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After a surge fueled by the opioid epidemic and the spread of fentanyl, drug overdose deaths in the United States have begun to decline, as have nonfatal overdoses.
The exact reasons for this drop aren’t entirely clear but likely include the increasing use of overdose-reversing drugs like naloxone, along with harm-reduction measures such as fentanyl test strips and needle exchange programs. In addition, loosened restrictions on opioid addiction treatments like buprenorphine and methadone have made these medications more accessible.
Another potential factor is the cyclical nature of drug use in the United States. Historically, drug crises have been followed by periods of reduced use, as seen in the decline of crack cocaine use after the epidemic of the 1980s. We may now be witnessing a similar reaction to the opioid and fentanyl crises of the early 21st century, reflecting broader societal shifts in awareness, policy and public health interventions.
Though overdose rates remain alarmingly high—exceeding 100,000 deaths in the past year—these recent trends suggest a potential turning point in addressing the crisis.
Neurobiologists study how drugs and alcohol affect brain activity and neurotransmission, focusing on the physiological basis of addiction, tolerance and withdrawal. Their research reveals how substances hijack the brain’s reward system, leading to dependency, and this understanding is crucial for developing medical interventions for substance use disorders.
Pharmacologists examine how drugs interact with organs and bodily systems, analyzing their metabolism, excretion and potential toxicity. They study how tolerance develops and explore the pharmacodynamics of substances, helping to create treatments and harm-reduction strategies, such as methadone for heroin dependence and medications to manage alcohol withdrawal.
Sociologists investigate the social and cultural contexts that contribute to substance use, including factors like socioeconomic conditions, peer pressure and cultural norms. They explore trends in drug use among specific demographics and examine how social inequalities, stressors like poverty and unemployment correlate with higher rates of substance abuse. This research reveals the environmental and systemic issues underlying addiction.
Psychologists focus on the mental and emotional drivers of substance use, such as stress, trauma, anxiety or depression. They study how addiction impacts behavior, relationships and decision-making and develop interventions like cognitive-behavioral therapy to manage cravings, prevent relapse and address the psychological roots of addiction.
Political scientists analyze the development and consequences of drug policies, such as prohibition, the War on Drugs and harm-reduction strategies. They evaluate how these policies affect public health, law enforcement and social justice, offering insights that inform policy reforms aimed at balancing public health with civil liberties.
What can historians contribute?
Historians offer a long-term perspective, analyzing how and why certain drugs become popular or stigmatized in different eras. They trace the cultural, social and economic forces shaping drug policies, public perceptions and societal responses to substance use. Historians help us understand cycles of moral panic, policy shifts and how media influences attitudes toward drugs, adding depth to current debates on addiction and drug control.
Historians excel at identifying patterns and long-term continuities, offering insights into how past events shape present-day phenomena. In studying alcohol and drug use, their ability to contextualize behavior over time provides a critical understanding that complements other disciplines. Here’s how historians can contribute to the understanding of substance use and inform policymaking:
- Providing longitudinal perspective: By examining patterns of alcohol and drug use across centuries, historians track how societal functions of substances evolve—from their religious or social uses to their criminalization or medicalization. This helps reveal the cultural and economic shifts that cause fluctuations in substance use over time.
- Situating substance abuse in social and cultural contexts: Historians explain why different substances and policy responses become popular at particular times. For example, Prohibition in the 1920s arose not just from temperance concerns but also reflected anxieties about immigration and urbanization. Understanding the social context helps policymakers anticipate and respond to substance abuse trends today.
- Identifying the factors that influence consumption: Historians show how broader economic and political forces—such as industrialization, deindustrialization, wars and economic crises—impact substance use. For example, post-WWII heroin use was linked to social displacement and wartime trauma, while cocaine use in the 1980s reflected a culture of excess during economic expansion.
- Revealing the cultural and symbolic significance of substance use: Historians examine how literature, art and media portray substance use, revealing societal values and anxieties. From the romanticization of drugs in the jazz scene to the countercultural embrace of psychedelics in the 1960s, these representations help policymakers understand public attitudes toward substances.
- Linking social class, race and gender to substance use: Historians explore how substance use has been shaped by social class, race and gender and how these factors influence the experience of addiction and legal responses to it. For example, the racialized nature of drug enforcement, seen during the crack epidemic, underscores the need for equity in policy interventions.
- Uncovering cycles of moral panic: Drug crises often trigger waves of moral panic, leading to punitive measures. Historians show how these cycles—like those seen with the crack epidemic and the War on Drugs—tend to repeat. Recognizing these patterns helps avoid a reactive approach to policy and encourages more sustainable and impactful solutions.
- Tracing policy evolution and impact: By examining the history of drug laws and alcohol regulations, historians reveal how political pressures shape policies and how these laws have often had unintended consequences, such as increased incarceration or racial disparities.
- Contributing to interdisciplinary understanding: Historians integrate economic, cultural, medical and legal histories, providing a holistic analysis that places current patterns in comparative perspectives and draws lessons from public health campaigns, from the temperance movement to modern harm reduction strategies.
Historians bring a broader temporal lens, linking past and present and recognizing patterns that can inform more effective, humane policies. By studying substance abuse, they show that addiction is not just a personal failing but a reflection of broader societal forces, from cultural anxieties to economic realities. This historical perspective is essential for crafting policies that not only address individual behavior but also tackle the systemic issues that drive substance abuse.
Written between 1939 and 1941 but not published until 1956, after his death, Eugene O’Neill’s semi-autobiographical Long Day’s Journey Into Night offers a profound exploration of addiction’s destructive impact on both individuals and families. Through the characters of Mary Tyrone, who is addicted to morphine, and her son Edmund, who struggles with alcohol abuse, O’Neill captures the cyclical and all-consuming nature of addiction.
Both Mary’s morphine addiction and Edmund’s alcoholism serve as forms of emotional escape from their unfulfilled lives. Mary uses morphine to numb the pain of her disappointing marriage and failed dreams, while Edmund turns to alcohol to cope with his inner turmoil and feelings of inadequacy. O’Neill illustrates how addiction often arises from an overwhelming need to avoid confronting emotional distress, leading to temporary relief but perpetuating deeper suffering.
The play reveals the inescapable cycle of addiction—where moments of temporary solace through substance use are followed by guilt, shame and even more profound emotional pain. Mary frequently vows to stop using morphine but continuously relapses, underscoring addiction’s hold over her. Edmund mirrors this struggle with his drinking, which intensifies the family’s dysfunction and resentment.
Denial plays a central role in the Tyrone family’s handling of addiction. James Tyrone, the father, alternates between acknowledging Mary’s addiction and downplaying its severity, while the sons, Edmund and Jamie, waver between confronting her and avoiding the issue. This dynamic reflects how families often become enablers of addiction, either by ignoring it or by indirectly supporting the addict’s behavior.
Guilt is another powerful theme in the play. Mary’s guilt over the death of her child and her failure to meet family expectations drives her addiction, while Edmund’s guilt about his illness and dependency on alcohol compounds his emotional struggles. Addiction, in this context, is not just the plight of the individual but a burden shared by the entire family.
Long Day’s Journey Into Night portrays addiction as a family disease that disrupts relationships, heightens unspoken tensions and creates a climate of emotional isolation. O’Neill’s portrayal is a haunting reminder of how addiction can fracture familial bonds and perpetuate cycles of pain and dysfunction.
Most American adults have a family connection to addiction. According to a 2023 Kaiser Family Foundation report, two-thirds of the adults surveyed say either they or a family member have been addicted to alcohol or drugs.
Addiction is not a fringe issue, but a deeply ingrained problem that affects millions of people, cutting across socioeconomic, racial and geographic boundaries. The widespread exposure to addiction has profound social and psychological implications, resulting in strained relationships, emotional trauma, financial woes and, in all too many cases, domestic violence. It’s not surprising, then, that popular culture has addressed this topic.
Twentieth-century literature and film provide valuable insights into shifting societal attitudes about substance abuse, reflecting the anxieties, struggles and cultural values of their times. Through depictions of addiction, excess and recovery, these works humanize the struggles of those affected by substance abuse while also critiquing the systems that fail them. They serve as cultural artifacts and powerful commentaries on how society perceives and reacts to addiction.
Some of the most important novels and films on substance abuse include:
- A Star Is Born (1937) portrays a successful but declining actor grappling with alcoholism. Alcoholism here symbolizes both the cause and effect of his professional downfall, as his addiction erodes his ability to work and damages his public image. The film highlights the pressures of fame, revealing how addiction serves as a coping mechanism for feelings of inadequacy, leading to public humiliation and self-destruction.
- The Lost Weekend by Charles R. Jackson (1944), set during World War II, explores the psychological torment and shame associated with alcoholism. Published when alcohol abuse was viewed largely as a moral failing, it delves into the psychological roots of addiction and challenges the stigma surrounding it. The story reflects society’s evolving view of alcoholism, moving from moral condemnation toward understanding it as a psychological struggle.
- Junky by William S. Burroughs (1953) offers unflinching look at the life of a heroin addict and reflects post–World War II disillusionment and alienation in an increasingly industrialized society. The novel portrays heroin use as both an escape and a prison, mirroring the postwar societal crisis and growing detachment from traditional norms.
- Fear and Loathing in Las Vegas by Hunter S. Thompson (1971) blends journalism and fiction to critique the emptiness of the American dream and the collapse of 1960s idealism through drug binges and wild escapism. The novel reflects a society grappling with the excesses of consumerism and the search for meaning in an era of disillusionment.
- Requiem for a Dream by Hubert Selby Jr. (1978) follows four characters as their lives spiral out of control due to addiction. The story criticizes society’s inability to provide effective support for addicts, highlighting the vulnerability and helplessness of those caught in addiction. It underscores how addiction can entrap individuals, with societal systems often failing to provide adequate safety nets.
- Leaving Las Vegas (1995) portrays an alcoholic’s deliberate path to self-destruction. It reflects the mid-1990s shift in storytelling toward a raw and unsentimental portrayal of addiction, focusing on the emotional desolation of the main character and his ultimate resignation to his fate.
- Trainspotting (1996), set in 1990s Edinburgh, presents a gritty portrait of heroin addiction among young, working-class Scots. It depicts the hopelessness and nihilism that drives many to drugs in a world where traditional social structures are crumbling and unemployment and lack of opportunity reign. The film critiques the socioeconomic realities that contribute to substance abuse.
Through these novels and films, shifting societal attitudes toward substance abuse emerge. Early depictions often portrayed addiction as a moral failing or a sin, laden with guilt and shame. Over time, however, addiction came to be viewed through different lenses—as a response to societal stresses, a manifestation of alienation, a form of countercultural rebellion, a treatable medical condition or a societal issue tied to poverty, mental illness and systemic neglect. These works offer profound commentary on how societies confront or fail to confront the complex realities of addiction.
To fully understand addiction, we must view it through the lenses of history and literature, which provide crucial insights into the cultural, social and personal dimensions of substance use and dependency. Examining addiction’s historical evolution is especially helpful. Patterns of drug and alcohol use have shifted dramatically across time, shaped by economic, political and social factors.
Opium in the 19th century was widely accepted as a medical treatment before racial fears led to its criminalization, particularly targeting Chinese immigrants. This shift reflects how society’s reaction to substances is often driven by external forces, such as economic interests, public sentiment and racial anxieties, rather than purely scientific evidence.
Prohibition (1920–1933) offers another historical example. Alcohol was banned due to concerns about its impact on social order and public morality, yet the ban failed to curb consumption, leading instead to organized crime and an underground drinking culture. This illustrates how cultural and social contexts can influence substance use far beyond biology or psychology alone.
The War on Drugs in the late 20th century criminalized addiction in minority communities, intensifying mass incarceration. A historical perspective helps us understand how policies rooted in race and class disparities influence the public’s perception of addiction and how policy interventions can reinforce inequality rather than treat the root causes.
Literature adds a deeply personal and reflective dimension to the study of addiction, often revealing the internal struggles of those affected. Classic and contemporary works about addiction offer critical explorations of how addiction impacts identity, relationships and society. Literature humanizes addiction and frames it as more than a biological condition—it’s a personal and societal issue wrapped in emotions like guilt, denial and despair.
By integrating historical and literary perspectives, we create a fuller picture of addiction that incorporates personal experiences, societal forces and cultural contexts. This understanding complements the biological and psychological approaches, creating a more comprehensive framework for addressing addiction today.
Addiction is not just a matter of biology, neurology or psychology. it is a deeply human experience shaped by historical forces and personal narratives. A holistic understanding of addiction must incorporate all of these dimensions, helping to inform more effective policy, treatment and empathy toward those struggling with substance abuse.
