The scale of contemporary drug use is really fabulous, but that use is also quite peculiar in kind as well. Throughout most of human history, people have used drugs for a wide variety of purposes — religious rituals, communal fellowship, as a way of dealing with the slow pace and drudgery of agricultural work — but today those uses have narrowed considerably, to the point where they’re really about self-optimization. Finding the right combination of stimulants to get you up for the day and help you perform well at work, then finding a different array of drugs to help you wind down in preparation for the next day.

There are two options for psychoactive drugs that don’t fit this paradigm: one is that they are straightforwardly demonized. Opiates, for instance, have always chafed against the approved recreational limits for drugs, and it’s no surprise that they have been a key target of the drug war for over a century.

The other option is that they are shoehorned into it. The contemporary use of psychedelics illustrates this well: these are drugs that defy description in many ways, drugs that don’t fit neatly into the upper/downer dichotomy. But today, in microdosed form, they are being used for productive purposes — whether to be more creative in brainstorming sessions at work or to “sparkle” at miserable office parties. They are also the most exciting, potential new psychiatric medications. MDMA used to be a club drug, but soon it will be known as a healing one.

Prohibition, both of alcohol and drugs, was a pretty remarkable project. In many ways, it didn’t make sense: the drugs and alcohol trade was enormously profitable for a wide range of interests. And there was a great deal of resistance to legislating on what many felt were moral issues. It’s a great affront to the libertarian impulse. So why did it happen?

There were many things that fed into it — the evangelical spirit, middle-class status anxiety, anti-immigrant sentiment — but at root, the temperance cause was about disciplining the workforce and providing some moral response to the social ills unleashed by industrial capitalism. There were many business leaders who found the grating moralism of the temperance movement repulsive, but they still supported it because they thought alcohol was a real obstacle to creating an efficient workforce.

To be clear, there was some truth to this: you could be drunk or high working out in the field with no real repercussions, but the demands of factory life meant that you had to be “on” in a new way, and that the consequences of screwing something up on the line were dire. With urbanization there were also just new forms of intoxication: rather than slow drinking throughout the day, factory workers in big cities went to saloons and got hammered. It wasn’t necessarily more alcohol that was being drunk, but it was much more concentrated, and more visible. The saloon in turn became an easy target of outrage for the temperance reformers.

In a recent article for Jacobin, I review the other part of this, which was the predominantly moral response to various social ills that the temperance movement offered in the absence of a properly political response.

There’s a simple answer to this question, and a much more complicated historical answer. The latter is basically the book, so I won’t get too much into that here. The simple answer is that Americans are, compared to denizens of other industrialized nations, uniquely subject to the predations of capitalism.

This is true in some small ways — for instance, the United States is one of only two countries in the world (the other being New Zealand) where direct-to-consumer pharmaceutical advertising is allowed. Those ads we are accustomed to seeing on television for powerful psychoactive chemicals — those don’t exist in most places.

But I mean this in a more general sense too. The United States does not have workers’ parties or a history of them. We have weak and historically segmented unions. We have a fraying social safety net, and a remarkably decayed associational life. Today 15 percent of men report having no close friends.

Given all these things, there’s a general lack of any countervailing structures or forces to mitigate the effects of the market. And in the absence of those, I think we’re prone to both excessive medication (sometimes self-medication) and excessive moralizing about the faults of others.

The biological revolution in psychiatry was rooted in many complicated changes in psychiatry — the turn against psychoanalysis, changes in drug development, deinstitutionalization — but the basic way to think about it is that it’s the reason we talk about things like “serotonin reuptake” when discussing depression. The dream it inaugurated was that we’d be able to clearly tie mental health issues to brain states and specific neurotransmitter actions in such a way as to clearly define drug treatments.

This dream has borne little fruit in terms of scientific knowledge, but it has provided great copy for pharmaceutical advertisements, and following the historian Edward Shorter and others, I think this is essentially why it caught on. In general, I think the psychological terminology that we’ve inherited from the biological revolution is quite reductive and inadequate. Human interiority cannot be described in the terms of dopamine and serotonin alone, as helpful explanatorily as some of those terms are in providing some fixed name for what ails us.

More specifically, I think the biological revolution in psychiatry has been tremendously damaging in occluding discussion of social factors that might lead to drug use. In the book, I include some pretty shocking pharmaceutical ads from the 1960s and ’70s. The messages are something like: Worried about Cuba and Czechoslovakia? Take Librium! Overworked in an isolating domestic cell? Take Serax!

There’s obviously something horrifying about these ads, but at least they tell you something direct about the social imperatives of the period. This is a stressful society — here are some drugs to help you deal with it. Once the official justifications become about neurotransmitter actions, it’s difficult to have a more honest discussion of the social determinants of mental illness and drug consumption.

The psychedelic renaissance isn’t my term, but in another article for Jacobin, I did say that the psychedelic renaissance was basically now a psychedelic enlightenment, and I don’t know, maybe I came up with that latter phrase.

I would say the key difference between the present psychedelic wave and the previous one is that the present one is more self-consciously responsible. It’s no longer disaffected New Left types taking heroic doses of LSD — it’s professional-class people microdosing and overseeing the rollout of psychedelic-assisted psychotherapy.

In fact, many current psychedelic enthusiasts really despise the previous counterculture, thinking that Tim Leary and the rest ruined things for two generations. They believe in the power of psychedelics, but only when curated and used responsibly by professionals. In that, the ethos is totally different. It’s not about freeing your mind; it’s again about self-optimization.

I don’t think psychedelic enthusiasts are necessarily wrong to think these drugs bear the potential to totally revolutionize mental health care. Psychiatrists have pretty ineffective tools at their disposal. The selective serotonin reuptake inhibitors (SSRIs), which are a standard treatment for depression, aren’t that great. So I think that when MDMA (which I’ve heard will be FDA approved in either the first or second quarter of 2024) and then psilocybin hit the market, a lot of people are going to realize that they’re better drugs than the alternatives.

The key question at stake right now, however, is whether we’re going to keep the basic psychiatric paradigm and rejuvenate it with new drugs, or whether new forms of therapy and care are going to upend the psychiatric profession. I think a lot of the most enthusiastic psychedelic proponents are hoping for the latter, though the material incentives point to the former, simply because it keeps the money flowing in the same ways.

One prominent response of drug liberals to the problems of the drug war has been to advocate for legalization. This is a response that I think the Left should be quite wary of as such.

For one, legalization has long been the principled position of the libertarian right: put everything in the domain of the free market, they say, and away go the various perversities of the black market. What they don’t mention is that by far the most dangerous drugs today — cigarettes and alcohol — are the legal ones. Putting additional psychoactive substances in the hands of for-profit companies, without nationalization of their production and distribution, or at least tight regulation, doesn’t seem like it’s in the interest of public health.

Drug liberals also often call for destigmatization, under the belief that if only we could dispel all the hoary mythmaking of the drug warriors, people could finally approach drug use rationally. In theory, I agree with this: liberal drug reformers from Andrew Weil to Carl Hart today argue that just about any drug can be used safely and any drug can be abused. In practice, however, given the negative associations that many people have with opioids, methamphetamine, and other drugs that are tearing apart poor and working-class communities, such efforts at destigmatization can appear hopelessly out of touch. What is it to say that any drug can be used safely when over a hundred thousand people a year are dying from overdoses in the United States?

Finally, liberal drug reformers often call for decriminalization and associated measures for reining in police abuses. This is a very sensible position in itself, and given that such policies bear majoritarian support, it doesn’t seem like a waste of political capital to pursue it.

The problem is that the liberals often leave it there. Simple decriminalization, without broader transformation of the social conditions that compel drug use in the first place, is not going to remedy the ills associated with the drug scourge. For that we need more and better jobs, the kind that might be created through a federal jobs guarantee, and we need a complete overhaul of our failing health care system, as might be created through Medicare for All. We should absolutely decriminalize drug use; the prohibitionist paradigm has been a complete failure. But we also need something to replace that paradigm with, and that means better jobs and social protections.

I have an article coming out in the next issue of Catalyst called “The Jobs and Freedom Strategy,” which is about what we can learn from Bayard Rustin and A. Philip Randolph’s Freedom Budget campaign. The Freedom Budget looked a great deal like the Bernie Sanders program: universal health care, jobs programs, greater funding for public education and services. There are many lessons to be drawn from that history, but I have to admit that the prospects for pursuing their strategy today are much dimmer than they were in the mid-1960s. There’s no way around that fact.

But the only way out is through. Then, as now, we need to build organizations that (unlike many nonprofit organizations today) that represent real constituencies, we need to focus our energy on concrete plans for making life better for masses of people, and organized labor needs to get its fighting spirit and power back. T

There’s no shortcut — no quick fix, you might say — out of the present impasse, but things can happen faster than anyone could predict. In 1932, labor was at its nadir in power and size; five years later, amid the sit-down strike waves, there was mainstream discussion of the possibility of social revolution. The levers of structural transformation are still there, but grasping them will take focus (and an avoidance of what Rustin called “frustration politics”), and pulling them will take sacrifice.