledges that there is much ambigu-
ity in the various early modern uses of the term “addicted.” Indeed, the use of the terms
“addicted” and “disease” was richer and less clinically restricted than is the case today, and
their use was in many instances rather metaphorical. Peter Frenetzy has noted that chronic
drinking was often listed amongst a variety of faults that were clearly not thought of as
diseases in any modern sense.6 These were not naturally occurring disorders of the mind
or body, but volitional acts.

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Te Ancient West
Across the range of Abrahamic, Greek, Roman, and other ancient texts, the loss of self-control
is a central feature in references to the heavy consumption of intoxicants. Certainly, there
are occasional Biblical references to wine’s capacity to “gladden the heart” and injunctions
to “give strong drink unto him that is ready to perish, and wine unto those that be of
heavy hearts. Let him drink, and forget his poverty, and remember his misery no more.” 7
Overwhelmingly, however, the concern in Scripture is over the consequences of excessive
drinking. Both the Old and New Testaments ofer repeated warnings: “Wine is a mocker
and beer a brawler; whoever is led astray by them is not wise”; and, “Do not get drunk on
wine, which leads to debauchery. Instead, be flled with the [Holy] Spirit.”8 To the modern
reader, these might appear to be cautions about the loss of self-control, but they are better
understood as calls to resist the inevitable temptation to sin. The diference has something to
do with what might be called the agency of the substance. In this ancient view, alcohol does
not displace or impair the self—there is no hijacking of cognitive processes here—rather,
intoxication simply weakens the capacity of the individual to resist the inevitable pull of sin.
It is important to recognise that abstinence or moderate consumption of intoxicants is itself
part of the righteous path which one ought to follow. In this context, intoxication is seen
through a moral, or rather, spiritual lens. Chronic drinking is persistent sinning rather than
some modern notion of addiction. In the sense that Lemon and Cree have identifed in the
early modern period, for the ancient Jews and early Christians too, chronic drinkers may
be addicted to drink, but they were not addicts so much as ardent sinners. In this view, the
integrity of the self is not diminished by intoxication such that moral agency could no longer
be ascribed to the drunkard.
Amongst Greek and Roman writers of the classical era, discussions of chronic drinking
were largely concerned with its evils and deleterious health and moral efects. There was not,
however, much consideration of the causes of chronic drinking, nor was there a sense that
the chronic drinker had a unique kind of problem. Dionysus and the rituals of bacchanalian
cults provided powerful images of the intoxicated person as wholly given over to a wilful
embracing of the irrational and various ecstatic pleasures.9 The god of wine’s hold on an in-
dividual might be irresistibly strong and dramatically transformative, compelling the drinker
to uncharacteristic and extraordinary behaviour, but this was not behaviour they regretted
nor sought to end. Further, as J. D. Rolleston observed nearly a century ago, in ancient
Greek and Roman writings, drunkenness was not generally seen as impairing cognition
such that moral agency was undermined. Indeed, Rolleston cites the proverbial claims in vino
veritas and “wine is the touchstone of character,” together with various episodes in classical
literature, all in support of the notion of “wine being the mirror of the soul.”10 This suggests
that although the drunken person’s comportment might betray a high level of intoxication,
their essential self remains intact. Thus, although excessive drinking might produce some
serious problems, the drunkard’s incapacity to give up persistent drinking in the face of ac-
knowledged harm was not amongst them, nor was their continuing cognitive impairment
seen to be such that they were “no longer themselves” and ought be absolved of culpability
for the harm they might do.11

Early Modern Galenism

This general sense of the character of intoxication and the nature of chronic, excessive
drinking is most richly developed in what might be called the Hippocratic/Galenic medical

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paradigm prevalent in Europe and its colonies of settlement from third century BC to the
later seventeenth century. The elements of this paradigm did not constitute a systematic,
unifed, or entirely coherent body of medical thought, and it evolved enormously over the
course of that period. What is referred to here as “Galenic medicine” encompasses thinking
originating in the writings ascribed to Hippocrates and Galen but upon which there was
much commentary and elaboration by subsequent pagan, Islamic, and Christian writers.12
Across this sprawling, manifold corpus on the human mind and body, conceptions of in-
toxication and addiction were remarkably consistent. Central to these views was the un-
derstanding of how psychoactive substances were understood to have their efects, and how
those efects were thought to bear on consciousness, personal identity or the self, and the
moral agency and culpability of intoxicated persons. As in the ancient literary sources noted
above, ancient, medieval, and early modern Galenic medical understandings of intoxication
were not such that individuals were subject to an enduring loss of self-control of the kind
that would become central to some modern notions of addiction. To understand how this
was so, it is important to recognise that the Galenic conception of the self and its engagement
with the mind/body problem is quite unlike that which would emerge in post-Cartesian
medicine in the seventeenth century.
Galenic medical writings from the ancient to the early modern periods asserted a unifed
sense of the self through a kind of ecological interaction of the mind or soul, the body, and
its external environment. At the heart of this scheme were the four humours: blood, yellow
bile, black bile, and phlegm. The character of each humour derived from its unique combi-
nation of two of the essential elements: earth; air; fre; and water. The humours, along with
the body’s key organs (the liver, heart, and brain), and the animal spirits, which animated
the body, were collectively known as “the naturals.” The temperament or complexion of
an individual arose from the particular balance of their humours. One’s mental and physical
health, indeed the constitution of one’s self, was a function of, or arose within, the com-
plex interaction of the naturals and their responses to six additional factors known as the
“non-naturals”: the physical environment; sleep; food and drink; exercise; and emotional
states.13 While the distinctions between mind and body were clearly recognised, they were
understood as two intimately bound aspects of the self. As the seat of consciousness and
conscience, the mind or soul might be deemed the more complex, interesting aspect of the
self, but the mutual interdependence of the mind and body meant that, normally, the un-
derstanding of mental states entailed an awareness of the condition of the body. As Robert
Burton wrote in The Anatomy of Melancholy:

For as the distraction of the mind, amongst other outward causes and perturbations,
alters the temperature of the body, so the distraction and distemper of the body will
cause a distemperature of the soul, and ‘tis hard to decide which of the these two do
more harm to the other.14

This view is evident in early modern medical writers’ discussions of intoxication and the me-
dicinal use of alcohol. Normally, the interaction of the soul and body was facilitated through
the movement of animal spirits, the fnest grade of matter, whose “natural heat” conveyed
the “power of the soul.”15 The composition of the spirits is very important; if they are impure
or “mingled with any strange or forraigne quality,” the “tanquillity of minde” is disturbed.
Francis Bacon, amongst others, observed that alcohol, or “spirits of wine,” displaced the nat-
ural animal spirits, thereby disrupting that tranquility of mind. The resulting “swift and un-
quiet motion of the spirits” also distorted vision, diminished motor control, and produced

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other features of drunken comportment.16 But the efects of alcohol consumption on a person’s
mental states could also be positive. Wine was widely prescribed as a remedy for melancholy
because it would strengthen the disturbed person’s “natural heat” and rebalance the excessive
black bile thought to be the cause of their depressive mental state. Wine might also be used
to relieve the unhappy and disconsolate as its “mild fumes and vapours so irrigate the braine,
that it may procure them quiet and comfortable sleepe….”17 Their connection meant that
the mind and body were consonant across a range of an individual’s physical, afective, and
moral conditions. As the German physician, Simeon Partlicius ( f. 1620–1624), wrote: “… the
body and soul are knit together by a certain Sympathy or Consent, and derive vertue and vice
from one another, and if there be such a Harmony between them, the one must needs require
help as well as the other….”18 Intoxication and chronic drinking were encompassed in this
vision. Such vices impacted and were expressed through the mind and body together. In the
mid-seventeenth century, the noted physician Humphrey Brooke wrote:

Tis observable, that there is a mutual infuence from the Body upon the Mind, and from
the Mind upon the Body:…That therefore thou mayest be Vertuous, keep they self in
good Health; that thou mayst be in good health, keep thy self Vertuous, and Regulate
thy Passions.19

Drunkenness was a vice that both arose and was experienced in both mind and body. Alco-
hol was understood to be a material substance that substantially afected the body produc-
ing intoxication which had mental efects: impaired cognition and distorted, extraordinary
emotional states and comportment.
Understanding the efects of alcohol and the nature of drunkenness in this way might
be thought to be problematic, given medieval and early modern Christians’ belief in the
immortal, immaterial nature of the soul, which was held to be the seat of consciousness and
conscience. This would ascribe an agency to alcohol that was neither technically explicable
nor theologically and morally acceptable. But the technical problem of how a material sub-
stance such as alcohol could afect the immaterial soul, and the doctrinally unpalatable asser-
tion that mental states might simply be the results of particular physiological conditions were
not engaged by early modern Galenic physicians’ thinking about intoxication and chronic
drinking. Such concerns would not arise and become problematic until the seventeenth cen-
tury’s post-Cartesian understanding of the dualistic self with its distinct elements of mind
and body, and when viewed through the lens of the period’s emerging empirically oriented
science. For Galenists such as Humphrey Brooke, Robert Burton, or Simeon Partlicius, the
self was not understood through the disaggregation and distinction of its component parts;
rather, theirs was an attempt to understand the individual as a union of mind and body and
in relation to the wider world. Human behaviour, then, was seen as rising in the context of
a kind of network of connections between the naturals (the elements of the body), non-nat-
urals (behaviours and bodily processes), and contra-naturals (diseases or causes of illness),
which together in the microcosm of the individual were connected to the macrocosm of the
universe.20 In several late Medieval texts, Philippa Maddern has seen the “indissoluble bond
between soul and body that alone constituted individual identity.”21 This conception of a
braided self intwining mental, moral, and physiological strands owed much to Medieval Ar-
istotelianism. Rejecting the Platonic detachment of the soul from the body, Thomas Aquinas
asserted that the soul was the form of the body, thus establishing the integral connection of
body and soul. Through this lens, the soul was seen as the formal cause of the body, which
together constituted the self.22

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This framing of the matter helped shaped medieval and early modern Galenistic accounts of
intoxication and chronic drinking as epistemological projects. The Galenist’s aim was to explain
the condition of patient’s body, mind, and environment as they constituted the whole self. The
efects of alcohol on the body, mind, and behaviour of an individual were not understood essen-
tially in causal mechanical and chemical terms (although there is something of that) but rather
as diferent manifestations of an essential moral quality of the individual. Thus, alcohol was not
seen as interfering with the brain and causing faulty reasoning—as might be the case in later,
more modern accounts of intoxication.23 Rather, for the Galenist, the state of the drunken body,
the malfunctions of cognition and perception, the distortions of emotions, and strained social
relations were all distinguishable aspects of a singular disturbed condition in a given drunken
individual. Certainly, the language of causation appears in Galenist medical writing—alcohol
dislodges the animal spirits resulting in slurred speech and misperceptions—but in terms that
might bear on the moral culpability of the drunken person, or in which we might say that chronic
intoxication undermines moral agency, the Galenist would see these less as causes of cognitive
failure, but rather as coincident with it. The various causes and manifestations of drunkenness are
all simultaneously related to who the person fundamentally is. Drunkenness arose in the course
of the interaction of the naturals and non-naturals that are constitutive of an individual’s con-
dition and identity. It is not as if there is an essential, normal, core self (a post-Cartesian idea of
the self) that has been interfered with by alcohol. It is not the case that one could be said to have
lost self-control because of intoxication; rather, the self arises from the interaction of the naturals,
non-naturals, and contra-naturals in the context of the individual’s complexion. When the con-
sumption of alcohol, a non-natural, gives rise to intoxication, that is who an individual is; and
that self is culpable for what it does. In this view, drunkenness is less something that happens to the
body and the mind, than it is a simultaneously interwoven moral, social, as well as physiological
condition, and state of cognitive impairment.24
The key elements of modern conceptions of addiction are not readily apparent in these late
medieval and early modern notions of the self, intoxication, and chronic drinking. There are
some interesting parallels between Galenic ideas about chronic drinking and some aspects
of recent neuroscience/brain disease and multifactorial accounts of addiction, especially in
terms of the interaction of physiology, social environments, and behaviours.25 Nevertheless,
as discussed above, the Galenists did not conceive of the self in such a way that substantially
accords with modern notions of loss of self-control. The drunkards’ “enslavement” to their
vice and sins arose from, or was an expression of, their essential selves; it was not simply the
unintended consequence of succumbing to the psychochemical efects of alcohol. The physi-
ological, spiritual, social, and moral harm of chronic drinking does feature largely in medical
and moralistic tracts of the sixteenth and seventeenth centuries. Yet, while there is regret for
sinfulness, there is nothing akin to a key element in modern conceptions of addiction: an
acknowledgement of the harmfulness of chronic drinking together with an expressed desire
to stop, which is, nevertheless, frustrated by some experience of dependence, compulsion, or
failure of volition owing to the agency of an intoxicating substance.
Before composition of the Christian Galenist texts, the materia medica of Islamic physi-
cians in the medieval and early modern periods included alcohol. Indeed, especially in cases
of mental health problems, Christian medical writers cited the Persian physician Avicenna
(Ibn Sīnā, 480–1073 AD) and his recommendation that occasional drunkenness might ease
the efects of melancholy.26 But the general proscription against intoxication and even the
consumption of alcohol meant that, for the most part, intoxication and chronic drinking
were thought to be moral and religious failings. Hence, amongst most Islamic physicians, the
agency of the chronic drinker was implied.27

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In ancient and medieval China, views of intoxication and chronic drinking were essen-
tially similar to those in the Galenic West. Chinese literary texts occasionally celebrated
intoxication as a means to lift spirits, and so drunkenness itself was not thought to be neces-
sarily a bad thing.28 Indeed, perhaps most famously, the poet Li Bai observed in the eighth
century:

To drown the ancient sorrows,

we drank a hundred jugs of wine
there in the beautiful night.29

Also in the eighth century, the Japanese poet Ōtomo Tabito found a more bitter sweet relief
in a perhaps more authentic, if intoxicated, frame of mind:

Rather than be wise

Churning out words,
Better drink your saké,
And weep drunken tears.30

In the early fourteenth century, Yoshida Kendō decried the vulgarity and loathsomeness
of the drunkard; yet, he could not help acknowledging that “a drinker is amusing, and his
ofence is pardonable.”31 Still, both Chinese and Japanese medieval writers show the same
concern about chronic excess as the Galenist writers in the European and Islamic worlds.
In the late sixteenth century, Lo Yü-jen wrote scathingly of the drunkenness of the Wan-li
Emperor and his addiction to vice.32 Translators’ use of the English word “addiction” in
poetic and literary descriptions of chronic drinking in ancient and medieval Chinese texts
seems apt, given the sense of the word in European texts of the period. This is not a modern
notion of addiction in which a kind of agency is ascribed to intoxicating substances which
impairs self-control. Rather, in all of these societies, the key to addiction or chronic intox-
ication is the moral weakness of the drinker. Amongst his many refections on the efects of
drinking, Li Bai observes that, “Wine does not delude people, they delude themselves.”33

Seventeenth-Century Empiricism and Eighteenth-Century Neurology

In the Western world, over the course of the seventeenth century, Galenic medicine gave
way to new “iatrochemical” and “iatromechanical” approaches that gradually changed the
theory, methods, and practice of medicine, but they did not precipitate modern addiction
theory. Nevertheless, the “medical revolution of the seventeenth century” did signifcantly
change the character of medical approaches and conceptions of chronic drinking.34 The
epistemological frame of the new medicine was strongly empirical and bore the infuence of
Cartesian dualism in its separation of mind and body. Herman Boerhaave (1668–1738), for
example, maintained that, although the mind and body constituted an interactive unity, they
nevertheless were of completely distinct, diferent natures. Moreover, despite mind-body
interaction, Boerhaave believed that the physician could know nothing about either the
particular workings of the mind nor the nature of its connection to the body. The doctor’s
sphere, then, was clear:

… the great Business of a Physician is to be acquainted with the Means of restoring lost
Health, and no cure can be efected by him, but through some Change in the human

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 David Clemis

Body by the Application of others, therefore this Search after the Connexion between
the Body and the Mind not appertaining to a Physician is to be rejected….The Physi-
cian, who cures the Diseases of the body, is not sollicitous about those of the Mind; for
when the frst is set to rights, the latter will quickly return to its Ofce.35

Because physicians could neither explain the physiological basis of the compulsion to drink,
nor reliably and consistently treat that condition, such efectively dualist iatromechanical
views had the practical consequence of assigning the physiological consequences of habitual
drinking to physicians, while leaving the causes to moralists. This comfortably accorded
with theologians’ views that the immaterial soul, the seat of consciousness and conscience
could not be afected by a material substance such as alcohol. As a consequence, the sin/vice
understanding of chronic drinking became yet more frmly entrenched.
In the early eighteenth century, moralists and physicians, who essentially wrote as moral-
ists, strongly afrmed the drunkard’s self-control. Certainly, drink was tempting, but it was
the path of sin and personal destruction. Nevertheless, it was believed that individuals had
the power to resist such temptation, as a 1712 tract put the matter:

Therefore the only way to avoid being Drunk is to exercise your intellects, and the Fac-
ulties of your Mind, especially your Memory; to remind you of the Filithy Discourses,
and Sights, which you have heard, seen or read of Drunkenness, as also of the Madness
and Follies, committed [by] Lewd and Debauch’d Persons, in their Excesses of Drink-
ing, and by Drunkards, the Ruin and Destruction of their Bodies, Goods, and Estates,
and the Danger of their Souls Emanently pursuing.36

As Roy Porter has observed, across the eighteenth century, many elements of modern dis-
ease conceptions of addiction appear in the writings of various physicians and moralists.
But it is important to note that while there are occasional assertions of the loss of self-con-
trol, substance dependence, agency of substance, acknowledged harm, and descriptions of
chronic drinking as a disease, there is often ambivalence and sometimes stark contradic-
tion in eighteenth-century thinking on chronic drinking. Stephen Hales’ 1733 pamphlet, A
friendly admonition to the drinkers of brandy, and other distilled spirituous liquors, clearly illustrates
the tensions in the thought of this period. Hales describes the drunkard as enslaved and ad-
dicted, although the drunkard’s moral agency is emphasised:

Then how much more should those who have been addicted to Drunkenness, bri-
dle their Appetite, and abstain from Intemperance, notwithstanding they have thereby
brought upon themselves such an unnatural depraved Thirst, as gives them great Uneas-
iness to forbear drinking…37
No Habit, however long in contracting, is impossible to be removed; it may be done,
though with some Difculty. There is no one so far gone in the Disease of Drunkenness,
or any other Sin whatever, but there is room for a Cure…38

And yet, so powerful is the hold of alcohol that the chronic drinker is without volition:

To recover him from this Condition, he must be, as it were, forced into his Liberty, and
rescued, in some measure, from his own depraved Desires; he must be dealt with like a
Madman, and be bound down, to keep him from destroying himself.39

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 Conceiving addiction

Hence we see what little Hopes there is of reclaiming, by any Arguments whatever,
these miserable Wretches, who are thus inslaved. For these Reasons, Men ought to be
extremely cautious, how on any Pretence whatsoever they indulge the Beginnings of so
pernicious a Custom…40

In the frst half of the eighteenth century, the era of the “Gin Craze,” it may be that the
perception of a spectacular increase in the consumption of higher alcohol by volume
distilled spirits destabilised the notion that chronic drinking was simply a matter of
bad moral choices and that the qualities of alcohol were seen by some as a factor in the
problem.41 Yet, in the absence of a compelling medical explanation of the mechanism
or process of dependence, the drunkard’s ultimate moral agency was still widely and
strongly asserted.
Most historians generally accept that it was not until the end of the eighteenth century,
with the work of Benjamin Rush and Thomas Trotter, together with the beginnings of the
temperance movement and the emergence of the psychiatric profession, that a recognisably
modern disease concept of chronic drinking began to gain purchase.42 It did so because over
the course of the eighteenth century, there developed a new neurological aspect of medicine
that was able to overcome the empirical, epistemological barriers and mind/body dualism
that had prevented iatromechanical medicine from seeing chronic drinking as a disease.
There had long been much discussion of the nerves and their bearing on mental health. But
from the mid-eighteenth century, medical writers professionally appropriated neurological
discourse as they became particularly concerned with the nervous system.43 With respect
to thinking about intoxication, these developments began in 1749 with David Hartley’s
Observations on Man, which proposed that mental states and behaviour could be explained
through the processes of the body’s neurological system. Infuenced by Newtonian physics
and Lockean concepts of sensation, perception, ideas, and association, Hartley held that the
vibration and conveyance of minute particles were the means by which perception, cogni-
tion, and the sensations of pleasure and pain were generated. He believed that alcohol intox-
ication had a particular efect on the body and mind: “[t]he common and immediate efect
of wine is to dispose to joy, i.e., to introduce such kinds and degrees of vibrations into the
whole nervous system or into separate parts thereof as are attended with moderate continued
pleasure.”44
This general conception of the nervous system and its particular understanding of intox-
ication were elaborated in subsequent discussions of intoxication and chronic drinking. In
the 1790s, Erasmus Darwin and John Coakley Lettsom asserted that, while alcohol produced
pleasure, it so damaged the nerves that the exercise of volition was undermined.45 William
Cullen was not directly concerned with intoxication; yet, his work constituted an important
step towards seeing that defective patterns of perception and cognition were the consequence
of neurological damage. It came to be held that physicians did not need to physically observe
such neurological damage and repair it in order to aid patients. It was thought that it might
be enough to understand patients’ patterns of perception and cognition to treat psychological
afictions.46 It was this general scheme that allowed Thomas Trotter, Benjamin Rush, and
those who followed them, to see chronic drinking as a disease. As Trotter observed: “[t]he
habit of drunkenness is a disease of the mind. The soul itself has received impressions that
are incompatible with its reasoning powers.”47 Rush observed that although the chronic
drinker initiated their afiction through the free exercise of choice, the habit of drinking
transformed intoxication into a necessity.48

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Te Nineteenth Century: Disease and Alcoholism

This disease conception of chronic drinking did not preclude the language of vice in the
writings of either physicians or more popularly oriented moralists. The decision to per-
sistently consume alcohol to the point of intoxication was, of course, thought to be a great
moral fault, and the nineteenth-century temperance movements devoted themselves to
dissuading people from choosing to start down that path. But with the wider acceptance
and elaboration of Trotter’s and Rush’s disease concept, the sense of drunkenness as a vice
shifted. While the habit of chronic, heavy drinking was understood to be freely made, and
so was morally condemned, the neurological damage it inficted was seen as resulting in a
loss of self-control. In 1832, Robert Macnish observed that

moral lectures do not come within the scope of a medical treatise, and seem to be of
little use at any time in terrifying drunkards from the continuance in their destructive
vice….Drunkenness debases and brutifes the intellect so much, that neither moral nor
religious considerations have any great efect upon it.49

As William Bynum has observed, Carl von Brühl-Cramer’s infuential Ueber die Trunksucht
und eine rationelle Heilmethode derselben (1819) even more strongly eschewed moral or spiritual
considerations in characterising the chronic drinker asserting: “since moderate drinking
is not considered immoral, the disease cannot be immoral.”50 Brühl-Cramer conceived of
“dipsomania” (Trunksucht) entirely as a disease manifest as “an involuntary desire for the use
of ardent spirits.”51 It was seen as arising from a predisposition and had to be treated through
medicines and dietary management.52
Although the language of disease had long been part of physicians and moralists’ accounts
of addiction, in the work of Rush, Trotter, and their successors, the formulation of the idea
of addiction as a disease was importantly diferent in two ways. First, it did not invariably
reference sin. Sin and disease had long rhetorical and conceptual associations, but these did
not carry on into the new medial discourse of chronic drinking in the nineteenth century.
Certainly, vice was spoken of, but vice did not have the inevitability or universality of
sin. Drunkenness, as a vice could be avoided, and while some might succumb to it, others
did not. Second, this disease conception of chronic drinking was invoked because disease
could be treated. Such physicians believed that they could “cure” chronic drinking, and so
throughout much of the nineteenth century, there were a variety of therapeutic approaches
and experiments in search of successful treatments for chronic drinking.
Habit was critical in the conception of the diseased will, and it became central in its cure.
Rush held that the habit “may be easily broken” through substitution of other drinks such as
cofee, “simple water,” and wine (the disease of chronic drinking was thought to arise from
distilled spirits).53 Most medical writers in the nineteenth century, however, acknowledged
how difcult it was to repair the will and enable the chronic drinker to give up the habit.
Trotter observed: “the cravings of appetite for the poisonous draft are to the intemperate
drinkers as much the inclinations of nature for a time, as a draught of cold water to a traveller
panting with thirst in a desart.”54 Accepting that the volition of the chronic drunkard was
damaged and hard to repair, Macnish sought to provide an account of the physical and men-
tal sufering caused by excessive consumption in hopes of discouraging it in the frst place.55
As the nineteenth century progressed, various experts proposed regimes for the refash-
ioning or reviving of the drunkard’s will. In 1812, Benjamin Rush proposed that both as
an act of charity and in the public interest, drunkards should be confned to a hospital “for

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the exclusive reception of hard drinkers.” He reasoned that the harm drunkards inficted
upon their families and society warranted confnement in the same way the incarceration of
thieves did. Having been committed to such a “sober house” by a court of physicians and
magistrates, the drunkard, under the direction of a physician, would abstain from ardent
spirits, have their food regulated, work for their own or the public beneft, and be subject
to “all the religious, moral, and physical remedies” that Rush believed to be helpful.56 This
notion was adopted and championed by J. Edward Turner, who endorsed and developed the
inebriate asylum concept in a paper in 1854.57 Four years later, Turner founded the New
York State Inebriate Asylum, which took its frst patients in 1864. Turner articulated an in-
fuential vision of inebriety as a disease. Against critics of that view, he argued that although
drunkenness entailed moral degradation, it was nevertheless a disease with an “independent
pathology and morbid anatomy, which is as well marked and defned as the morbid anatomy
of any disease that the human family is heir to.”58
Perhaps inevitably, this new disease conception shifted focus from the moral qualities of
the drunkard to the agency of the substance alcohol. The very rich historiography of tem-
perance movements and alcohol regulation tells the story of the perceived threat of alcohol
in the nineteenth and twentieth centuries.59 This understanding of the power of alcohol to
destroy the will prompted many physicians to proclaim the importance of their profession
in dealing with what came to be seen as a major social problem. The disease concept and
the public health threat of chronic drinking were infuentially brought together in Mangus
Huss’ Alcoholismus chronicus (Chronic Alcohol Disorder) (1849–1851), which coined the potent
and enduring term “alcoholism.” The public health efects of drinking led many physicians
to frst express concern about the misuse of alcohol and eventually to join in calls for temper-
ance.60 These concerns resulted in the foundation of the American Association of the Study
and Cure of Inebriety in 1870 and its British counterpart in 1884.
As Mariana Valverde has shown, physicians’ formulation of the disease concept of chronic
drinking became enmeshed in the various interests and agendas of moral reformers, phy-
sicians, jurists, and legislators. Inevitably, wider social and cultural tensions exposed the
concept’s limitations and saw it wrenched in diferent directions by the period’s ideological
conficts and competing social visions. The notion of a disease of the will, the remedy of
which required an exercise of the will, left a rather indeterminate role for the physician and
left open the intervention of non-medical agents. More signifcantly, this paradox made
legislation on the institutional commitment of inebriates impractical, thus exposing the in-
coherence of this framing of the disease concept.61 It is evident that before the First World
War, the disease concept originating with Rush and Trotter but most fully articulated by J.
Edward Turner and Norman Kerr was no longer infuential. The legislation and institutions
it had inspired proved impractical and, failing to realise its vision, were eventually aban-
doned. The American Association of Inebriety dissolved in 1912 and Britain’s Society for the
Study of Inebriety became a much diminished force.62

Te Twentieth Century: Te Meanings of Disease

While the decline of these institutions signalled the collapse of this iteration of the disease
model, a general notion of chronic drinking as a disease persisted in the discourse of phil-
anthropic organisations such as the Salvation Army and Alcoholics Anonymous (AA). But it
did so largely to the extent that it was congenial to the aims of reducing the stigma attached
to chronic drinkers and conveying a sense of the powerful the grip of alcohol upon them.
Harry Levine has suggested that after prohibition, the essence of the problem of alcoholism

591
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was relocated to the body of the individual; it is only some people who, “for reasons un-
known, become addicted to alcohol.”63 Thus, while the notion of disease is present in the
AA approach, it is reframed in acknowledgement of the particularity of every individual. In
this view, the paradox of chronic drinking as a disease of the will that can only be overcome
by acts of the will is not found troubling, but rather is embraced. In this view, alcoholism is a
condition of ongoing personal crisis whose resolution will only come by the recovery of the
self through personal, spiritual development.64
It was not until the 1940s that physicians again engaged in substantial new thinking
about the causes and treatment of chronic drinking. Initially, through the work of E.M.
Jellinek, the basis of the disease conception shifted.65 Turner, Kerr, or Brühl-Cramer be-
lieved chronic alcohol drinking to be a disease in which the substance destroyed bodily
tissues producing a range of deleterious physiological and psychological conditions leading
to various moral and social harms. Jellinek redefned the disease in terms of the drinker’s
loss of control and the harms that arose therefrom. His infuential fve categories of prob-
lem drinking patterns arranged conceptions of loss of control and harm together with their
severity and duration in a typology that spanned a range of drinking behaviours and their
consequences. In only two of these categories was the loss of control deemed sufcient
to constitute a disease. This model retained some of the virtues of the old disease con-
cept—attempting to reduce stigmatisation and conveying a sense of the afiction’s strong
grip—and it better accorded with common understandings of the experience of chronic
drinking. That it did so was the inevitable consequence of Jellinek’s principal research
subjects: members of AA.66 Efectively, the new model used a scheme of harms and markers
of loss of control as diagnostic signs, which became the symptoms and defning character-
istics of the disease. Scholars and researchers have subsequently found the evidentiary basis
for Jellinek’s model wanting, but its infuence has been enormous. It was embraced by AA,
and institutionally entrenched at the Yale Centre for Studies in Alcohol (1935), the Na-
tional Council of Alcoholism (1950), and the World Health Organization, where Jellinek
was active in the 1950s.67 Yet while the post-Jellinek framing of harm and loss of control
within a disease framework became the basis of much medical and expert discourse on
alcohol problems, the vision of a disease characterised by a clearly delineated aetiology and
discrete set of symptoms slipped from view. As Valverde has shown, Jellinek’s approach
was eclectic and infuential but the lines of infuence were various and divergent.68 In the
later twentieth century, the term “disease” became less widely used, but the notions of
harm, loss of control, and the sense of the condition as an afiction all featured very largely
in expert discourse and conceptions of drug and alcohol problems. They were entrenched
in the successive diagnostic schemes of the W.H.O.’s ICD and the American Psychiatric
Association’s DSM. Notions of harm and loss of control then became key elements in the
conceptualisation of addiction and deeply informed subsequent research, as well as at-
tracted considerable scholarly commentary.69
This research is often seen as dividing into either sociological or biomedical accounts of
addiction. Darin Weinberg has observed that contemporary social science understandings of
addiction are largely derived through social interactions (between clinicians and patients) in
which the object of study is the nature of the patient’s wider social interactions in the course
of their lives.70 Jellinek’s typology and the diagnostic criteria of successive editions of ICD
and DSM have drawn much scholarly commentary for their construction and use of social
interactions. What constitutes harm must invariably be cast, in large measure, in terms of
local social contexts that may vary considerably across and between societies and over time.
Note, for example, two of the DSM’s criteria:

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6. Continued alcohol use despite having persistent or recurrent social or interpersonal

problems caused or exacerbated by the efects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced be-
cause of alcohol use.71

The conception of these problems and activities, their signifcance, and the manner and
extent to which they are afected by the chronic drinker’s alcohol consumption all admit
to considerable variability. Various sectional or community identities, as well as shifting
cultural norms, undermine the coherence and stability of these criteria in the construal
chronic drinkers’ experience. While this may not undermine practitioners’ confdence in
the criteria’s local clinical utility, it does mean that they do not readily yield a technically
coherent, consistent, universal concept of addiction. Furthermore, the identifed harms that
constitute the criteria of alcohol use disorder are difcult to disaggregate from other causes
of social, psychological, and physiological harm. Poverty, various forms of social exclusion,
and/or mental health problems make the distinct conception of alcohol use disorder difcult
to establish. Other cultural factors, too, have made this conception of alcohol use disorder
problematic. This model relies on the chronic drinker’s self-reporting of their desires, ex-
periences, and cognitive and afective states. Thus, it relies on an understanding of the self
rooted in modern conceptions of subjectivity and personal identity which are increasingly
contentious. Similarly, the notion of loss of self-control, as diagnostic criteria, depends on
contentious historically contingent values and measures pertaining to conception of the self
and self-regulation within changing patterns of economic, social, and cultural relations.72
Recent neuroscience-based accounts of addiction as a brain disease have become preem-
inent. The increasing infuence of this approach owes much to its empirical grounding and
its reinforcement of the loss of self-control element of the disease model.73 Explanations of
addiction, and especially relapses into harmful substance use in terms of a “hijacking” of the
“neural reward system,” have provided an empirical, medical explanation that appears to
preserve a place, initially at least, for the substance user’s agency. As NIDA director, Nora
Volkow, has put the matter:

…most drugs of abuse exert their initial reinforcing efects by activating reward cir-
cuits in the brain and that, while initial drug experimentation is largely a voluntary
behaviour, continued drug use impairs brain function by interfering with the capacity
to exert self-control over drug-taking behaviours and rendering the brain more sensitive
to stress and negative moods.74

Various scholars have been critical of inferences or speculations about the nature of addiction
that extend beyond existing biomedical evidence. It has been suggested that the hijacked
neural reward system model is not yet sufciently detailed to defne the limits of addiction.
Its extension into “process addictions,” including such as activities as sex, gambling, and
digital gaming, suggests that anything producing pleasure and stimulating dopamine is, in
principle, potentially disease-addictive.75 Weinberg has argued that such biomedical accounts
of addiction fail to embrace how “cultural learning and social context shape whether and
how drug use becomes pleasurable or compelling.” 76 In the face of the diferences amongst
people’s pleasure in drug taking, and the fact that their experiences of intoxication can be
circumstantially contingent, Weinberg questions biomedical accounts’ claims that “the in-
gestion of certain chemicals invariably produces pleasurable experiences.” 77 Although its pro-
ponents suggest that “neuroscience identifed addiction” should be understood “as a chronic

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 David Clemis

brain disease with strong genetic, neurodevelopmental, and sociocultural components,” 78

Helen Keane has observed, those sociocultural components are “relegated to the vague back-
ground realm of ‘environmental infuences’ or refgured as efects of disordered brain chem-
istry.” 79 Indeed, it is difcult to see how, in the current construction of biomedical accounts,
it could be otherwise. It is not presently possible to map the sociocultural experience of the
chronic substance user into the neuroscientifc understandings of mental states. The key to
the notion of the loss of control must lie in the conception of the nature of the self as a con-
scious agent, which is apparently enmeshed, or perhaps, constructed, within an ecology of
social, cultural, and physical conditions. Weinberg asserts that “it is absolutely indispensable
for addiction research to include clear concepts of what the self actually is such that we fnd
it capable of moving into and out of control of human actions in the frst place.”80 This may
well be, but it engages the enormous philosophical and psychological questions of what the
self is, what it controls, and what it means to say that the self does or does not have control.
These are matters going to the heart of what constitute the parameters of the self, and what
are the contexts, inputs, and conditions of its agency.

Conclusions: Te Intoxicated Self through History

It is tempting to assert that the history of Western medicine’s various attempts to under-
stand chronic drinking are crudely reducible to shifting conceptions of the self. A richer
grasp of the matter will acknowledge that conceptions of the self and the idea of addiction
have been subject to the social, moral, and political climates, as well as the epistemological
frames through which they have been constructed. In the general Galenic understanding of
chronic drinking, personal identity is preserved, and however extraordinary or problematic
the drunkard’s behaviour, their essential self-control and moral culpability is retained. In
this construction of the self through the interaction of the mind, body, and environment,
chronic drunkenness is, in efect, a kind of expression of the self. As the new epistemological
frame of the seventeenth-century medical revolution prompted a more empirically driven
conception of what constitutes medical understanding and knowledge generation, the self
was cast within a Cartesian dualistic framework. The empirical inability to account for the
formation of mental states meant that drunkards were held to be ensnared by their own vice.
Over the course of the eighteenth century, with the waning of theological demands that the
soul be conceived as the immaterial seat of consciousness and conscience, intoxication and
drunkenness came to be understood as arising from alcohol-induced neurological damage. It
then became possible for something of a modern disease concept to emerge in which loss of
self-control can be alleged—this is an idea of the displaced or impaired self. Certainly, neither
within the feld of medicine nor more broadly across society was this paradigm universally
accepted. Nevertheless, despite its considerable reconfguration from the time of Rush and
Trotter to Turner and Kerr, the disease concept of chronic drinking exerted great infuence.
Jellinek and the second iteration of the disease concept proved to be so infuential because it
was rooted in the categorisation of behaviours rather than particular strong conception of the
self. This enabled researchers to elaborate on Jellinek’s basic model in a variety of diferent
ways. It thus informed or set the parameters for both much biomedical and sociocultural
research. The synthesis that is proposed in the conception of addiction “as a chronic brain
disease with strong genetic, neurodevelopmental, and sociocultural components,”81 however
problematic contemporary scholars may fnd it, interestingly bears some similarity to the
Galenic view in its eclectic, cross-disciplinary aspirations. Both are constructed beyond the
dichotomous sin/vice versus disease/medicalised delineation of conceptions of addiction that

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inevitably arose out of seventeenth-century medicine’s embracing of a mind/body dualism

and the virtual detachment of mental states from physiological conditions. Neuroscience
fndings, particularly relating to neuro-plasticity, as well as work in the social sciences, have
led some addiction experts to emphasise that choice is seen as not necessarily rational, and
that the complex interaction of physiological conditions with cognitive acts problematises
the notion of self-control.82 Such addiction theorists posit a complexity of mind/body inter-
action which efectively transcends the old mind/body dualism and dissolves the free choice
versus disease dichotomy.
However, it is important to note that early modern Galenists seldom engaged the prob-
lem of how material and immaterial substances interact. For them, it was simply not the
key problem, and its resolution was not necessary within their epistemological framework.
Theirs was as a kind of Aristotelean understanding of the soul as the animator of life in which
psychological and biological explanations were not completely distinct, discrete aspects of
one’s being.83 Moreover, the primary aim of their accounts was to understand the person as
an integrated whole. Thus, the qualities and character of intoxication, which are now com-
monly understood within various distinct social, moral, physiological, and psychological
categories, were, for the early modern Galenist, much more likely to be woven together
within a more comprehensive conception of intoxication. In this way of thinking, the efects
of alcohol on the body (a non-natural efect on the natural self ), its impairment of cognition,
and the social context and consequences of drinking were all seen as of a piece. The moral
agency of the drunkard could not be denied because their inclination to drink, the character
of their drunken comportment, together with the personal and social impacts of their drink-
ing, all simultaneously arose from, and were constitutive of, their self. In the twenty-frst
century, there is no consensus on anything like such an integrative, expansive conception of
the self; nor is it at all clear what such an idea would entail. It may be that in its absence, the
marrying of biomedical and sociocultural conceptions of addiction will remain a challenge.

Notes
1 Robin Room, “The Cultural Framing of Addiction,” Janus Head 6, no. 2 (2003): 221–234; Helen
Keane, “Addiction: Critical Refections on a Debated Concept,” in The Sage Handbook of Drug &
Alcohol Studies, edited by Betsy Thom, Geofrey Hunt, and Torsten Kolind (Thousand Oaks: Sage
Publications, 2016), 367–381; Grifth Edwards, “The Trouble with Drink: Why Ideas Matter,”
Addiction 105, no. 5 (2010): 797–804; Craig Reinarman, “Addiction as Accomplishment: The
Discursive Construction of Disease,” Addiction Research & Theory 13, no. 4 (2005): 307–320.
2 Suzanne Fraser, David Moore, and Helen Keane, Habits: Remaking Addiction (London: Palgrave
Macmillan 2014); Helen Keane, “Addiction: Critical Refections”; Darin Weinberg, “Post-Hu-
manism, Addiction and the Loss of Self-Control: Refections on the Missing Core in Addiction
Science,” International Journal of Drug Policy 24, no. 3 (2013): 173–181.
3 Jean-Charles Sournia, A History of Alcoholism (Oxford, New York: B. Blackwell, 1990); Mariana
Valverde, Diseases of the Will: Alcohol and the Dilemmas of Freedom (Cambridge; New York: Cam-
bridge University Press, 1998); Berridge, Demons: Our Changing Attitudes to Alcohol, Tobacco, &
Drugs (Oxford: Oxford University Press, 2013); Virginia Berridge and Alex Mold, “Special Issue
on Concepts of Addiction in Europe, 1860s-1930s,” Social History of Alcohol & Drugs: An Inter-
disciplinary Journal 28, no. 1 (2014); Virginia Berridge, Jennifer Walke, and Alex Mold, “From
Inebriety to Addiction: Terminology and Concepts in the UK, 1860–1930,” Social History of
Alcohol & Drugs: An Interdisciplinary Journal 28, no. 1 (Winter 2014): 88–106; Dan Malleck, “The
Meaning of Addiction in the Rubbing Alcohol Habit: The Rise and Fall of the Rubby,” Social
History of Alcohol & Drugs: An Interdisciplinary Journal 25, no. 1/2 (Fall 2011): 130–147; David T.
Courtwright, The Age of Addiction: How Bad Habits Became Big Business (Cambridge: Harvard
University Press, 2019).

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4 Jose Murgatroyd Cree, “Protestant Evangelicals and Addiction in Early Modern English,” Re-
naissance Studies 32, no. 3: 446–462; Jose Murgatroyd Cree, “The Invention of Addiction in Early
Modern England” Ph. D., University of Shefeld, 2018; and Rebecca Lemon, Addiction and Devo-
tion in Early Modern England (Philadelphia: University of Pennsylvania Press, 2018).
5 Jessica Warner, “`Resolv’d to drink no more’; Addiction as a preindustrial construct,” Journal of
Studies on Alcohol; 55–56 (1994), 685, 689; and Jessica Warner, “Before There Was ‘Alcoholism’:
Lessons from the Medieval Experience with Alcohol,” Contemporary Drug Problems 19, no. 3 (1992):
409–429.
6 Peter Ferentzy, “From Sin to Disease: Diferences and Similarities between Past and Current Con-
ceptions of Drunkenness”, Contemporary Drug Problems 28 (2001): 363–390.
7 Psalms 104:15; and Proverbs 31:6–7 (King James Version).
8 Proverbs 20:1; and Ephesians 5:18.
9 Sournia, A History of Alcoholism, 5–6; and Andrew Dalby, The Story of Bacchus (London: British
Museum Press, 2005).
10 J. D. Rolleston, “Alcoholism in Classical Antiquity,” The British Journal of Inebriety XXIV, no. 3
(1927): 104–105.
11 Rolleston, “Alcoholism in Classical Antiquity,” 101–120.
12 Owsei Temkin, Galenism: Rise and Decline of a Medical Philosophy (Ithaca: Cornell University Press,
1973), 103.
13 The humoral system during the Renaissance is described in Mary Lindemann, Medicine and Society
in Early Modern Europe, 2nd ed. (Cambridge: Cambridge University Press, 2010), 14, 88; Valen-
tin, Groebner, “Complexio/Complexion: Categorising Individual Natures, 1250–1600,” in The
Moral Authority of Nature, edited by Lorraine Daston and Fernando Vidal (Chicago: University of
Chicago Press, 2010), 361–383. Fernando Vidal, The Sciences of the Soul: The Early Modern Origins
of Psychology (Chicago, Ill: University of Chicago Press, 2011) 34–35; and Harold J. Cook, “Med-
icine and the New Philosophy in Seventeenth-Century England,” in Reappraisals of the Scientifc
Revolution, edited by David C. Lindberg and Robert S. Westman (Cambridge: Cambridge Uni-
versity Press, 1990), 397–436.
14 Robert Burton and Holbrook Jackson, The Anatomy of Melancholy (New York: New York Review
of Books, 2001), I: 374.
15 Thomas Sydenham, Dissertatio Epistolaris ad Gulielmum Cole, M.D. de Observationibus nuperis circa
curationem variolarum confuentium Nec non de Afectione Hysterica Per Tho. Sydenham, M.D. (London:
Walteri Kettilby, 1682), 103, 105, 119, 121f, 123, & 126; Levinus Lemnius, The Touchstone of
Complexions… (London, 1633), 11; see also Hansruedi Isler, Thomas Willis, 1621–1675: Doctor and
Scientist (New York: Hafner Publishing, 1968), 135–137; and, Richard Sugg, Smoke of the Soul:
Medicine, Physiology and Religion in Early Modern England (London: Palgrave Macmillan, 2013), 3–4.
16 Francis Bacon, Sylva Sylvarum: Or a Naturall Historie. In Ten Centuries… Published after the Authors
Death. By William Rawley (London, 1627), 187; and Levinus Lemnius, The Touchstone of Complex-
ions… (London, 1633), 11–13, 24, 78–79, 237–281.
17 James Hart, 𝛫𝛬𝛪𝛮𝛪𝛫𝛨 [Klinike] or the Diet of the Diseased (London: J. Beale for R. Allot, 1633),
123.
18 Simeon Partlicius, A New Method of Physick: Or, a Short View of Paracelsus and Galen’s Practice…;
(London: Peter Cole, 1654), 45.
19 Brooke, Humphrey, Ugieine or a Conservatory of Health…. (London: G. Whittington, 1650),
224–225.
20 Jacques Bos, “The Rise and Decline of Character: Humoral Psychology in Ancient and Modern
Medical Theory,” History of the Human Sciences 22, no. 3 (2009): 29–50.
21 Philippa Maddern, “Murdering Souls and Killing Bodies: Understanding Spiritual and Physical
Sin in Late-Medieval English Devotional Works,” in Conjunctions of Mind, Soul, and Body from Plato
to the Enlightenment, edited by Danijela Kambasković (Dordrecht: Springer, 2014), 29–30.
22 Thomas Aquinas, Summa Theologica, I.75.4, trans. Fathers of the Dominican Province, revised by
Daniel J. Sullivan, Great Books of the Western World, edited by Robert Maynard Hutchins, vol. 19
(Chicago: University of Chicago Press, 1954), 381; and, E. Ruth Harvey, The Inward Wits: Psy-
chological Theory in the Middle Ages and the Renaissance (London: Warburg Institute, 1975), 54–56;
Anthony Kenny, New History of Western Philosophy (Oxford: The Clarendon Press, 2010), 191–193;
and Fernando Vidal, The Sciences of the Soul: The Early Modern Origins of Psychology (Chicago, 2011),
31–32.

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 Conceiving addiction

23 David Clemis, “Medical Expertise and Understandings of Intoxication in Britain, 1660–1830,”

in Intoxication and Society. Problematic Pleasures of Drugs and Alcohol, eds. Jonathan Herring, Ciaran
Regan, Darin Weinberg, and Phil Withington (Basingstoke, 2013), 42–47.
24 David Clemis, “Great Annoyance to Their Mindes”: the Humours, Intoxication, and Addiction
in English Medical and Moral Discourses, 1550–1730”, in Humorality in Early Modern Art, Material
Culture, and Performance, edited by Kaara L. Peterson and Amy Kenny (Basingstoke: Palgrave/
Macmillan, 2021).
25 Barbara S. McCrady and Elizabeth E. Epstein, in Barbara S. McCrady and Elizabeth E. Epstein
(eds.), “Introduction,” in Addictions. A Comprehensive Guidebook, 2nd ed. (Oxford: Oxford Uni-
versity Press, 2013), xix–xx; Suzanne Fraser, David Moore, and Helen Keane, Habits: Remaking
Addiction (London: Palgrave, 2014), 3; Howard I. Kushner, “Taking Biology Seriously: The Next
Task for Historians of Addiction?,” Bulletin of the History of Medicine lxx, (2006), 115–143.
26 Robert Burton, The Anatomy of Melancholy (New York: New York Review of Books, 2001), II:
245; Sajjad H. Rizvi, “Avicenna (Ibn Sina)” in Internet Encyclopedia of Philosophy, ISSN 2161–0002,
https://iep.utm.edu/avicenna/; and, A. S. Sarrafzadeh, et al., “Ibn Sina (Avicenna)” Neurosurgical Focus
11, no. 2 (2001): 3.
27 Stephanie Honchell, “Islamic Law,” in The SAGE Encyclopedia of Alcohol. Social, Cultural, and
Historical Perspectives, edited by Scott C. Martin (Thousand Oaks: SAGE Publications, 2015); and,
Kathryn Kueny, The Rhetoric of Sobriety: Wine in Early Islam (Albany: State University of New York
Press, 2001).
28 Mu-Chou Poo, “The Use and Abuse of Wine in Ancient China,” Journal of the Economic and Social
History of the Orient 42, no. 2 (1999): 123–151.
29 Li Bai, “Mountain Drinking Song” https://americanliterature.com/author/li-bai/poem/
mountain-drinking-song.
30 Ōtomo Tabito, “Soaking in Sake” trans. Jefery Bownas and Anthony Thwaite in Lampham’s
Quarterly, Intoxication 6, no.1 (Winter 2013): 26.
31 Yoshida Kendō, Essays in Idleness, c. 1330 quoted in Lampham’s Quarterly – Intoxication, 6 no. 1
(Winter 2013): 147.
32 The Plum in the Golden Vase or, Chin P’ing Mei, Vol. 4, The Climax, edited by David Tod Roy
(Princeton University Press, 2011), 726n. 81; also see Roy, The Plum in the Golden Vase, Vol. 1,
464n. 4.
33 The Plum in the Golden Vase, Vol. 4, 722n33.
34 Andrew Wear, “Medical Practice in Late Seventeenth- and Early Eighteenth-Century England:
Continuity and Change,” in The Medical Revolution of the Seventeenth Century, edited by Roger
French and Andrew Wear (Cambridge: Cambridge University Press, 1989), 294–302; Lindemann,
Medicine and Society…97–109.
35 Herman Boerhaave, Dr. Boerhaave’s Academical Lectures on the Theory of Physic (London: W. Innys,
1744), 1:70; also see Cook, “Medicine and the New Philosophy …”, 399.
36 Anon., An Antidote against Drunkenness; being the Drunkards’s Looking Glass… (London, 1712), 27.
37 Stephen Hales, A Friendly Admonition to the Drinkers of Brandy, and Other Distilled Spirituous Li-
quors…. 2nd ed., (London: Joseph Downing, 1734), 21.
38 Hales, A Friendly Admonition, 22.
39 Hales, A Friendly Admonition, 8.
40 Hales, A Friendly Admonition, 10.
41 James Nicholls, The Politics of Alcohol: A History of the Drink Question in England (Manchester: Man-
chester University Press, 2009); Jessica Warner, Craze: Gin and Debauchery in an Age of Reason (New
York: Four Walls Eight Windows, 2002); Patrick Dillon, The Much-Lamented Death of Madam Ge-
neva: The Eighteenth-Century Gin Craze (London: Review, 2002); and, Peter Clark, “The ‘Mother
Gin’ Controversy in the Early Eighteenth Century,” Transactions of the Royal Historical Society 38
(1988): 63–84.
42 Benjamin Rush, An Inquiry into the Efects of Spirituous Liquors on the Human Body (Boston: Thomas
and Andrews, 1790); Thomas Trotter, De Ebrietate ejusque efectibus in corpus humanum (M.D. diss.
University of Edinburgh, 1788); Thomas Trotter, An Essay, Medical, Philosophical, and Chemical,
on Drunkenness. 2d ed. (London: Longman, Hurst, Rees, and Orme, 1804); Joseph Hirsh, “En-
lightened 18th-century views of the alcohol problem,” Journal of the History of Medicine and Allied
Sciences, 4 (1949): 230–236; Hirsh’s work followed the seminal publication: E. M. Jellinek, “Phases
in the Drinking History of Alcoholics: Analysis of a Survey Conducted by the Ofcial Organ of

597
 David Clemis

Alcoholics Anonymous,” Quarterly Journal of Studies on Alcohol, 7 (1946): 1–88. See also E. M. Jell-
inek, The Disease Concept of Alcoholism (New Haven: Hillhouse, 1960); Harry Gene Levine, “The
Discovery of Addiction: Changing Conceptions of Habitual Drunkenness in America,” Journal of
Studies in Alcohol 39 (1978): 143–174; Roy Porter, “The Drinking Man’s Disease: The Pre-History
of Alcoholism in Georgian Britain,” British Journal of Addiction 80 (1985): 385–396; also see Nich-
olls, The Politics of Alcohol.
43 Heather Beatty, Nervous Disease in Late Eighteenth-Century Britain: The Reality of a Fashionable Dis-
order (London: Pickering & Chatto, 2012), 7–35.
44 David Hartley, Observations on Man, His Frame, His Duty, and His Expectations (London: J. Johnson,
1749), 1:393.
45 Erasmus Darwin, Zoonomia; or, the Laws of Organic Life (London: J. Johnson, 1796), 1:252; John
Coakley Lettsom, History of Some of the Efects of Hard Drinking (London: W. Darton and Co., 1789,
7–8.
46 William Cullen, First lines of the Practice of Physic… (New-York: J. Crukshank and R. Campbell,
Philadelphia, R. Hodge, S. Campbell, and T. Allen, 1793), 2:258–259, 2:273; see also Roy Porter,
“Medicine,” in An Oxford Companion to the Romantic Age: British Culture, 1776–1832, edited by
Clara Tuite, Iain McCalman, and Gillian Russell (Oxford: Oxford University Press, 2001), 176.
47 Thomas Trotter, Essay, 172. See also Rush, An Inquiry; Roy Porter, Flesh in the Age of Reason (New
York; London: W.W. Norton, 2004), 311–314, 400–401; and Clemis, “Medical Expertise,” 44–47.
48 Benjamin Rush, Medical Inquiries and Observations Upon Diseases of the Mind (Philadelphia: Kimber
& Richardson,, 1835), 261, 264.
49 Robert Macnish, The Anatomy of Drunkenness (Glasgow: W.R. McPhun, 1832), vii–viii.
50 William F. Bynum, “Chronic Alcoholism in the First Half of the 19th Century,” Bulletin of the
History of Medicine 42, no. 2 (1968): 171.
51 Carl von Brühl-Cramer, Ueber die Trunksucht… (Berlin: Nicolai, 1819), 21–22, quoted in William
F. Bynum, “Chronic Alcoholism in the First Half of the 19th Century,” Bulletin of the History of
Medicine 42, no. 2 (1968): 170.
52 Bynum, “Chronic Alcoholism…” 173.
53 Rush, Ardent Spirits…, 20.
54 Trotter, An Essay, 172.
55 Macnish, The Anatomy of Drunkenness, vii–viii.
56 Rush, Medical Inquiries…, 261, 265–266.
57 J. Edward Turner, The History and Pathology of Inebriety (1854) cited in T. D. Crothers, Sketch of the
Late Dr. J. Edward Turner, the Founder of Inebriate Asylums (Hartford, 1889), 7.
58 J. Edward Turner, History of the New York Inebriate Asylum (New York: J. Edward Turner, 1888), 27.
59 This work includes: Brian Howard Harrison, Drink and the Victorians; the Temperance Question in
England, 1815–1872 (Pittsburgh: University of Pittsburgh Press, 1971); J. Blocker, American Tem-
perance Movements Cycles of Reform (Boston: Twayne, 1989); Susanna Barrows and Robin Room,
Drinking: Behavior and Belief in Modern History (Berkeley: University of California Press, 1991);
Nicholls, The Politics of Alcohol.….
60 Bynum, “Chronic Alcoholism…” 174; Valverde, Diseases of the Will…, 68–95.
61 Mariana Valverde, ““Slavery from Within’: The Invention of Alcoholism and the Question of Free
Will,” Social History 22, no. 3 (1997): 267–268; Mariana Valverde, Diseases of the Will: Alcohol and
the Dilemmas of Freedom (Cambridge; New York: Cambridge University Press, 1998), 68–94.
62 Grifth Edwards, “The Trouble with Drink: Why Ideas Matter,” Addiction, 105 (2009): 800.
63 Levine, “The discovery of addiction,” 144.
64 Keane, “Addiction: Critical Refections,” 370.
65 Research Council on Problems of Alcohol. Scientifc Committee and E. M. Jellinek, Alcohol Ad-
diction and Chronic Alcoholism (New Haven: Yale University Press, 1942); E. M. Jellinek, “Phases
in the Drinking History of Alcoholics: Analysis of a Survey Conducted by the Ofcial Organ of
Alcoholics Anonymous,” Quarterly Journal of Studies on Alcohol 7 (1946): 1–88.; and, E. M. Jellinek,
The Disease Concept of Alcoholism.
66 Valverde, Diseases of the Will, 110–111.
67 Joseph W. Schneider, “Deviant Drinking as Disease: Alcoholism as a Social Accomplishment,”
Social Problems 25, no. 4 (1978): 365–369; Craig Reinarman, “Addiction as Accomplishment: The
Discursive Construction of Disease,” Addiction Research & Theory 13, no. 4 (2005): 313; Edwards,
“The Trouble with Drink” 801.

598
 Conceiving addiction

68 Valverde, Diseases of the Will, 114–119.

69 “Substance-Related and Addictive Disorders,” in Diagnostic and Statistical Manual of Mental Disor-
ders, DSM Library: American Psychiatric Association, 2013. http://library.mtroyal.ca:3420/doi/
full/10.1176/appi.books.9780890425596.dsm16#CHDIBCJD; and, “Mental and behavioural dis-
orders due to psychoactive substance use (F10-F19)” in “Chapter V, Mental and behavioural disor-
ders (F00-F99) in WHO, International Statistical Classifcation of Diseases and Related Health Problems,
10th Revision, 2015, http://apps.who.int/classifcations/icd10/browse/2015/en#.
70 Darin Weinberg, “Praxis, Interaction and the Loss of Self-Control,” in Intoxication and Society.
Problematic Pleasures of Drugs and Alcohol, edited by Ciaran Regan Jonathan Herring, Darin Wein-
berg, and Phil Withington (Basingstoke: Palgrave Macmillan, 2013), 232.
71 “Substance-Related and Addictive Disorders.”
72 Room, “The Cultural Framing,” 224–228; and, Keane, “Addiction”, 375–377.
73 Fraser, Habits, 27. For popular reception neuroscience brain disease accounts, see Jefery Kluger,
ed., The Science of Addiction (New York: Time/ Meredith Corporation, 2019); and, Fran Smith,
“The Science of Addiction,” National Geographic (September 2017): 30–55.
74 Nora D. Volkow and Marisela Morales, “The Brain on Drugs: From Reward to Addiction,” Cell
162, no. 4 (2015): 712.
75 Keane, “Addiction,” 373; and Reinarman, “Addiction as Accomplishment…” 309.
76 Weinberg, “Praxis,” 234.
77 Weinberg, “Praxis,” 234.
78 Volkow, “The Brain on Drugs,” 712.
79 Keane, “Addiction,” 372.
80 Weinberg, “Praxis,” 235.
81 Volkow, “The Brain on Drugs,” 712; see also McCrady and Epstein, ‘Introduction,’ xix–xx; Fra-
ser, Habits, 3; and, Kushner, ‘Taking Biology Seriously,” 115–143.
82 Jefrey Stephen Poland and George Graham, Addiction and Responsibility (Cambridge, Mass., 2011),
3; Marc Lewis, The Biology of Desire: Why Addiction Is Not a Disease (Toronto: Doubleday Canada,
2015), 11–22.
83 Katherine Parker and Eckhard Kessler, ‘The Concept of Psychology’, in The Cambridge History of
Renaissance Philosophy, edited by Charles B. Schmitt and Quentin Skinner (Cambridge: Cambridge
University Press, 1988), 455–463.

599
 INDEX

Note: Bold page numbers refer to tables; italic page numbers refer to fgures and page numbers
followed by “n” denote endnotes.

Abdulkarim, A. 52 post-abolition Brazil 373–377; and paradoxes

academic conferences, as drinking sites of liberalism in post-independence Brazil
181–184 365–373; prohibition 27; rituals 294–295; use
‘acid house’ 134, 138n6 in workplace 179–181
acid house party Bill 128, 134 alcohol by volume (ABV) 169
acid rain 252 alcohol-fuelled violence 490
actor network theory (ANT) 205, 206, 265 Alcohol Health Alliance Ireland 536, 537
acute intoxication 321 alcoholic drinks and social class 118
Adam see ecstasy alcoholic psychosis 532
adaptational psychodynamics 312 Alcoholics Anonymous (AA) 296, 471, 529, 591,
addiction 311, 312, 347, 485; amphetamine-type 595n42
stimulants 414; Cheever’s evocative allegory alcoholism 503, 530, 532, 546, 590–591
of 74; defned 311; Dimedrol 213–214; heroin Alcoholismus chronicus 591
213–214; as historical problem 581–582; alcohol policy discourse 484–496
methadone 205; nicotine 463; opiate 24–25; alcohol violence 496
tea 564–577; theories of 587–589 Aldridge, J. 338
Addiction Research Center (ARC) 311–314, ale 21, 114, 116, 120, 121, 503
320, 322n3 Alexander, B. 29
Addictive Consumption: Capitalism, Modernity and Allenby, E. 249
Excess (Reith, 2018) 90 Allik, M. 440
Adekeye, O.A. 52 All Party Parliamentary Groups (APPGs) 447
Adler, M. 166 altered consciousness 178
adulteration 109 Altered State (Collin, M.) 129
Afghanistan 247 altered states 310, 501–519
Africa: Brazil’s importation of African slaves Alternative London 136
361–362; drug use in 51–53; Khat in 400; Altheida, D. 443
Zulus 243 American Homebrewers Association 114, 115
age 183, 299, 316–317 American Psychiatric Association 346, 473, 592
Agora 103, 106 Amis, M. 70, 72
agorism 109 amphetamine 51, 245–246
Albayrak, E. 239 amphetamine democracy 245
alcohol 20, 73, 161, 242; abstinence from 185; amphetamine-type stimulants (ATS) 243, 246,
in colonial Brazil 361–365; modernity and 412; “after-efects” discourse 428–429;
the racialization of drinking behaviors in psychopathological features 428–430;

601
 Index

smuggling 427; symbolic meaning 428–430; “balloon efect” 470

as symbol of outlaw economy 427–428 Bancroft, A. 37, 40, 97, 178, 187, 328, 345, 346,
Amundsen, R. 244 463
The Anatomy of Courage (Moran, L.) 241 Barad, K. 345
The Anatomy of Melancholy (Burton, R.)584 barbiturates 314
Anslinger, H.J. 24, 314 Barnaby Rudge (1841) 547
Anstie, F.E. 275, 276, 511 Barnett, R. 264, 266
antidote 314 Bassi, K. 29n1, 30n2
anti-khat campaign 401 Bataille, G. 89
Anti-Narcotic League 162 Baumann, G. 290, 401
Antin, T.M.J. 266–267 BBC online 452
anti-smoking movement 23–24 The Beatles 22
anxiety-situational reaction type 429, 431n9 Beccaria, F. 297
Anyanwu, O.U. 52 Becker, H.S. 35, 54, 60, 63, 292
Apperson, G.L. 170 Beck, J. 132
appraisal discourse 419–420 Beecher, H.K. 314, 316
Aquinas, T. 595n22 The Beer Academy 118
ARC see Addiction Research Center (ARC) beer gardens 8
Arensberg, C.M. 530, 531 beer geek 121
Aristotle 96, 291 Behan, B. 23
Ariyama, N. 418 behavioral pharmacology 316–317
Arlidge, J.T. 566, 567, 572, 574 Bell, D. 96
Armstrong, L. 22 Bell, E. 182
arrhythmias 264 Bell, K. 463
Asahi Shinbun 413 Benci, J. 365
Asberg, C. 458 Benjamin, W. 30n5
Aschenbrandt, T. 243–244 Bennett, J. 169
Asia 24, 204, 568 Bentbaša, Sarajevo 147
Atkinson, A.M. 445 Bentsen, L. 132
atropine 249–250 Benzedrine 245
ATS see amphetamine-type stimulants (ATS) Berger, B. 29
ATS control: after 1954 campaign 425–426; Berlant, L. 464, 465
campaign 424–426; condemnation of groups Berman, D. 131
in late 1940s 415; condemnation of specifc Berreman, G.D. 300
people 416–417; conversion of medical Berryman, J. 72
research 417–420; demand for control by Biden, J. 136
medical doctors 415; in Japan 412–431; Kyoko Big Data 91, 95
Incident 1954 424; nationalist discourse Bigelow, G. 317
424–425; political factors and ATS in 1950s Big Food 94–95
422–423; problem after WWII 414–415; Big Gambling 95–96
Stimulant Control Law of 1951 421–422; ‘big G’ model 494
youth problem and reason for 420–422 binge drinking 502
Australia: LGBTQ+ in 273–274; methadone Bishop, E. 72, 74, 79
treatment in 206; vapers in 34 Bishop’s Beer 169
Australian alcohol policy discourse, handling Black, W.T. 570
complexity in: approach 485–486; method Blitzkrieg 244
486–487; policy stakeholder 489–494; policy Bluelight 330, 339n1
texts 487–489 Blue, S. 34, 265
Azbel, M.F. 197 Boak, J. 513
Boerhaave, H. 587
The Bacchae 468 Boettke, P. 481n12
Bacchi, C. 208, 440 bootlegging 312
Bacchus 596n9 Booze Britain 512
Bacon, S.D. 301 Bordo, S. 98
Bailey, R. 513 Bosnia: cofee consumption in 143–156; cofee
Bales, R. 530, 531 cultures 144
Balfour, C.L. 545 The Bottle (1847) 551

602
 Index

Bourdieu, P. 119 Canada: collective lifestyles of smoking 266;

Bourgois, P. 408 drug-related deaths in 439, 441; MDMA
Bourke, J. 572 in 130
The Boys in the Band (Crowley 1968) 277 cannabis 24, 51, 52, 195, 249–250; hotspots 387,
Braddon, M.E. 550 389; legalisation 122; in medicines 24; in
Brain, K. 92 Nigeria 383–385; use among street-involved
Braudel, F. 23 youths 382–396; in warfare 249–50
Braun, V. 55 capital destruction 166
Brazil 144; alcohol and paradoxes of liberalism capitalism 91, 96–97
in post-independence 365–373; alcohol Caputo, P. 248
in colonial 361–365; craft beer consumers ‘carefully managed hedonism’ 97
in 120; modernity and the racialization of Caribelli, G. 146
drinking behaviors in post-abolition 373–377 Carpenter, W.B. 546, 549
Brennan, T. 241 Carpentier, C. 192
Bretherton, G. 527, 528 Carrier, N.C. 400
BrewDog 502, 513–516 Carry on Jeeves (Wodehouse, 1925) 72
Brewery, K. 519n4 cat-eye pills 245
brewpubs 115–117 Catholicism 471, 505, 516
Bridget Jones’s Diary (Fielding, 1996) 80 Center for Psychedelic and Consciousness
Bridgman, T. 181 Research 26
Britain: governing excess in twentieth-century Central Control Board (CCB) 510
510–513 Centre for Social Justice (CSJ) 447
British Medical Journal 570 Chaldeans 249
The Brontë sisters 546–549 champagne 118
Brooke, H. 585 Champion, S. 127
Brown, E. 568 Chandler, R. 72
Brown, P. 122 Chapman, N.G. 121
Bruno, R. 70, 73 charka 242
Brunton, L. 570 Cheever, J. 69, 74, 75, 77, 81
Brussels Conference Act (1890) 473 chefr 248
Bucerius, S.M. 408 Chemical Weapons Convention (CWC) 240
Buchanan, D. 394 chemosocialities 463
‘Buddha of euphoria’ 136 Child Messenger Act (1901) 171
Bukowski, C. 77 Children’s Act (1908) 171
Bulls, J. 543 China: Taiping Rebellion 250; tea 576; tobacco
Bunyan, J. 71 167–168
buprenorphine 198 Chinese Nationalist Party 422
Bureau of Narcotics 25 chronic addiction 309
Burns, R. 72 chronic barbiturate intoxication 313–314
Burroughs, W. 91, 92 chronic drinking 582–583, 585–592
Burton, R. 584, 585, 595n14, 597n26 Chronicle of Higher Education 183, 185
Business for Punks (Watt, 2015) 514 chronic volunteers 315
Butler, J. 273, 345 Churchill, W. 241
Byron, L. 72 Cielemęcka, O. 458
cigarette smoking 458, 463, 465
cachaça 361, 362, 364, 369, 374 citizens: as consumers 29; as workers 29
cafés 143, 146, 150, 155, 160, 161, 165 Civil War 247
cafeine 95, 161, 163, 182, 565 clandestineness 240
Cailbault, I. 445 Clarke, V. 55
caipirinha 364 Clemis, D. 543, 595n23
Californian Department of Public Health 36 Clinton, B. 247
Calvin, J. 505 close-fstedness 167
Campaign for Real Ale (CAMRA) 115, 118, Clua-García, R. 223, 230, 234, 236
120, 121, 514 Cobbett, M.P.W. 567
Campbell, C. 91 cocaine 52, 226, 244, 250
Campbell, J. 301 CODA 27–29
CAMRA see Campaign for Real Ale (CAMRA) codeine 57

603
 Index

cofee: as mourning 152–155; as social stimulant Critchlow, B. 277

145–147; on street 150–152 Croatia 147
cofeehouse 145, 146, 163, 164 Cruikshank, G. 545, 551, 552
Cohen, S. 128, 442 Crusoe in England (1976) 79, 80
Cold War 22, 143, 249–253 cryptomarkets 102–104, 107–109
Coleridge, S. 90 crystal-meth see methamphetamine
collective lifestyles framework 266 Csikszentmihályi, M. 96
Collin, M. 129 Cullen, J. 526
Collins, A.B. 446 Cullen, W. 589
Collins, R.L. 69 cultural capital 8, 26, 114, 116, 183, 342
Collins, W. 545–550 cultural competence 401, 406
colonialism 28 cultural remission 295
commensal hospitality 166 culture: and ritual 292–293; of sharing 198
Committee on Drug Addiction and Narcotics cultures of intoxication 128
(CDAN) 311, 315 Curry, R. 79
Committee on Problems of Drug Curto, J. 362
Dependence 312
commodifcation 90–93, 105–106 Da Ali G Show 135
commodities 7, 22, 28, 90–93, 95, 96, 99, D’Abernon, L. 510
102, 169 Dalton, S. 78
communitas 296–297 Danesbury House (Wood, 1860) 545, 549, 558
Comprehensive Drug Control Act 24 Dangerous Drugs Act (1920) 25
Confessions of an English Opium Eater Daniels, J. 444
(deQuincey, T.) 90 Darcy, C. 53
“consciousness of induced consciousness” 29 Darwin, E. 543, 546, 589
conservatism: ritual and 299–300 Darwin, H. 121, 515
constructive drinking 292, 299 Das, V. 395
contemporary imprisonment 194 Datura stramonium see James-Town Weed
Controlled Substances Act 132 David Copperfeld (Dickens, 1849) 71
Cooke, M.G. 71 Davies, N. 442–443
Cooney, J.E. 575 Dayton Peace Agreement (DPA) 150, 155
Cooney, J.G. 534 DCR see drug consumption room (DCR)
COPD 320 Dean, G. 534
Cope, N. 194 Defence of the Realm Act 474
coping with stress 40 degeneration theory 373
corporate interests 7 Deleuze, G. 168
cortisol 288n3 delirium tremens 546, 558
Cosgrave, E.M. 526, 527, 530 Deller, J. 128
counter-corporealisation 287 Delmestri, G. 118
counterperceptions 147 Demant, J. 303
counter-reformation 504 Dennis, N. 166
Courtwright, D. 28, 161, 169 Dennis, S. 265
Couty, L. 372, 373 Department of Health and Human Services 33
COVID-19 461 depressants 247
craft beer 113 depression 57
craft drinks: connoisseurship and intoxication deQuincey, T. 90
119–122; emergence of 113, 115; revolution deranging gas 253
115–117; taste and status 117–119 de-ritualisation 300–301
craving and ‘the bliss point’ 94–95 Derrida, J. 89
Creasy, W. 250 Dertadian, G. 63
Cree, J. 582, 583 desafricanization of Brazil 368
Crewe, B. 193, 194, 197, 198 designer drugs 92
crime syndicate 426 desire 311–313
Criminal Code (1830) 367 detoxifcation 464
criminalization 371 deviance disavowal 277, 278
Criminal Justice and Public Order Act dextroamphetamine 245, 246
(1994) 135 džezve 147, 149, 149

604
 Index

dhikir/zikir 145 evaluation 471–473; cultural values and

diamorphine 104, 320 secular control 473–474; divine warning
Dickens, C. 71, 161, 167, 169, 545–549, 552, to prohibitionists 468–471; feedback loop
553, 556, 557, 560n27 477–478; international 474–475
Dietler, M. 166, 172 drug control system 13, 384, 468, 470, 477–478
Dimedrol 208, 211–217 drug dealers 101–103, 438, 478
dimethyltryptamine (DMT) 330, 332 drug dealing, in prisons 197
Dionysus 468, 469, 474, 583 drug dependence 312, 322n9
dipsomania 590 drug distribution markets 7
Dirisu, O. 52 Drug Enforcement Administration (DEA)
Discursive Constructionism 413 130, 132
disease 529–534, 546; and alcoholism 590–591; drug foods 90, 92
concept 523, 525, 527, 534, 591, 592; drug free world 469
meanings of 591–594 drug policy 469
Disease Concept of Alcoholism ( Jellinek, 1960) 512 drug potency 104, 106–108
dis/inhibition 275–276, 286 drug-related crime 27, 191–192
divine madness 472 drug-related deaths (DRDs) 437, 438;
DIY (Do It Yourself ) therapy 332 competing paradigms 440–442; local
DMT: The Spirit Molecule (documentary) 332 coverage of drugs issues and 450, 451;
The doors of perception (1954/2010) 328 media framing 442–447; national coverage
Douglas, M. 105, 118, 299 447, 448–449; online and TV coverage of
Drapes, T. 572 local events and action 452; prohibitionist/
DRDs see drug-related deaths (DRDs) abstinence 441; regulation/harm reduction
Dream Songs (1969) 72 441–442; rising rates of 439–440;
drinking: banal 293; constructive 292, 299; vulnerability 442
cultures 14, 116, 290–291, 302, 502, 524; Drugs Deaths Taskforce 453
Mediterranean 294; modernity and the drug trafcking 384
racialization, in post-abolition Brazil 373– drug use: before, during and after imprisonment
377; ritual 293; vertical 510; at work 179–181 191–193; by combatants 241–248; gendering
drinking places 159–160; atmosphere 170; of 52–53; motivations for 193–196; in Nigeria
commensality 164–165; expanded sites, 51–53
mobile objects 171–172; gift of drink The Drunkard (MacNeice, 1946) 83
166–167; hospitality 164–165; and intoxicants, The Drunkard’s Children (1848) 551
1850–1950 161–163; material culture 166; drunk as a Pole 502–510
material engagements 168–170; public places drunken comportment 10, 276, 292, 297, 595
and intoxication 163–164; sociability 164–165 drunken deportment 170
drinking studies network 502, 519n1 drunkenness 19, 20, 26, 90, 178, 344, 346, 366,
drug: commodifcation 105–106; defnition 504, 586; chronic 546, 547; determined 92, 114
364; distribution 101–102; intoxicating DSM’s criteria 592–593
consumption 91–93; making 104–105; self- Dublin Journal of Medical Science 526
administration 317; social organisation and Duf, C. 170
196–198 Duis, P. 164
drug abusing immigrants 409 Duncan, T. 223
Drug Addiction Rehabilitation Center (DARC) Dundee’s Drugs Crisis 452
431n8 Dunlap, E. 395
drug consumption room (DCR): in DuPois, M. 99
Copenhagen, Denmark 224–225; Durkheim, E. 70, 290, 300
establishment 222; H17 224–233; harm- Duster, T. 24, 25, 29n1
reduction service 221; institutional space and dysphoria 285, 316
drug scene 228; legislation 228; modes of use
233–235; risk minimization 222; as safe and Earleywine, M. 69, 75
legitimate place 227–228; Skyen 224; social Earnshaw, S. 73, 77
setting for using drugs 228–231; time slots East Lynne (Wood, 1860) 545
232–233; trade-ofs 221, 223, 230, 233, 236 Ebel, E. 367
drug consumption rooms (DCRs) 442 e-cigarettes 36, 48, 463
drug control 26–27; benefciaries 478–480; Economic and Social Research Institute
Christian condemnation to psychiatric (ESRI) 533

605
 Index

ecstasy 93; before the rave, 1912–1985 130–132; Fear and Loathing in Las Vegas 334
criminalisation 132; cultural trappings female drunkard 554–558
128; and dance culture in UK, 1986–2009 femininity 7, 52, 56, 64, 76, 81, 121
132–136; emergence of 130; see also fentanyl 106, 447
3,4-methylene-dioxy-meth-amphetamine Ferentzy, P. 595n6
(MDMA) The Ferret 452
Edgerton, R.B. 276, 292, 295, 344 Ferriter, D. 525, 527, 532
EDM (Electronic Dance Music) 129 feudalism 426–427
Edmundo, L. 375 Fielding, H. 80, 543
Edwards, H. 568 Fiesta: The Sun Also Rises (Hemingway, 1926) 79
The Efects Can Last Forever campaign 128, fldžani 147, 149
134, 135 Finalise Early (FE) 107
E is for Ecstasy 136 Findley, J. 317
electronic gaming machines (EGMs) 95 Fiorucci Made Me Hardcore 128
electronic nicotine delivery systems (ENDS) 262 Fischler, C. 165
Eliot, G. 544–549, 558 Fitzgerald, F.S. 77, 78
Elliot, E. 395 Flack, W. 116
Elster, J. 70 Fleetwood, J. 392
emotion 57 Foan shobun 429
endorphins 178 Fogel, C. 63
Energy Flash (Reynolds, S.) 129 food 7, 23, 90–96, 152, 172, 179, 183, 387, 565
Engels, F. 554 Forced March 244
Enghof, O. 338 Foucault, M. 97, 274–276, 280, 290, 460
England: cocaine use 25; ecstasy and dance Foxx, A.J. 185
culture in 132–136; tobacco in 23 Franco-Prussian War 247
Enlightenment 29 Franklin, B. 20
Erowid 330, 339n1 Frank, V.A. 346, 347
“ethnic cleansing” campaign 152 Fraser, S. 206, 347, 355, 445, 453, 485, 487, 489,
ethnicity 4, 12, 146, 150, 401–403, 407–409 495, 595n2
ethnifed intoxication 401 Frederico Leopoldo Cezar Burlamarqui 371
euphoria 178–179, 312, 315–316 French cafés 164
Euripides 468 Frenetzy, P. 582
Europe: beer-laden porridge 20–21; drinking Freudian movement 529
cultures in 501–519; drug-related deaths Frew, E. 184
439; drug use before, during and after Freyre, G. 368
imprisonment 191–193; immigration 373; Frohlich, K.L. 266
khat use in 400; methadone implementation Frydl, K.J. 28
in 204; smoking in 162 Fukushima, A. 429
European Court of Human Rights 156n8 Fukuyama, F. 515
Everybody In the Place 128 functional intoxication 37–41, 463
excess 290–292, 481n1, 501, 581; BrewDog
513–516; craft beer 513–516; governance Galen 503, 584
of 502, 510–513; navigating boundaries in Galenic Medical Paradigm 583–584
Europe’s long Reformation 503–506; social Galenic medicine 584, 587
norm to national problem 502–510 Galenism 583–587
‘the experience economy’ 90–91 gambling 22, 95–96, 312
Eyal, N. 91 Gaskell, E. 555
Ezzell, M.B. 53 gender and class 550–551
General Headquarters/Supreme Commander for
The Face (magazine) 132, 133 the Allied Powers (GHQ/SCAP) 422
Facebook 92 George Cruikshank’s Fairy Library (1853) 552
Factotum (1975) 77 Gerich, J. 75
Family and Community in Ireland (Arensberg & Germany: drinking places 163; drug
Kimball) 531 consumption room in 223; drug-related
Fanon, F. 373 deaths in 439; MDMA in 130, 136
Farrugia, A. 345, 356n1 Giddens, A. 91, 266
fatigue rum 242 Gifort, D. 25, 322n1

606
 Index

Gilbert, P. 549 Hammer, J. 514

Gillespie, D. 22 Hangi, A. 147
gin craze 543, 550, 560n19, 589 hangovers 69–83
Gin Lane and Beer Street 543 Hangover Square (Hamilton, 1941) 76
Gissing, G. 558 Hanson, V.D. 242
Glenn, N.M. 266 Hard Times (1854) 548
Global North 90 Hardy, T. 71
glocalisation 129 Haritavorn, N. 386
Goddard, T. 408 harm 9, 13, 42, 48, 103, 128, 186, 385
Gofman, E. 27, 266, 273 harm reduction approach 441–442
Golub, A. 395 Harrison, B. 545
Gomart, E. 344 Harrison Narcotic Act (1914) 25
Good Beer Guide 118 Harris, S. 537
Goodbye to Berlin (Isherwood, 1939) 79 Harrisson, T. 166
Goodman, E. 249 Hartley, D. 589
Good Morning, Midnight (Rhys, 1939) 79 Haskin, D. 556
Goodwin, S. 208 Hattox, R. 146
Goody, J. 294 Hayward, K. 512
Gorski, P. 28 Heads of National Drug Law Enforcement
Gough, J.B. 162, 548 Agencies (HONLEA) 479
governance 96–98 healthism 464
governmentality 97, 207, 266 Heath, D.B. 294, 297, 298, 530
Grace, S. 195 hedonism 101–109
Graham, H. 40 Heggie, V. 570
Great British Beer Festival 118 Hemingway, E. 79
The Great Good Place (Oldenburg, 1989) 164 Henderson, E.F. 182
Green, C.D. 574 Henley, J. 513
Greene, L.W. 250 Hennion, A. 344
Greenwood, R. 118 Henry, J. 135
Gregg, M. 180 hepatitis C 27, 203
grey zone 180–181 heroin 104–106, 195, 208, 209, 212, 224, 247
Grindr 280 Herring, J. 70
Grundetjern, H. 386 Herzegovina, cofee consumption in 143–156
The Guardian (newspaper) 135 heterotopia 283
Gulf War 245 Higo, M. 420
Gurr, E. 452 Hilton, M. 161
Gusfeld, J.R. 23, 92, 430, 516 Himmelsbach, C.K. 311, 320
Guthman, J. 99 Hippocrates 584
gutter-water 54 historical representations 581–599
HIV/AIDS 27, 203, 274
H17 224–233; see also drug consumption room Hobbs, D. 512
(DCR) Hofmann, A. 328, 332
Habermas, J. 163 Hogarth 543
Habitual Drunkards Act 526 Holmes, C.H. 573
habitual drunkenness 546 Home Rule 525
habitus 386 Home Salon 169
Habsburg 144, 146, 147 homosexuality 275
Hague International Opium Convention Horimi, T. 416
(1912) 240 Horowitz, V. 22
Haig, A. 571 hotspots 387, 389
Haight, G.S. 552 House Selected Committee on Crime 245
Haines-Saah, R.J. 266 How to Build Habit-Forming Products
Haine, W.S. 164 (Eyal, 2014) 91
Hajdarpašić, E. 146, 156n6 Hromadžić, A. 150–152
Hales, S. 543, 588, 595n37 Hubbard, P. 116
Hamilton, J. 162 HufPost 452
Hamilton, P. 76 Hunt, G. 198, 267, 345, 347

607
 Index

Hussein, S. 246 Jane Eyre (Reed, 1847) 547

Huss, M. 546, 591 Japan, ATS control in: ATS problem after
Huxley, A. 25, 328 WWII 414–415; campaign 424–426;
hyper consumption 91 Kyoko Incident 1954 424; medical research
hyper-masculinity 492, 493 417–420; methods 413; moral judgment and
medical knowledge 415–417; political factors
Illicit Drug Anti-Proliferation Act (2003) 136 422–423; second wave of epidemic and crime
imprisonment 367; motivations for drug use syndicates 426–428; Stimulant Control Law
193–196; pains of 193–196; prevalence of of 1951 421–422; symbolic meaning of ATS
drug use before, during and after 191–193; 428–430; youth problem and reason for
social organisation and drugs 196–198 420–422
impulse neurosis 312 Japanese Communist Party 422
incarceration 392 Japanese Medical Association 417
In Darkest England And The Way Out (Booth, Japanese Miracle 428
W.) 162 Japanese National Diet 413, 415
Indian Hemp Act (1975) 384 Japan-Korea Treaty of 1905 431n5
Indigenous people 374 Jarvinnen, J. 97
The Information (Amis, 1995) 70, 72 Jaufret-Roustide, M. 445
Ingbar, Y. 75 Jellinek, E.M. 512, 529, 592, 594
inquiry discourse 420 Jenkins, R. 401, 407
Inside Higher Education (Layton, R.) 184, 185 Jennings, P. 511, 512, 515, 547
intellectualisation 118 Jessica’s First Prayer (Stretton, 1866) 545
Intensive Care Unit (ICU) 319 Jews 298, 509
internalized moral principle 70, 73 jimsonweed see James-Town Weed
International drug control 474–475 Joe-Laidler, K. 129, 137
International Narcotics Control Board (INCB) John Barleycorn: Alcoholic Memoirs (London, 1913) 73
471, 475 Johnson, O. 52
International Opium Convention (1912) 474 Jolley, C. 319
intoxicated self 594–595 Jones, G. 132
intoxicating environments 92, 95 José da Silva Lisboa 366
intoxication: defnition of 19–20, 178, 355; Journal of the American Medical Association
and femininity 7, 52, 56, 64, 76, 121; and ( JAMA) 316
masculinity 62–64; territory of 20 Juul 36, 48
intoxication practices, challenging and changing
184–186 kafći 150, 151
intoxigenic digital spaces 92 Karasch, M. 369
Iraq 247 Kasamatsu, A. 419
Ireland: drinking culture 523–538; Home Rule Keane, H. 34, 35, 45, 48, 265, 345–347, 355,
525, 538n3 463, 595n2, 598n64
Ireland Sober, Ireland Free 524–529 Keating, M.F. 531
Irish Free State 529 Kennedy, A.L. 81
Irish Home Rule 525, 538n3 Kennedy, P. 241
Irish Medical Association 530 Kerr, N. 526, 530, 591, 592, 594
Irish National Council on Alcoholism (INCA) ketamine 129, 136, 137
533, 535 “ketjubung” 250
The Irish News 452 khat: anti-khat campaign 401; association with
Irish Pioneer Total Abstinence Association somali community in Sweden 400–410;
526, 532 negative efects 401; pleasurable efects 400
ironic intoxication 343 khat cafés 400
Isbell, H. 313, 314 Khoshnood, K. 394
Isherwood, C. 79 ‘kilns’ 159
Istanbul 137, 145, 154, 164 Kimball, S.T. 530, 531
King, D. 182
Jackson, C. 81, 245 King James 23
Jackson, H. 595n14 Klantschnig, G. 384, 400
Jacobs, W.W. 167 Klee, G. 251
James-Town Weed 249 Klein, A. 385, 389, 401

608
 Index

Kleist, N. 402, 405 Lipton, B. 186

Klinenberg, E. 165 liquid courage 242
Koch, E.S. 120 Livesey, J. 545
Kofyar 296 Lloyd, C. 192, 195, 196
Kohn, M. 25 Lloyd’s of London 187
koknar 248 local coverage, of drug-related deaths 450, 451
Kolb, L. 311, 316 Lock, M. 395
Kolte, B. 261 London, J. 73, 74
Koob, G. 321 The Lost Weekend (Chandler, 1944) 72, 81
Korean War 245, 250, 431n6 Lowborough, L. 548
Kublai Khan (Coleridge, S.) 90 Lo Yü-jen 587
Kurino, R. 419 LSD see lysergic acid diethylamide (LSD)
Kyoko Incident 1954 424 Lucherini, M.C. 266
Kyrgyz prisons, methadone treatment in: Luhmann, N. 13
analysis 208; methadone-Dimedrol 211–217; lutheranism 505
methadone in relation to heroin 208–211; Luther, M. 504, 505, 516
methods 206–208; theoretical approach lysergic acid diethylamide (LSD) 25–26, 131,
205–206 239, 252, 284, 285, 330, 331, 335

Lady Audley’s Secret (Braddon, 1862) 549–550 MacAndrew, C. 276, 344

Laing, R.D. 133 MacArthur, D. 422
Lamb, C. 548 MacNeice, L. 83
Langhamer, C. 511 Macnish, R. 546, 548, 558, 590
Larney, S. 192 mafrish 400
Lasagna, L. 316 Magnan, V. 373
Lashar-e-Taiba 246 Maguire, S. 120
Latham, A. 165, 168, 169 Maher, C. 63
Latour, B. 168, 485 Mainichi Shinbun 413
Law Enforcement Against Prohibition (LEAP) Mair, J. 184
481n11 Malcolm, E. 525–528
Law, J., 485, 491, 494 Malins, P. 267, 268
Layton, J. 165 Malungo 362
Layton, R. 184 marijuana 24, 35, 55, 251; see also cannabis
League of Nations 24 Marijuana Tax Act (1937) 24
Leary, T. 25, 131 market exchange 101
Leckey, M. 128 Markham, F. 95
Lefebvre, H. 264 Marković, I. 264
legal highs 92, 93, 136 Martin Chuzzlewit (1842–1844) 552
Lemass, S. 531, 532 Mary Barton (1848) 548, 555
Lemon, R. 582, 583 masculinity 53, 76; construction and
Lennox, A. 132 reinforcement 62–63
lethal dose (LD) 317 Mass Observation 166, 167, 173, 511
Lettsom, J.C. 548, 589 mass sexual assault incident 431n4
Levine, H.G. 20, 28, 29, 29n1, 591–592, 598n63 Matthee, R. 163, 164
LGBTQ+ 272, 273; dis/inhibition Mauss, M. 166
275–276; licentious conduct 276–278; The Mayor of Casterbridge (Hardy, 1886) 71, 553
sexual drifting 278–280; uninhibited McAllister, A. 545, 560n21
play 281–286 McAndrew, C. 292, 295
Li Bai 587 McCormack, D. 168, 169
liberalism 365–373 McCormack, K. 543
Liboiron, M. 460, 465 McCready, G. 267
licening 519n3 McDonagh, M. 571
The Life and Death of Mr. Badman McDonaldisation of beer 115
(Bunyan, 1680) 71 McFarland, F.E. 527
limbic capitalism 28 McKay, G. 135
liminality 294–296, 300 McKirnan, D.J. 274
liminoid 301–303 McQuoid, J. 34, 45

609
 Index

MDMA see 3,4-methylene-dioxy-meth- Murray, E.J. 531

amphetamine (MDMA) Muslim 145, 146, 150, 152
meanings of drunkenness 12, 591–594 Musto, D.F. 407
Measham, F. 52, 92, 97 Mystical Experience Questionnaire (MEQ)
the media 12, 51, 64, 251, 403, 407, 437–453 329, 338
The Medical Pioneer (1892–1897) 546
The Medical Temperance Journal (1869–1892) 546 naloxone 342, 349, 351, 352
Medico-Social Research Board 533, 534 Napoleon Bonaparte 250, 365
Meier, P.S. 33 narcotic bondage 312
Meiji Restoration 431n7 Narcotics Control Law 426
Mellor, P.A. 301 national coverage, of drug-related deaths 447,
Melville, C. 135 448–449
Melville, H. 73 National Drug Law Enforcement Agency
Mendoza, S. 444 (NDLEA) 384, 385
Menninger, K. 548 National Health Service (NHS) 447
Mental Treatment Bill 530 National Institute of Mental Health (NIMH) 311
mescaline 131 National Institute on Drug Abuse (NIDA) 93,
methadone: and Dimedrol 211–217; in Kyrgyz 178, 481
prisons 203–218; psychological efects naturally occurring 330
214–217; in relation to heroin 209–210; as “the naturals” 584
taking over body 210–211; withdrawal 209 Naysmyth, P. 132, 133
methamphetamine 57, 244, 413, 415, 430n2 Nazi 244
methodological considerations 329–337 necropolitics 156n11
3,4 methylenedioxyamphetamine (MDA) 130 necroviolence 156n11
3,4-methylene-dioxy-meth-amphetamine Neinhaus, K. 69
(MDMA) 105, 127, 130, 137n1, 283, 284, 476 Nembutal 313
mild intoxication 184 neoliberalism 90, 91, 99
Miller, J. 546, 558 neolocalism 116
Millier, B.C. 79–80 Nestle, M. 94
Mill, J.S. 96 Netherlands 24, 26, 27, 242, 244, 320, 401
Milloy, M.J. 192 The Nether World (Gissing, 1889) 558
Minas do Ouro 362 networking 183, 184
Minas Gerais 362, 365 neural respiratory drive (NRD) 320
minority stress 273, 275 neurology 418, 587–589
Mireour du Monde 504 neuroscience 93
Misuse of Drugs Act 1971 133 new prudentialism 97
Mjåland, N. 198 new psychoactive substances (NPS) 195
mlinovi 147, 149, 149 newspapers 163, 401, 413, 444, 447, 448, 449, 451
modafnil 246 nic’d out 42, 48
moderation 10, 13, 71, 90, 116, 120, 186, 343, nic’d up 33–49
352, 355, 501–504, 516 Nicholls, J. 550, 595n41
modern consumption 91 nicotine 458; circadian rhythms 264; control
modernisation 290 and calibration 41–43; drug, set, and setting
Mol, A. 485, 491, 494 263–267; identity 266–267; more-than-
mood changes 316 human theory 264–265; performativity
Moore, D. 35, 595n2 266–267; place-embedded social practices
moral careers 23–26 265–266; spatial politics 266–267; vaping
moral panic 128, 134, 442, 550 33–49
Moran, L. 241 nicotine replacement therapy (NRT) 265
Morel, B. 373 NIDA see National Institute on Drug Abuse
more-than-human theory 264–265 (NIDA)
Morgan, P. 131 ‘Nietzsche sickness’ 73, 81
morphine 25, 247, 311 Nigeria: cannabis use, social deviance
morphine abstinence syndrome 311 and policing 390–391; drug laws and
Moss, S. 170, 173 enforcement practices in 383–385; policing,
Muraven, M. 69, 75 structural violence and well-being 391–392;
Murphy, S. 29n1 social exclusion and cannabis use among

610
 Index

street-involved youths 388–390; street habitus Papazian, C. 114

and responses to policing 392–394 Papua New Guinea 145
Nigerian Police Force (NPF) 385 Paradise (Kennedy, 2004) 81
Nigeria, recreational drug use in: constructing Parker, H. 93
and reinforcing masculinity 62–63; coping Partanen, J. 297
with diverse negative emotions 55–58; data Partlicius, S. 585, 595n18
analysis 55; gendering, of drug use 52–53; pastoral power 460
heartbreaks management 58; participants Pearce, L. 264, 266
and interviews 53–54, 54; pleasurable sex performance and image-enhancing drugs
enhancement 60; sexual arousal 61–62; (PIEDs) 342; hepatitis C transmission 348;
smoking competition 62–63; study site and intoxication 352–355
53–54; tramadol, in sex elongation 58–60; Permanent Central Opium Board (PCOB)
women’s power in sex negotiation 61 474, 475
“Night Eagle” 246 perverse implantation 275, 276
Nixon, R. 24, 464 Pervitin 244
Non-Aligned Movement 144 Peters, D.J. 440
non-drinking academics 185 pharmacogenic orgasm 322n5
non-lethal weapons (NLWs) 239 Pharmacopoeia 24
normalisation 92 pharmacothymia 322n5
normative substantiation 278 pharmakon 98
North America 118, 127, 145, 153, 155, 277, Phillips, R. 502
364, 444, 446, 472 Philopon see methamphetamine
The Physiology of Temperance and Total Abstinence
obesity 98 (1853) 549
O’Brien, J.A. 531 PIEDs see performance and image-enhancing
Oda, S. 415, 417 drugs (PIEDs)
The Odd Women (Gissing, 1893) 558 Pienaar, K. 345
Ofce for National Statistics (ONS) 447 The Pilgrim’s Progress (Bunyan, 1678; 1684) 71,
Oldenburg, R. 160, 164 72, 73
O’Malley, P. 97 Pini, M. 137
onion hosting 102 Pioneer Total Abstinence Association 526, 532
online drug market: drug commodifcation 105– PippUK 332, 339n1
106; drug making 104–105; illicit drug culture “pito do pango” 368
101–103; infrastructure 107–108; research 103; pleasure 27–29, 35, 89, 198–199
risk-refexive subjectivity 106–107; supply chain Plester, B. 179, 180
efects 105–106; user subjectivity 101 Poland 13, 244, 261, 262, 266, 501, 508, 516
ontopolitically-oriented approach 342–356 policing: social deviance and 390–391; street
opiate use 25 habitus and responses to 392–394
opioid overdose 349–350 policy stakeholder 489–495
opioid withdrawal syndrome 351 The politics and poetics of transgression (Stallybrass
opium 247, 249–250 and White, 1986) 163
Oppenheim, J. 567 Pollak, M. 370
oppositional valence 26 polydrug 56
oppression illness 386 Porter, R. 588
Orford, J. 78 Portuguese 362
organisational culture 181 positivism, limits of 320–322
Osborne, G.B. 63 post-addicts 315, 316
‘The Ostler’ (1855) 557 post-Cold War 144
Ōtomo Tabito 587, 597n30 Post Ofce (1971) 77
Ottoman 144, 146, 147 Poststructural Interview Analysis 207
Our Mutual Friend (1864–1865) 547, 552 post-traumatic stress disorder (PTSD) 246
Outing (magazine) 71 Posture Code (1830) 367, 368
Out of It (Walton, 2003) 89 “The Potato Eaters” 21
overdose 309, 317–320, 349–352 potency, drug 104, 106–108
prescription drugs 1, 4, 64, 182, 224, 314
Paasonen, S. 280, 286 Presley, E. 22
Pakistan 246 Priestley, J. 71

611
 Index

prisons: drug dealing in 197; intoxication in the reformation 501

191–199; prisoner society 196–198 Reinarman, C. 28
problematisation 290–292 Release and Scottish Drug Forum 441
prohibition 469 Renaissance 29
promotion 290–292 Reverse Pingpong 332
proportion 290–292 Reynolds, S. 129, 138n3
propranolol 247 Rhodes, T. 204, 205, 277
Protestantism 71, 291 rhythmanalysis 264
Prozac 21 Rio de Janeiro 365–367, 371
psilocybin 330 risk 437–453, 512
psychedelics 25, 104, 330; context of 331–334; risk environment 193, 199n2
inner experiences 334–336; methodological risk-refexive subjectivity 106–107
considerations 329–331; peaking in Ritalin 21
psychedelic experiences 336; renaissance Ritchie, J.E. 162
338; role of setting 333–334; subsiding rituals: benefcial outcomes 297–299; of
intoxication 337; trip planning 332–333 cigarette smoking 463; communitas 296–297;
psychoactive commodities 90, 93, 95, 96 and conservatism 299–300; controlled
psychoactive substances 9, 20, 22, 37, 53, 89, 92, decontrolling 295–296; culture and
182, 195, 291, 293–298, 301, 401, 441 292–293; drinking 293; gift giving in 297;
psychoactive weapons 248–249 in modernity 300–303; process 293297; to
Psychochemical Warfare: A New Concept of War 250 refexivity 290–304; transformation 301–303;
psychonauts 328, 329, 331 transition 294–295
psychotoxic arsenals 250–253 Robinson, D. 120
psychotoxic water 253 Robinson, S. 247
Public Health (Alcohol) Act 523, 537 Rodrigues, N. 374
Public Health England (PHE) 447 Rohypnol (Ruchy) 54, 56, 63
public health policy 291 Rolfe, A. 78
pubs 116, 159, 160, 162–164, 167, 199, 517, 531 Rolleston, R.D. 583
pub test 276, 287n1 The Romantic Ethic and the Spirit of Modern
Consumerism (Campbell, 1987) 91
Quan, A.M.L. 446 Room, R. 92, 595n1
queer cultures 272–287 Roseberry, W. 118
3-quinuclidinyl benzilate (BZ) 252 Rosenbaum, M. 29n1, 132
Rosenzweig, R. 26
racism 373 round-buying 166
Rado, S. 312, 316, 322n5 Royal Navy 245
Rapadura 372, 378n2 Ruchy (Rohypnol) 54, 56, 63
Rappaport, E. 565 A Rumor of War 248
rationality 106–107 Rush, B. 472, 543, 546, 589, 590, 595n42
re-addiction 311, 312
real ale 116, 120, 123n1 Sagvaag, H. 180, 184
reciprocal demonization 26 St Patrick’s Day 523
recreational drug use, in Nigeria: constructing Sala, G. 159, 160, 167, 170
and reinforcing masculinity 62–63; coping Sandberg, S. 383, 386, 391
with diverse negative emotions 55–58; data Sanders, E. 266–267
analysis 55; gendering, of drug use 52–53; Sao Paulo 362
heartbreaks management 58; participants Sarajevo 145, 147–149
and interviews 53–54, 54; pleasurable sex Sarmatism 508
enhancement 60; sexual arousal 61–62; Saturday Night and Sunday Morning (1958) 77
smoking competition 62–63; study site Sauerbronn, J.F.R. 120
53–54; tramadol, in sex elongation 58–60; Saunders, N. 136
women’s power in sex negotiation 61 scapegoating 11–12, 510
red oil 252 scaremongering approach 127
Reducing Americans’ Vulnerability to Ecstasy Schivelbusch, W. 163
(RAVE) Act 136 Schmidt-Semisch, H. 261
Reed, J. 547 Schnell, S.M. 116
Reese, J.F. 116 Schüll, N.D. 95

612
 Index

science and technology studies (STS) 343, 345 Socialist Federal Republic of Yugoslavia (SFRY)
scientifc racism 373 144, 155n1
secrecy 240 social marginalization 393
Sedgley, J. 547 social media 123, 185
Šehović, A. 145, 152, 153 social organisation and drugs 196–198
self-actualisation 463 social practice theory 265, 266
self-control 69, 75, 276 social smoking 264, 268
self-fagellation 74, 77 social supply 101, 102
self-government 194 Somalia 246, 400, 403, 404
self-medication 194, 195, 272, 273, 310, 464 Somali immigrants 401
Senanayake, N. 458 Somali problem 408
sensation fction 549–550 Sournia, J.-C. 550, 595n3
sensuous perplexity 458 Sousslof, C. 29n1
sex negotiation, women’s power in 61 Soviet Afghan War 248
sexual arousal 61–62 Span, S. 69, 75
sexual drifting 278–280 Spicer, A. 182
sexual drinking 279 spill-over 470
sexual harassment 185 Spracklen, K. 120
Shilling, C. 301 Starck, P. 131
Shiman, L. 546, 559n11 Starmer, S. 135
Shroomery 330, 339n1 Starowolski, S. 508
Shulgin, A. 127, 130 ‘state-change’ 287
side efect 105 status anxiety 279
Siegel, R.K. 132–133, 309, 310 status politics 23, 92, 93
Sierra Leone 246 status recategorization 118
Silk Road 92 Steinbeck, J. 73, 74
Sillitoe, A. 77 Stepney, M. 184
Simmel, G. 165 Stergaard, J. 303
Sinatra, F. 22 Stevens, J. 131
Singapore, smoking point in 459–461 Stevenson, R.L. 542
Single Convention on Narcotic Drugs stigmatization 266, 267
470, 471 Stimulant Control Law (1951) 414, 420–422
Skarbek, D. 196 Stimulants and Narcotics (Anstie, 1865) 275
Sketches by Boz (1836) 552 Stojaković, J. 154
Slade, G. 197 Stolac 150–151
Slatter, R. 172 Stopka, T. 394
slaves 365, 366 Storming Heaven (Stevens, J.) 131
Small, W. 227, 230, 231, 236 The Straits Times (2021a) 460
smart drugs 92 Strang, J. 309, 318, 319
Smith, B.A. 527 Straus, E. 312
Smith, E. 566 stress 40
Smith, R. 275 Stretton, H. 545
smoking 34, 160; and drinking 162; (not-so-) structural violence 385–386, 391–392
toxic geographies of 458–463 structural vulnerability 385–386
smoking ban 459, 460 Stubbs, C.W. 569
smoking competition 62–63 STV News 452
smoking corners 461–462 substance use 52
smoking games 62 sudden sickness 78
smoking points, in Yishun, Singapore 459, Sue 490
460–462, 462 Suf mystics 145
social and personal control mechanism 75–83 suicidal comfort 548
social class 53, 115, 117–119, 318, 383, 488 Sulkunen, P. 345
social constructionism 54 The Sun (newspaper) 128, 134
social context 262–264, 317 supply chain 105–106
social control 26, 27 Swedish National Board of Health and
social deviance and policing 390–391 Welfare 409
social exclusion 388–390 ‘The Swimmer’ (Cheever, 1964) 69, 74

613
 Index

Sydenham, T. 595n15 Turner, V. 293, 294, 296, 299, 300, 302

Sykes, G. 193 Twain, M. 26
symbolism 121, 122 Twitter 92, 123
synthetic cannabinoid receptor agonists
(SCRAs) 195 Uchendu, E. 57
Syria 246 The UK: brewpubs in 115; Campaign
Szymkiewicz, J. 508 for Real Ale (CAMRA) 115, 120;
drug-related deaths 437–439; ecstasy and
Tai, H. 420 dance culture in 132–136; penal power in
Taiping Rebellion 250 prisons 194
take-home naloxone 348 ‘The Unbeliever’ (Bishop, 1946) 72, 73, 81
Tan, Q.H. 264, 265 uninhibited play 281–286
Tatetsu, S. 419 United Nations Ofce of Drugs (UNOD) 469
Taylor, D. 552 United Nations on Drugs and Crime
tea: addiction 564–577; drunkenness 573–576; (UNODC) 475
excessive drinking 568, 574; mind and body United Nations Single Convention on Narcotic
570–573; nerves and degeneration 566–570 Drugs 382
temperance fction 549–550 United States Dispensatory 24
temperance movement 23, 413, 544 University of Sydney Human Research Ethics
The Tenant of Wildfell Hall (Anne, 1848) 71, 547, Committee 274
551, 560n15 The US: alcohol prohibition 28; The Beatles
tetrahydrocannabinol (THC) 252, 476, 477 in 22; cannabis, and opiates in 25; craft
Thackeray, W. 547 breweries in 114, 115; drug-related deaths in
Thaemlitz, T. 129, 137, 138n4 439–440; saloons 164; status politics 23
THC see tetrahydrocannabinol (THC) US Chemical Corps 251
thematic analysis 55 U.S. Food and Drug Administration 313
This Side of Paradise (Fitzgerald, 1920) 77 US Harrison Act (1914) 240
Thompson, H.S. 334 US Narcotic Farm 311, 315
Thompson, L. 264 U.S. National Institute on Drug Abuse 206
Thurnell-Read, T. 120, 170 US Navy Special Warfare Development
tobacco 21, 23, 161, 262; British per capita Group 246
consumption (1850) 161; in China 167–168; US Patent and Trademark Ofce 239
in England 23; pipe 163; scholarship 262–263;
Tobacco 21 law 36 Valentine, K. 206
tolerance 317–318 valium (diazepam) 247
Tompkins, C. 196, 197 Valverde, M. 35, 591
Toner, D. 525 Van de Baan, F.C. 192
Tor 102 Vanity Fair (Thackeray, 1848) 547
Tortilla Flat (Steinbeck, 1935) 73 vaping 463; competences 34; control and
toxic 457–458 calibration 41–43; forging social connection
toxicity: geographies of 457–458 and community 43–47; functional
traditional-punishment model 69–75, 81 intoxication 37–41; intoxicating elements
tramadol 51–52, 54, 58–60 37–47, 38–39; materials 34; meanings 34;
Trance and Dance in Bali (documentary flm, as skeuomorphic assemblage 264; spatial
1952 ) 30n6 fexibility 34–35
transgression 75 Vasilou, E. 198
Treasure Island (Stevenson, 1881–1882) 542 Veblen, T. 160, 165, 519n7
Treaty of Versailles 474 Vermeer, J. 21
Treeby, M. 70, 73 vertical drinking 510
trip reports 328–339 Veyne, P. 205
Trocki, C. 92 vice of drunkenness 371
Trojan War 247 Vietnam War 251
Trollope, A. 545, 553 violence 185
Trotter, T. 543, 544, 546, 558, 589, 590, 594, violent syndicates 426
598n47 vital materialism 169
Turkey 145 Volkow, N. 593
Turner, J.E. 591, 592, 594, 598n57 Von Brühl-Cramer, C. 590, 592, 598n50

614
 Index

Von Felsinger, J. 316 Wodehouse, P.G. 72

Vrecko, S. 98 The Woman in White (Collins, 1860) 549–550
vulnerability 442, 446 The Women of England series (1839–1843) 555
‘women’s alcohol’ 52
Walker, B. 181 Wood, E. 545, 549
Wallace, A. 120 Wood, J. 575
Walsh, D. 533 workplace, alcohol use in 179–181
Walton, S. 89, 90 World Health Organization (WHO) 20, 203,
Ware, J.R. 162 204, 311
warfare, intoxicants in: drug use by combatants World War I 162, 477, 527
241–248; historiography 240–241; World War II 28, 162, 309, 383
psychoactive weapons 248–253 Worlidge, J. 507
Warner, J. 582, 595n5 Wright, M.A. 135
Warner, M. 283, 286 Wurdz, G. 71
war on drugs 24, 240, 382
Washington, G. 242 ‘X’ see ecstasy
Wasson, G. 328
Watt, J. 514 Yates, S. 494
The Way We Live Now (1875) 553 Yomiuri Shinbun 413
Weber, M. 96 Yoshida Kendō 587
Webster, F. 444 Young, M. 95, 267
Weinberg, D. 592–594, 598n75 Young Woman’s Tract 555
Weschler, L. 30n3 Yugoslavia 143
West, C. 52 yuppie cofee 118
Wetherspoon, J.D. 515
Whitaker, M. 183 Zef, L. 130
WHO see World Health Organization (WHO) zero-tolerance policy 196, 224
Wikler, A. 309, 311–315, 320 Zieger, S. 568
Wilmot, R. 278–280, 286 Zimmerman, D.H. 52
Wilson, T.M. 524, 525 Zinberg, N.E. 104, 193, 261, 262, 297, 329,
Wilton, R. 53 333, 337
wine 23, 118, 296, 469, 583 Zulus 243
‘withdrawal-relief ’ recovery method 69, 74 Zuxiang, W. 168
Withington, P. 164 Zwingli, H. 505

615