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Bulletin of the History of Medicine 76.1 (2002) 180-182



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Book Review

Forces of Habit: Drugs and the Making of the Modern World


David T. Courtwright. Forces of Habit: Drugs and the Making of the Modern World. Cambridge: Harvard University Press, 2001. viii + 277 pp. Ill. $24.95 (0-674-00458-2).

A distinguished student of the American history of illegal drugs and social history, David T. Courtwright, has searched an intimidating range and amount of material to produce a major world history of habituating substances. He has successfully synthesized the scholarly, and to some extent the scientific, literature. He produces a coherent and sensible perspective on a wide variety of pleasure-producing, unnecessary, and addictive chemicals. He gives perspective to his narrative by placing it in the context of world/international history, [End Page 180] including both the idea of modernization and the persistent role of these substances in labor (and especially colonial) exploitation.

Forces of Habit is a remarkably "good read," written in an understandable and often colorful style. It will probably make an impact on both the general reading public and captive audiences of college students, who may actually enjoy reading the two hundred pages of text. Scholars (who may also enjoy reading this work) will take away a perspective that is both informative and challenging. The writing is remarkably spare. Most of the basic arguments in the literature appear in one place or another in Courtwright's text--sometimes only a sentence or two, but they are there. This is a wondrously well-balanced representation of the literature, enriched by many primary sources.

The most refreshing part of the book is Courtwright's choice of substances about which to write. He starts out with the "big three" largely legal substances: alcohol, tobacco, and caffeine. Only in a second part does he take up the often-sanctioned opium, cannabis, and coca (and their congeners). Using the whole panopoly of drugs, Courtwright posits a major world force for the last five hundred years, the psychoactive revolution. "People everywhere," he writes, "have acquired progressively more, and more potent, means of altering their ordinary waking consciousness" (p. 2). He portrays the process as the democratizing of drug consumption, for habits that were initially expensive spread to the masses--whether coffee and cocoa or injected heroin and absinthe.

What were the forces involved? "The spread of drug cultivation . . . depended on conscious human enterprise, and only secondarily on unconscious biological processes" (p. 3). Courtwright shows without difficulty that commercial greed was and is fundamental to the whole modern history of habituating substances. Some of us might dissent a little from his treating so respectfully ideas of biological vulnerability (sometimes he seems to believe that the human animal is inherently evil), but the advocates of legalization of drugs will find this book to be cold comfort indeed. Looked at from Courtwright's distant perspective, all of us who collaborate in eating, smoking, drinking, or sniffing are somewhat silly-looking players in historical, mostly commercial, developments.

Courtwright writes his account often in the present tense, signaling that he is concerned about public policy and current arguments (many of which are, of course, historical in nature), and he is refreshingly blunt in confronting and correcting propaganda. His own general historical outlook reflects David Musto's idea that substances generally follow a cyclical pattern of increasing use and then decreasing tolerance as members of society see how bad the excesses are. Virtually all of the habituating, stimulant substances at one time were used for medical purposes, and nonmedical use generated indignant reactions. Then the chemicals themselves could appear to be unhealthy, especially in industrializing and modernizing societies: "The clash between opportunities for profit and concerns about health forms the central moral and political conflict running through the history of psychoactive commerce" (p. 91)--a conflict that, as Courtwright shows, the high-tech medicine and big business of the late twentieth century did not change. [End Page 181]

In this book, the historical details are delightful, the...

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