AOH :: COKE.TXT|
Snow Job: Cocaine's hazards and addictive power have been greatly exaggerated.
This article is adapted from chapter 5 of Bruce Alexander's book
_Peaceful Measures: Canada's Way Out of the "War on Drugs"_
(University of Toronto Press, 1990).
Snow Job: Cocaine's hazards and addictive power have been greatly
By Bruce Alexander
In the propaganda of the drug war, cocaine is an unmitigated evil, perhaps
symbolized most vividly by one of those none-too-subtle images from the
Partnership for a Drug-Free America: a revolver with its barrel aimed up
the user's nostril. At other tmes and in other places, however, the drug
has been known as a benign stimulant and a marvelous tonic for a variety of
major and minor ills.
The modern controversy over cocaine is neatly framed by the writings of two
bold young doctors: Sigmund Freud and the American addiction specialist
Mark Gold. Working a century apart, Freud and Gold both established their
reputations by investigating the effects of cocaine. Both were skilled
physiologists who undertook the study of cocaine soon after they left
medical school. But their conclusions about the drug are diametrically
opposed. Indeed, it is at first difficult to believe that they are
describing the same substance.
Gold, a former member of the psychiatry department at Yale Medical School
who now directs private hospitals in Florida and New Jersey, considers
cocaine terribly addicting for experimental and recreational users. Freud,
on the other hand, believed that cocaine addiction is rare and confined
largely to people already addicted to other drugs. Gold maintains that
nonaddictive use of cocaine is useless and dangerous, but Freud thought it
medically harmless and beneficial. While Gold calls for warlike
drug-control measures to combat the cocaine menace, Freud eagerly explored
the drug as a potential blessing to humanity.
Although current conventional wisdom supports Gold's position, the bulk of
modern clinical, experimental, and historical evidence indicates that Freud
was closer to the truth on the first two issues. On the third issue, both
Freud and Gold are wrong. It turns out that cocaine is neither a terrible
scourge nor a great boon. Simply put, it's not nearly as important as it's
made out to be.
The data on cocaine use tend to support freud's view of the drug's
addictive potential rather than Gold's. In spite of widespread
availability and declining prices, most people never use cocaine; of those
who do, most use it only once or a few times; of those who become casual or
regular users, most do not become dependent or addicted; of those who
become dependent or addicted, most return to moderate use or voluntarily
abstain without treatment; and of those whose addiction becomes serious
enough to require treatment, most had lives that were marked by severe
alienation or misfortune before they first used cocaine. None of this is
intended to deny the horrors of severe addiction to cocaine, but rather to
challenge the view that these horrors prove cocaine is a highly addictive
Whatever the drug's power, the vast majority of American's have managed to
resist it. Cocaine use appears to have peaked by 1979, leveling off in the
early 1980's. The National Household Survey on Drug Abuse indicates that
at the peak, less than 10 percent of Americans had ever used cocaine and
less than 2 percent had used it even once in the year in which they were
The "addictive liability" of a drug is not a precisely defined term, but it
should be reflected in the difficulty that people have in terminating use.
When the National Institute on Drug Abuse questioned high-school seniors
who were considered recent users of cocaine in 1983, 3.8 percent reported
that they had tried to stop using cocaine and found they could not. By
comparison, 18 percent of cigarette smokers reported that they were unable
to give up tobacco. Other American surveys of more geographically limited
populations have produced similar results.
Taken together, the survey data indicate that cocaine is used by a minority
of Americans and that only a small fraction of this minority uses very
much. Of course, general population data like these tell little about
special populations, such as school dropouts, in which more people may use
cocaine and a higher proportion may become addicted.
In addition to the surveys, there have been a few studies of cocaine users
who were located through advertising or personal networks. Since these
samples were not randomly selected, they do not represent all cocaine
users. They do, however, tend to provide more in-depth information on
users than do random surveys because the participants, as volunteers, are
unlikely to conceal information from the interviewers. Subjects in these
studies generally report considerable control over their patterns of use.
They often use the drug casually for years without progressing to heavy
use, and when use does get out of hand, they are able to cut back or stop.
(There is a recognizable sequence of reactions after a binge of heavy use,
including a dramatic "crash." However, cocaine does not produce physical
withdrawl symptoms comparable to those that follow heavy use of alcohol,
barbituates, or opiates. Indeed, authorities differ on whether the
aftermath of heavy cocaine use should be called "withdrawal symptoms" at
The number of clients seeking help for cocaine problems in the United
States and Canada increased substantially during the late '70s and '80s.
But this does not necessarily indicate that cocaine is an especially
addictive drug. It is just as likely that some of the disturbed people who
were previously apt to receive treatment for alcoholism or other types of
deviance started using cocaine as the drug became popular and relatively
Clients who identify cocaine as their primary problem are likely to be
abusing a number of other drugs at the same time. Drug addicts, including
those addicted to cocaine, tend to suffer from anxiety, depression,
hyperactivity, and other serious behavioral problems before becoming
addicted. Therefore, it's likely that the people who are treated for
cocaine addiction would be in other kinds of trouble if they did not have
access to cocaine.
Drug wariors often cite studies of laboratory animals as evidence of
cocaine's unique addictive power. When animals are given intermittent
opportunities to self-administer cocaine in the laboratory, there is little
evidence that cocaine is highly addictive. Many different mammalian
species have been tested, and some members of each will press levers to
inject themselves with cocaine. The amounts they self-administer are
moderate and controlled. If the concentration of the injected solution is
raised, the animals generally respond proportionately less, and if it is
lowered they generally respond proportionately more. There are signs of
stimulation from the drug, but convulsions from overdoses are rare. It
seems that mammals find the drug pleasantly stimulating but naturally
maintain the stimulation at a safe level.
Reaserchers who make cocaine available to animals around the clock,
however, report indications that the drug is highly addictive. In one
experiment, three monkeys were put in cages where they were allowed to
press only one of two levers - one producing an infusion of cocaine, the
other producing food pellets - every 15 minutes. During the eight-day
experiment, all three monkey chose cocaine almost exclusively. Even on
trials where they did not choose cocaine, the monkeys did not press the
food lever. The animals lost weight and displayed strange, stereotyped
behaviors. In other experiments, monkeys and rats have self-administered
cocaine over periods of several days until they died of convulsions.
Such research is often interpreted as reflecting the fate of human beings
if cocaine were freely available. Psychiatrist Sidney Cohen of UCLA has
stated: "Under conditions of access to large amounts of cocaine the human
response remarkably resembles that of the laboratory animal.
Cocaine-dependent humans prefer it to all other activities. They will
continue using until they are exhausted or the cocaine is depleted....All
laboratory animals can become compulsive cocaine users. The same might be
said of humans."
But generalizing from the results of animal studies is dubious for many
reasons. To begin with, monkeys are gregarious, active, curious animals,
with a great resistance to being handled or restrained. The same is true
of wild rats and, to a lesser extent, of their laboratory-bred descendants.
Cocaine self-administration studies isolate such creatures in small cages,
where they are surgically implanted with a catheter and tethered 24 hours a
day to the injection apparatus. There is virtually nothing for these
creatures to do in their solitary confinement but press a lever on the wall
that produces temporary euphoric stimulation.
There's little reason to think that these animals would consume as much
cocaine in a more natural habitat. In fact, recent data indicate that rats
housed in isolation self-inject much more cocaine in daily tests than rats
housed more naturally in groups between tests. The observable behavior of
both animals and humans in their natural environments run contrary to the
insatiable cocaine consumption of isolated animals in the laboratory.
Moreover, the failure of animals to eat in some experiments may simply be
due to the fact that cocaine is a potent appetite suppressant.
It's widely reported in the news media and medical literature that smokable
cocaine is much more addictive than snorted cocaine hydrochloride. Crack,
in particular, is frequently said to be "instantly addictive" or the "most
addictive drug on earth." Some iminent scholars take these claims about
smokable forms of cocaine seriously. But others note that these claims are
suspiciously similar to the unsubstantiated stories that were told about
marijuana, glue, heroin, and cocaine hydrochloride when they first became
matters of public concern.
Smokable cocaine reaches the bloodstream much faster than dies nasally
administered cocaine hydrochloride. This in itself dies not prove that
smokable cocaine is more addictive than other drugs. The speed with which
smokable cocaine reaches the bloodstream is no greater than that with which
smoked marijuana or nicotine (or intravenouly injected cocaine
hydrochloride) normally enters the bloodstream.
Pharmacologically, the effects of smoking crack should be similar to those
of smoking coa leaves because the active ingredient, the cocaine alkaloid
is the same. Parke, Davis & Company introduced coca-leaf cigars and
cigarettes in 1885, and other drug companies offered similar products,
primarily as treatments for respiratory infections. Although cocaine in
general was gaining a bad reputation in this period, no one claimed that
these smokable forms were especially addictive. In fact, some users
publicly endorsed them as mild and effective remedies.
In spite of many media testimonials about the addictiveness of smokable
cocaine, the only experimental evidence that I have found to support them
comes from as single study on smoking coca paste in Lima, Peru. The
subjects were all described as nondependent, "occasional" users. All
subjects (the total number does not appear in the report) became anxious
before smoking, all expressed an "extreme desire" for alcohol during the
experimental sessions, and two reported "an inability to resist smoking"
during the sessions. Nonetheless, all subjects must have resisted smoking
enough to stop voluntarily, since no injuries or deaths were reported, even
though the subjects were allowed as much coca paste as they wanted during
two of the three experimental sessions in which each participated.
There is no statistical evidence of widespread use of crack or any other
form of smokable cocaine in North America. In the United States, 5.6
percent of high-school seniors surveyed in 1987 had ever used crack (as
compared to 15.2 percent for all forms of cocaine). Only 1.5 percent
reported use in the 30 days preceding the interview (as compared to 4.3
percent for cocaine in general). Thus, crack did not cause "instant
addiction" in the great majority of people who tried it.
A study in Miami found that juvenile delinquents generally preferred
cocaine hydrochloride to crack, because its effects last longer. Many of
them used crack in addition to cocaine hydrochloride, however, because it
was sold in smaller, cheaper doses. The study also fund that addiction to
crack was rare among the subjects. Taken together, these data suggest that
there is no difference in addictive liability between crack and cocaine
The data from surveys, self-selected user studies, clinical studies, and
animal experiments, together with the limited information available on
smokable cocaine, provide no evidence that cocaine in any form has a high
addictive liability or that we are experiencing an epidemic of cocaine use.
The widespread belief that cocaine is extraordinarily addictive is based
largely on subjective reports and anectotal evidence. Although most people
who experiment with cocaine subsequently use it intermittently and
moderately, if at all, some report that they "cannot control" or "can't
handle" cocaine, and must therefore abstain completely. Patients and
hotline callers often describe cocaine as irresistibly addictive. It is
unwarranted, however, to say that a drug has a high addictive liability if
the great majority of people who have used it are not addicted, even if
some of them find abstinence to be the best policy.
People who are inclined to become addicted to drugs tend to prefer cocaine,
just as people who are likely to become obese or bulimic are more drawn to
junk foods than to Brussels sprouts or turnips. Likewise, people who
become compulsively religious are more apt to be involved in an evangelical
sect or a trendy cult than in Presbyteriansim. If we define addicteve
liability in terms of the preferences of addictive people among the
available options, then cocaine is only one of hundreds of everyday
substances and activities that is highly addictive.
Cocaine use is closer to a fad of conspicuous consumption than an epidemic
of addiction. To call it a fad is not to trivialize it; fads exert
powerful effects on people's motivations. One subgroup that has been
caught up in the cocaine fad is adventurous, young, affluent adults. For
many such people, "Coke is it." As with other expensive fads and fshions,
the consequences for the great majority of participants are not dire,
although a small fraction of the participants become addicted or suffer
serious side effects.
Perhaps even more than the young and affluent, fads attract socially
marginal people who see, magical remedies to their problems. Because their
need is greater, they are more likely to use cocaine excessively. People
who at other times in history would have become obsessed with marijuana,
LSD, alcohol, sex, gambling, or political fanaticism became addicted to
cocaine in the 1980s.
The idea that cocaine addicts are sicially marginal runs counter to the
media prtrayal of "normal" people becoming addicted merely because of an
ill-advised experiment. Yet some people who appear successful are inwardly
disaffected and desperate. Throughout history disaffected and desperate
people have fallen into compulsive involvements, chosen from the
fashionable indulgences of the day.
On the question of whether moderate use of cocaine is useful and harmless,
as Freud believed, or useless and harmful, as Gold maintains, Freud was
again closer to the truth.
Heavy cocaine use can produce unwanted side effects, including
hallucinations, feelings of paranoia, unpleasant tacticle sensations called
"coke bugs," repetitive behaviours, and severe depression. In the most
extreme cases, the unwanted effects resemble a short-term paranoid
psychosis accompanied by convulsions. In addition to these experiences,
excessive use of cocaine sometimes damages the nasal tissues and kidneys.
The great majority of cocaine users, however, take the drug in moderate
amounts and experience positive effects. Some moderate users experience
side effects, but they are generally minor.
Experimental and recreational users of cocaine do not feel "stoned"; they
feel more competent and confident. It is possible that these perceived
benefits are illusory, but many careful observers have reached the
conclusion that cocaine helps people do simple tasks, expecially when
fatigued or hungry, and that it helps performers of various sorts achieve
the confidence they need.
Cocaine measurably improves performance on simple physical tasks in North
Americans who are fatigued or deprived of sleep. South American Indians
working to the point of exhaustion also had slightly better endurance and
higher heart rates when chewing coca leaves than on non-coca trials. There
is also experimental evidence that chewing coca leaves affords some
protection against the cold.
As in Freud's research, these modern studies suggest that cocaine is of
little benefit to people who are well-rested. Contrary to Freud's
observations, however, cocaine apparently does not help with complex mental
or learning tasks.
The stimulation from a moderate dose of cocaine can be as useful as the
lift from a cup of coffee, a short nap, or the satisfaction of a task well
done. Of course, legal lifts seem more proper than cocaine highs. But
outside the sheltered world of the well-fed and well-adjusted, for whom
little naps and tasks well done are a realistic possibility, illegal highs
may be a sensible recourse. Andean peasants used cocaine in this way for
centuries without provoking alarm, until they fell under the searchlights
of the war on drugs.
Negative effects are relatively uncommon among moderate cocaine users.
About 17 percent of Ontarians who have used cocaine report that they either
rarely or sometimes "become violent or aggressive," and 23 percent report
that they rarely or sometimes "feel that someone was out to get you" when
they use cocaine. However, the remaining 83 percent and 77 percent of
these Ontario cocaine users never have these reactions. These adverse
effects are less common among infrequent users than among heavier users.
There is direct evidence that moderate doses of pure cocaine, administered
intranasally, are reasonably safe. Cocaine is routinely applied
intranasally in doses of 200 milligrams or more in nasal surgery. These
doses are comparable to those typically taken by Canadian recreational
cocaine users, and the peak blood levels of cocaine following medical
administration are comparable to those found following doses that produce a
"high" in experienced users. A survey of plastic surgeons revealed five
deaths (.005 percent of the patients) and 34 severe nonfatal reactions (.03
percent of the patients) following 108,032 applications of cocaine in
surgery. Moderate injected doses of cocaine have also proved safe in
experimental studies with human subjects.
There is no doubt that overdoses of cocaine can cause illness and death.
The victims generally become excited and confused shortly after a large
dose of cocaine and subsequently undergo convulsions, depressions, coma,
and, in severe cases, death from respiratory depression or, sometimes,
heart failure. Overdose death usually occurs within a few hours. This
syndrome has been well documented in human beings since the 19th century
and can be replicated in experimental animals.
There is little evidence, however, that modrate doses are often fatal.
After an extensive search of the literature, I have concluded that the
widespread conviction that moderate use of cocaine is dangerous is based on
horror stories that are accepted uncritically and on medical research that
is misinterpreted because of the presuppsitions of the war on drugs.
The misinterpretation of medical research entails each of the following
errors: (1) exaggerating the amount of sickness and death that is
associated with cocaine; (2) gratuitously assuming that people harmed by
using cocaine are moderate rather than heavy users; (3) neglecting
indications that medical emergencies that befall heavy cocaine users could
just as well have resulted from their other drugs, activities, or
pathologies; (4) gratuitously assuming that cocaine purchased by users who
experience medical emergencies was unadulterated; and (5) ignoring the fact
that many legal drugs and activities are just as dangerous as cocaine.
Since 1982, the Drug Abuse Warning Network (DAWN) has reported dramatic
annual increases (up to 200 percent) in the frequency of "emergency room
mentions" of cocaine relative to other illegal drugs in many of the 27
cities that it surveys. However, these DAWN data do not mean that cocaine
has become a substantial health hazard. Cocaine is currently "mentioned"
in only 2.6 out of every 1,000 emergency-room visits in the DAWN cities.
A mention does not mean that a drug necessarily caused the emergency-room
visit, since each report may mention several drugs detected in a patient.
Moreover, the fact that a patient has used drugs dies not necessarily mean
that drugs have caused his or her illness. In addition, the DAWN cities do
not represent the United States as a whole, which has a substantial rural
and small-town population.
Similarly, although cocaine is currently mentioned in 14.4 of every 1,000
deaths reported by medical examiners in the DAWN cities, this does not mean
that cocaine caused that proportion of American deaths. Medical examiners
may mention several drugs in connection with a single death, so cocaine is
certainly not the cause of them all. Most routine deaths are not reported
to medical examiners, so this is hardly a sample of typical American
deaths. Most important, there is no information in the DAWN studies to
show that any significant proportion of the emergencies and deaths are
related to moderate cocaine use, or that the "cocaine" used by any of these
decedents was free of common black-market adulterants.
Nonetheless, cocaine is a heart stimulant. The data indicate that even
moderate doses could increase the risk of heart attacks in people who
already have high blood pressure or severe heart damage from other causes.
But instead of singling out cocaine as uniquely dangerous, these data place
it squarely in the company of a broad class of agents that include
caffeine, alcohol, tobacco, sports, gambling, and sex.
It's widely accepted in North America that crack and other forms of
smokable cocaine are especially dangerous. Some of the reports on which
this impression are based are simply false. For example, 'USA Today'
attrubuted 563 deaths to cocaine and crack in the first six months of 1986.
After a careful study of the official government reports and available
medical literature, Arnold Trebach, president of the Drug Policy
Foundation, found that none of these deaths could be confirmed.
Some articles in medical journals claim that crack, free-base, coca paste,
and other forms of smokable cocaine are significantly more harmful than
cocaine hydrochloride. However, apart from the well-established fact that
smokable cocaine reaches the bloodstream faster than orally or nasally
administered cocaine, these articles offer little data to support this
assertion. The authors seem to have relied on uncritical assumptions about
evidence, including all five of the logical errors mentioned above.
I do not mean to claim that harm never results from moderate use of
cocaine. All drugs, including cocaine, can hurt people. However, the
existing research dies not justify the claim that using cocaine in
moderation is an unusually dangerous practice.
When a person dies as a result of jogging, playing squash, driving a car,
or engaging in sexual intercourse, that event may lead people who engage in
these activities to reassess the costs and benefits. It does not provide
the occasion for a War on Jogging, a War on Squash, a War on Cars, or a War
on Sex. The kind of research that has been taken as serious proof that
cocaine rgularly causes heart attacks and other dire consquences in
moderate users only proves the existence of an extraordinary, warlike
mentality. This kind of thinking forfeits a normally critical perspective
to embrace spurious justifications for the war on drugs.
The third difference in the outlooks of Gold and Freud is the tone of their
writings on cocaine. Gold discusses cocaine only in the context of
pathology and control. Freud, by contrast, was uncharacteristically
lyrical in his description of the drug and its effects. In his proposals
that cocaine be used to cure most diseases and improve most human
activities, Freud appeared to view the drug as a welcome benefactor and a
savior from the stress of life.
Upon reflection, it is clear that both views ar wrong. Contrary to Gold's
view, cocaine cannot hurt us much. It is a drug that can be used in
destructive ways, but it is very unlikely to lead to addiction or injury
except in people who are already in deep trouble. The great majority of
people who try cocaine find it possible to use it in a generally beneficial
way or to leave it alone. The percentage of users who are harmed by it is
probably comparable to the percentage who are harmed by other stimulating
bu socially acceptable activities.
Feud was aldo wrong. Cocaine is not the great chemical savior he thought
it was - it is just a stumulant, an dstumulants do little more than enable
people to borrow from psychic reserves that have to be repaid later.
Sometimes such loans are useful, even pleasurable, but they don't represent
a net gain.
No drug can make people feel alert, health, and alive for very long. The
only hope for aa persistent sense of well-being is the patient cultivation
of courage, honesty, friendship, realism, and hard work. The promises of
the ancient homilies are far more valid than the magical promise that
cocaine held out to Freud. Cocaine has potential medical applications that
might be investigated further if not for the drug-war atmosphere, but there
are no signs that it can be the panacea that Freud imagined.
In sum, cocaine neither causes the problems that wrack our times, nor can
it rid us of them. Rather, the abundance of refined cocaine is yet another
complexity of a technological age. It may improve our lives to a degree if
we learn to use it wisely. But using it wisely could torun otu to mean not
using it at all.
In this century we have overreacted to the dangers of coaine with a futile
attempt to ban it from the world. This campaign stains the earth with
blood and corrupts the fragile institutions of democracy. Worst of all, it
diverts our attention from the real causes of the misery and conflict that
surround us. Cocaine is not a significant source of crime, violence,
addiciton, heart disease, brain damage, unhealthy babies, student apathy,
low productivity, or terrorism in the Third World. The real danger is the
destructive illusion that we can relieve these deeply rooted problems by
From _Reason_ magazine, December 1990:
Bruce Alexander is a professor of psychology at Simon Fraser University in
Burnaby, British Columbia.
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