The New Prohibition

Years ago, during my psychiatry clerkship in medical school, I learned to classify people with personality disorders as either “onions” or “garlics,” depending on their degree of self-knowledge. The “onions” were offensive to other people and knew they were offensive. The “garlics” were offensive to other people but didn’t know they were offensive. A person with a dependent personality was an “onion.” A narcissist was a “garlic.” Yet all of us are “onions” or “garlics” to one degree or another. People who purposely belch after big meals are “onions.” Leaf blowers who start work at the crack of dawn and dog-owners who run their big dogs off leash are “garlics.” Yet we don’t say these people have personality disorders, let alone herd them into therapy. The reason seems obvious, and yet that reason is hard to explain.

Similar confusion surrounds the issue of addiction. Addiction is defined as using a substance or engaging in behaviors in a compulsive manner despite harmful consequences. Opioid and alcohol addiction are classic examples. Over the years, the definition of addiction has expanded to include activities such as shopping and golf. But when one thinks about it, we all have compulsive behaviors that border on the harmful. Such behaviors are even central to our identities. We know people by what they love and what they hate, typically expressed in a sentence that begins with the word “I,” as in “I love this and I don’t love that.” This “I” of ours—including its peculiar property of loving one thing and not another with varying degrees of intensity, be it ice cream, work, or sexual partners—is how we distinguish one person from another in our minds.

The notion of addiction as a spectrum is not new. Shakespeare used the word addiction when referring to a “strong inclination” toward useless activities. But the notion has particular relevance today. Nicotine—once inhaled only through smoking, but now available in safer form through vaping—has thrown a monkey wrench into our understanding of what constitutes an addiction worth policing. When confined to adults, nicotine is less harmful than opioid or alcohol abuse, shopping to the point of bankruptcy, or golfing to the point of divorce. Yet government regulators spend an inordinate amount of time trying to regulate nicotine, while public health authorities hold sway on the issue by spreading anxiety among the public and arousing a consciousness of guilt.

If vaping nicotine sits on the safer end of the addiction spectrum, why does government pay so much attention to it? Indeed, the FDA recently proposed banning all JUUL vaping devices, pulling back only in response to public pressure. The answer is that regulators are using a half-century old model for policing addiction that has gone too far.

The Prohibition analogy

During the 19th century, religion gave America its first model for policing addiction, and alcohol became its first target. Although worried that alcohol might cloud a person’s God-given free will, religious activists quickly shifted their attention to alcohol-induced social pathologies, such as crime and family breakdown. In the early 20th century, social workers joined the movement. Prohibition passed in 1920.

Prohibition’s repeal in 1933 demonstrated the limits of the religious model. A fanatical bossiness tried to transform an entire country into a rigid obedience machine. Yet it is hard for religion to dictatorially impose a single world view on a country the size of America, as there are always enough people to resist such servitude and refuse to think in prescribed forms. It wasn’t just futile that religion aspired to do so; it was also banal. People missed drinking. Crime syndicates catering to their desire sprang up. Once state governments realized how much money in alcohol taxes they were losing, repeal became inevitable.

The religious model failed because, in the long run, the appeal of the sensual life is always stronger than that of any abstract teaching. While excessive drinking leads to ill health, modest drinking makes life pleasant. Because opiates lack this welcome upside, the 1914 Harrison Act restricting their use endured while Prohibition did not. President Franklin D. Roosevelt practically declared the triumph of the sensual life upon signing the bill to repeal Prohibition, when he teased, “I think this would be a good time for a beer.”

A more sustainable model for policing addiction ruled for the next 40 years. It swept into its net those substances that lacked redeeming qualities and caused serious social pathology. Alcohol’s pleasant upside shielded it from aggressive regulation. Although religious activists had succeeded in getting cigarettes banned in 15 states, the public resisted on that front, too. In 1964, when the Surgeon General published a report on smoking and health, 40 percent of Americans were regular smokers.

The common sense approach prevailed for the next few decades. Then another aggressive model for policing addiction arose—only not when people think. The seminal event was not the exposure of cigarettes as a health danger. American physicians had been discussing that problem since the late 18th century. Medical reports, actuarial studies, and epidemiological research in the middle of the 20th century simply confirmed it. That research culminated in the Surgeon General’s 1964 report declaring cigarette smoking a health hazard. Yet the addictive nature of smoking (and nicotine) was never addressed. The new warning labels on cigarette cartons and the new restrictions on tobacco advertising were meant to educate consumers and protect them from tobacco industry abuses, not from their own inclinations. Reformers saw smoking as nothing more than a bad habit. Their concept of addiction hardly differed from what Shakespeare had described four centuries before.

In the 1970s, neuroscience ushered in the modern concept of addiction—and with it a new model for policing addiction. Opioid receptors were discovered first. Research on neurotransmitters (especially dopamine) and brain circuitry followed, establishing the basis for addiction science, which quickly expanded beyond opioids to include alcohol and cigarettes, and, later, shopping and golf. Addiction science began to influence public policy in 1988, when the Surgeon General declared, “Cigarettes and other forms of tobacco are addicting.” During the 1990s, FDA commissioner David Kessler moved to regulate cigarettes more aggressively. The Supreme Court rebuffed his efforts, but in 2009, Congress gave the FDA the authority to proceed. Meanwhile, anti-smoking public health activists began to stigmatize cigarette smoking as a form of abnormal behavior.

The neuroscience model of policing addiction replicated the earlier religious model in tone but with some interesting twists. The older religious model believed in human free will and condemned alcohol for interfering with it. The new neuroscience model held that people lack free will and condemned addictive substances for exploiting their weakness. Neuroscience had already been arguing during this same period that the mind was an extension of the brain, and that human behavior originated not in free and independent decision-making, but in matter and energy relations that proceeded in a deterministic fashion. According to neuroscience, a person’s claim to identity, and even the feeling of “I” itself, were just illusions; a person’s inclination toward a particular substance or activity, which helped define that person, was a consequence of regularized neurotransmitter action and cellular processes rather than a free expression of individuality.

Although superficially less moralizing than religion, neuroscience’s understanding of addiction contained the same belief that people were fundamentally flawed, easily swayed, prone to illusion, and victimized by forces beyond their control. The big difference was that activists guided by the new neuroscience model saw the devil in more places, causing them to wage war on more fronts. They believed that people are so lacking in free will, so endangered by their irrationality and lusts, and so vulnerable to the dictates of neurotransmitter action, that they need to be closely watched in other areas of life—not just when consuming alcohol or cigarettes, but also, for example, when shopping or golfing. According to addiction science, all activities potentially lent themselves to addiction, since all activities can generate the necessary dopamine loops needed to turn an activity into a compulsion. The devil was now everywhere and potentially in everything.

Such thinking enabled activists to medicalize activities that Shakespeare had once casually referred to as “useless pursuits.” Because all useless pursuits threatened to rob people of their time or money, and since the inclination toward these pursuits supposedly had a biochemical basis beyond the person’s control, more regulations and mental health interventions were called for. What was once said of the husband who played too much golf—that it was “just his way”—was now a matter of “disease,” justifying counseling or other professional therapies.

The neuroscience model had a second twist on the old religious model. Early on, the religious model shifted its focus from the individual to social concerns. The neuroscience model, in contrast, stayed true to religion’s first intentions. It kept a watchful eye on the individual; it remained committed to perfecting the person. So, even when addiction failed to cause serious social pathologies, it remained a concern. Lifestyle addictions, which some people even boasted of having, ranging from eating to gaming to plastic surgery to thrill-seeking activities, were now pathologized through neuroscience despite lacking harmful social effects. Each addict, whatever the basis for his or her addiction, was now first and foremost a patient independent of whether or not he was also a troublemaker.

The neuroscience model inevitably led to pushback. Ideologues always underestimate the resistance rooted in the inertia of human beings; they always think that decisive reform can be realized quickly in real life as with their intellectual constructs. Critics called the new order the “nanny state.” They had no problem with government cracking down on addictions that caused serious social pathologies or that risked harm to others—for example, enforcing drunk driving laws or policing second-hand smoke in the workplace. But in private life, in sensual life, in the life of the individual, they wanted to be left alone to enjoy the little pleasures that made life easier, whether it involved eating fatty foods, playing video games, or smoking. One person’s addiction was another person’s preferred way of blissfully relaxing, they declared. They refused to fit into the pious, obedient herd, where all that was unique to them, and pleasant to them, threatened to be dissolved without a trace into the general order.

The problem of nicotine

At first, nicotine posed no real threat to the neuroscience model of policing addiction. Inhalable nicotine was trapped inside cigarettes, which were dangerous to individual smokers and to those who lived or worked in close proximity to them. That nicotine was also addictive seemed not to matter; the tar and carbon monoxide in cigarettes sufficed to condemn the whole carton. Although many smokers grumbled about the new restrictions and taxes placed on cigarettes, they accepted the reasoning behind them.

The problem arose in the first decade of the 21st century, when industry separated nicotine from tobacco and made it available for vaping in pure form. Government’s insistence on regulating nicotine as aggressively as it had regulated cigarettes flushed out the truth behind the neuroscience model of policing addiction. Although vaping nicotine was safer than smoking cigarettes, and second-hand nicotine vapor was safer than second-hand smoke, none of this seemed to matter to the regulators. What mattered was that nicotine was an addictive substance—perhaps one of the most addictive substances. To give nicotine a pass would be to undermine the neuroscience model of policing addiction, as it would mean that addiction was not the major concern after all—that instead serious disease and social pathologies were the concern. This would mean returning to the policy of the 1960s and letting people freely act out what Shakespeare had called their “strong inclinations” toward useless activities. Forgiving nicotine meant reinvigorating the sensual life at the expense of neuroscience’s abstract model of behavior.

The Biden administration’s recent demand that industry drop the nicotine level in cigarettes to minimal or non-addictive levels reveals how nicotine addiction rather than serious disease remains the neuroscience model’s primary concern. Lower nicotine levels in cigarettes will have no effect on dangerous tar or carbon monoxide levels. People will still be at risk if they smoke. Even if they avoid developing a smoking addiction, they will still be able to smoke as much as if they were addicted. Indeed, with less nicotine in cigarettes, smokers may feel free to smoke even more, creating more of a health hazard.

Yet for many regulators, nicotine’s addictiveness is the central issue. Much of the regulatory apparatus that has grown up over the last 30 years, along with much of the counseling industry that works in the area of lifestyle addictions, operates on the assumption that people are practically wired to be addicts—a hopeless, unruly mob of sinners. Viewed from this perspective, giving people freedom is risky, as it is inherent in people to abuse such freedom. It is why, according to adherents of the neuroscience model, people must be held on a tight leash. To do otherwise not only contributes to human fallibility, but also gives up on the goal of perfecting people.

Americans who vape nicotine, either to quit smoking or because they enjoy the experience, are fighting back. But their fight is really the old fight over Prohibition in a new guise. The religion-social worker axis is now the neuroscience-public health axis. The distinction that sensible people tried to draw in the 1920s, between the amiable social drinker and the bitter alcoholic who drinks alone, is today the distinction between the person who vapes and enjoys an innocent fix of pleasure, and the smoker who pants on home oxygen because his or her lungs are black with tar.

As during Prohibition, today’s regulators seem surprised by the rebellion. They do not understand why people refuse to be pressed down, shut up, plugged up, and obediently bottled. It is always the way of adherents devoted to a single idea, whether the idea is banning alcohol or banning nicotine: such people grow insensitive to any other thought than their own, even if it is a very human thought. They also forget that compulsion rarely makes people better, and that those who want to force others to behave the way they do are like doctors trying to push food into sick people’s mouths with a stick.

The sensual life is separate from neuroscience. In theory, all of us are addicts, and all of us could benefit from treatment. But the sensual life, although a realm of human fallibility, passions, and distractions, is vital to people’s wellbeing. It has a different purpose to that of neuroscience. Let us preserve this small oasis of sensual pleasure in a universe of scientific regulation. If the nicotine addict who vapes is neither seriously harmed nor a risk to society, let that person continue to enjoy a small portion of life the way our ancestors did, as they wish, relishing the sensual life as they have chosen. Let us agree there really is an “I” that loves this and doesn’t love that, not an illusion generated by neurotransmitters but a real entity deserving of respect, whose every carefree breath is not a sin.


This is a companion discussion topic for the original entry at https://quillette.com/2022/07/25/the-new-prohibition/
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Many years ago, I dated a lady who chewed Nicorette gum. She chewed the gum to avoid smoking cigarettes. At the time, I thought long-term Nicorette gum chewing was dangerous. I was wrong. Chewing Nicorette gum imposed an economic cost. However, the health impact appeared to be modest. The gum was originally developed for Swedish sailors, because they could not smoke on submarines.

My guess is vaping isn’t all that dangerous either. For the record, I don’t use Nicotine in any form. In my youth I was slightly addicted to second-hard cigarette smoke. However, that was a long-time ago.

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I think the onions are the American right. Sadly the garlics are the American left, including the author.

Yes dear, you are offensive to us onions because you are trying to thread the needle.

This is similarly just wrong. Yes there are many functional alcoholics and yes there are many functional opioid addicts.

We adults learn to cope with our lives and some of us are very successful.

We don’t need the preachy female garlic choir.

I am a black man. I smoke menthol cigarettes. I abhor you garlics’ attempt to impose on my bad choices.

Just let us be, white garlic lady. We are perfectly capable of choosing our own poisons, even if you think you are so superior to us.

There is an interesting discussion elsewhere about how banning smoking in pubs killed the UK pub business. Literally, the dream of clean air pubs and the expected new business just didn’t happen.

Is that good, is that bad? It’s certainly a culture change in the UK.

We clowns like our poisons. No needle threading will change that. At least we used to be sociable while doing our poisons.

Pfft, the narcissistic garlics can’t even see themselves in the mirror.

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One of the things I learned from more libertarian sources is the economics of addiction. Apparently, the drinks industry focuses on advertising to the 20% of drinkers who are the heaviest drinkers, for the simple reason that they represent two-thirds of the market, in terms of consumption. This also holds true for most drugs, including heroin, although I would be willing to place a modest wager that fentanyl operates somewhat differently, because of the tendency to eliminate its users so quickly…

It seems to be there should be lessons here, for prevention, treatment and using probation systems and open air drug use enforcement to track back to the logistical level and increase the costs to market. That’s one area which the Environmental Health experts agree on- incrementally raising the price of restricted or controlled drugs reduces addiction in the next generation.

I wish they had told me when I was young that my brain would be more likely to form addictions before 25. Like you I am an inveterate smoker, although my poison of choice is rolling tobacco. I abhor the urge to ban and prohibit people for their ‘own good’. By all means tax me if you wish to treat healthcare costs as an externality- that’s fair- but don’t forget to subtract the reduced cost of socialised care or public or private pensions in the long run. Fair’s fair.

I might have been willing to eat the bugs they want everyone to eat, if I had been offered them. Travelling, I tried plenty of foods which many of the more lily-livered would find repulsive. But tell me I have to eat bugs to save the planet- and I’ll them to shove the bugs where the sun don’t shine- like Mr Kellogg’s enemas.

image

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I’d like to keep sex out of this conversation @Geary_Johansen2020 , altho as the garlic lady said:

I couldn’t have put it better meself.

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I did used to smoke Old Holborn in the UK. What’s your poison of choice.

I didn’t smoke much before I was 40? Now I’m pretty much a pack a day. Either with coffee or alcohol, and sometimes with marijuana or mushrooms occasionally.

I’m leaving the opioids til I’m old enough to need them properly. Hopefully never

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Golden Virginia.

All of the above! :slight_smile: I’m rurally based, so unless I’m not travelling anywhere for a spell, I have to foreswear most, but not all, of these pleasures. The great thing about Norfolk is that there are plenty of stretches of fallow land where you can pick your own mushies, the right time of year. I haven’t had any in a few years though- they are so much less synthetic in feel than acid, don’t you think? Especially, on the come down, where acid tends to impart that rubbery plastic skin feel.

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Given your name, are you a new invader, or one name left from the original Vikings?

I have no skin in this, my best mate locally in southern Africa is a noob - Atle of the Jorgensen clan.

I don’t take acid. Mushies are pure beauty for me. Nothing to do with natural or not. But if I just want to reset myself, then mushies are great.

I’m not a psychedelics junkie, altho one of my son’s has dabbled deeper. And now is a leading rock climber locally. Who knows.

Maybe control of self?

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My dad’s parents were Norwegian immigrants to the States. He met my mother when stationed in the UK, although her ancestral roots are also Viking, from the Danelaw. You wouldn’t know it though- she’s the quintessential English retired primary school teacher.

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The great NW in the USA is full of Viking names.

Ah well my mom was a librarian. Dad a research chemist cum photog in his latter years.

I think you mostly manifest your mom. Lovely prose.

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I fear the author of this article does little to address the concerns associated with addiction itself. He equates addiction with sensual pressure. They are not one and the same thing.

The link he makes is the assumed health risk. If there is no evidence of health risk therefore, it is merely sensual pleasure, and therefore no harm done.

Addiction by definition is enslavement. It means not being in control and it has severe consequences in maintaining relationships, a job, and generally being able to participate fully in a social context.

Equating addiction with an enthusiasm to play golf whenever possible, or enjoying a drink at the bar with friends after work is not accurate. An alcoholic is someone addicted to alcohol, and that is a totally different ballgame to someone who enjoys a drink with friends. The author clearly has not encountered a true alcoholic in one’s family as some of us have.

On the issue of vaping. The idea that vaping helps folks who are already addicted to smoking is one thing, using it to lower barriers to entry for the young is quite another. JUUL deliberately targeted young people by tailoring their product specifically. This is what triggered the response from the public.

A closer look at addiction in all its forms where the basis assumed is loss of individual control might be appropriate as a follow-up to this article. I’m all for freedom to experience sensual pleasures and letting go once in a while, but get very nervous when this results in perminant loss of control.

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Why would anyone buy such a stupid line? Like sensual life happens at some spiritual level in an immaterial, disembodied soul? Of course the sensual life happens neuroscientificially, in a biochemical brain, the exact way everything else happens.

This idea of separation, especially coming from a supposed doctor shows how far people will go denying basic reality to serve some higher idea they get stuck in their heads.

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Oh daddy please help me?

Control yourself then you can control others.

Don’t get nervous, just control yourself @ThePragmatist .

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I equate addition quite easily. It is the fundamental property of a mathematical group.

One of which is the monster group, which is interesting itself.

Check spelling. Addition is not addiction.

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They cant stop me. I’ll smoke sawdust rolled up in a torn piece of envelope, idgaf.

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Heresy. What does that kind of thinking do to Gender Identity? We now know this is the central feature of one’s life. Not neurotransmitters but the essence of one’s transcendental soul.

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I started thinking this piece is weird about the point of “religion gave America its first model for policing addiction, and alcohol became its first target.”

What on Earth did that mean? Religion + policing? Good and evil, plus policing the criminal? Huh?

So the movement against alcohol started with the American Temperance Society, founded in 1826, on the normal 19th century mutual-aid society model with lots of branches and people taking the pledge not to consume.

Then we have the Women’s Christian Temperance Union, founded in 1873. This reads to me a lot more like nascent Progressivism, as it starts to get involved in politics.

The final part of the Prohibition coalition was the Progressive movement, the class-based movement of the educated and the Anointed to regulate everything in America through the administrative state.

So naturally the regulators are outraged that anyone should challenge their class-based right to dictate vaping regulations. They are no different from the activist admininstrators at the EPA on climate change, and the DEI administrators on systemic racism.

In our age, the only question is how much power we give the Anointed to order around us peasants, the Benighted. On anything.

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When my son was about 18 he started smoking. Drove me nuts.

Then, a couple years later, he switched to vaping, which he claimed would make it easier to quit. I shook my head, but kept quiet.

I was wrong. He was right. After about six months of vaping he just wasn’t interested anymore.

Leave vaping alone.

On another subject, as I understand it, part of the appeal of smoking cigarettes is visual. It’s fascinating to see the tip glow as you inhale, and fascinating to watch the smoke as you exhale.

For you smokers - try smoking an entire cigarette with your eyes closed. Let me know what you think.

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I’ve done a lot of drugs, and have quit, relapsed, and quit again often in my life. However smoking has often proven one of the toughest to stick with.

You are right that there is something else going on. “Smoking” is far more addictive than nicotine is. I usually experience zero desire to go back to narcotics, but when stressed I still long for a cigarette. This despite the fact that drugs like heroin are insanely more addictive. So addictive you can literally die from the withdrawal symptoms.

I am less certain that its the lit glow that is the capture point. Although it certainly could be in some people. In myself its the act of raising something to your mouth, breathing it in, and then a long exhale. Once I realized this, I found that just bringing my fingers up to my mouth in the pantomime of a cigarette and breathing in, followed by a long relaxed exhale, could drastically reduce the cravings. I’ve never found anything else, not gum, not chewing on straws, nothing, that has proven so effective at controlling the cravings.

On the subject of vaping to quit, I am conflicted. I have seen some people I know quit with the help of vaping. However on the aggregate (and within myself) I found vaping to be no help at all in quitting. Since it is just vapor and not smoke, instead it just increased the number of places it was acceptable to smoke in. I was not able to kick it reliably until I figured out my pantomime method.

Of course, all of this stands outside the issue of whether a government should be able to tell free citizens what they can do with their own bodies.

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