I Learned It by Watching You: How Television Distorts Drug Addiction

Fictional dramas aid leading medical historians in misrepresenting what happens when people get hooked on cocaine and other substances.


"The Knick"

Addiction is not a function of drug use—it is a standard feedback phenomenon that occurs with or without drugs, whereby people immerse themselves in immediately rewarding experiences that detract from their larger lives.

This definition of addiction makes clear that addiction is not a drug-centered trait. Addiction doesn't occur only with drugs and doesn't invariably occur when certain drugs are used.  There is nothing inherent in narcotics, cocaine, alcohol, tobacco, or marijuana that makes them irresistibly addictive. Moreover, people who do become addicted, contrary to both popular mythology and government pronouncements, usually attenuate or end their addictions.

So where have we gotten our idea that addiction is the inevitable and irreversible result of the use of one or more kinds of drugs? (Keep in mind, cigarettes and cocaine were only declared addictive in the 1980s, and marijuana in the 1990s.)

Specifically, we may ask, "Why do we all know that drug addiction unconditionally strikes anyone who uses cocaine (and heroin), even though, certainly with cocaine (and with heroin when we consider its equivalence to Oxycontin and Vicodin), many of us have used these drugs without harm?"

The answer is, "We saw it on television." Consider The Knick, the popular new Cinemax series, directed by Steven Soderbergh, based on a fictional New York hospital early in the last century.

The lead character, a surgeon played by Clive Owen, takes cocaine. Which of the following potential patterns do you guess his use takes?

1. He uses it sporadically or temporarily and it has a tangential effect on his life. In fact, this is the primary finding from the U.S. government's annual National Survey on Drug Use and Health. The NSDUH shows that only a small percentage (less than five percent) of people who have ever used cocaine, heroin, crack, and meth are currently addicted to these drugs. Carl Hart, an experimental neuroscientist and author of High Price, calculates that 10 to 20 percent of those using drugs (he studies crack and methamphetamine) encounter problems.

2. He encounters problems that he remedies. Some research questions users in detail about their current and past drug experiences. The largest and most thorough such investigation of cocaine was conducted at Canada's addiction research agency. The study, published as "The Steel Drug," found that the large majority of people who experienced a range of problems from cocaine use (sinusitis, nasal irritation, headaches, insomnia) quit the drug or cut back their use of it. Those crazy fools—where could they have come up with such a wild response to negative drug consequences!

3. He uses cocaine for an extended time, but quits or controls his habit so that it doesn't impair his ability as a distinguished physician.  This pattern is actually what occurred for the subjects of Howard Markel's book, An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine. Markel strives to show that two young physicians in the 19th century were laid low by their cocaine addictions, even though Freud clearly quit cocaine, and Halsted largely did, but sometimes returned to the drug. Markel contends that Freud's missing the actual abuse underlying his traumatized patients' claims resulted from his snorting cocaine decades earlier, and worries about how Halsted maintained his position as the world's foremost surgeon (Halsted pioneered the use of aseptic procedures and anesthesia) although he periodically injected the drug.

4. He gets uncontrollably fucked up on cocaine. Or perhaps Owen's character, Dr. John Thackery, becomes so severely hooked on cocaine that he cannot possibly live without it, even momentarily, and when his hospital loses its supply he breaks into a pharmacy and is arrested by the police. They then let him go despite his committing a major felony, one that normally would have landed someone in prison. 

Halsted avoided police and imprisonment and pursued his habit secretly over the course of his illustrious career (he died in 1922). This was readily possible for him since cocaine—along with heroin and marijuana—was only made illegal by the Harrison Act in 1914 based on sensational stories quite like Markel's hysterical vision of drug use. Indeed, our preoccupation with the dangers of cocaine—and Markel's need to prove how addictive it was a century before it was declared so by American pharmacology—makes his book most notable as an example of historical and scientific revisionism.

Meanwhile, I've already given the answer to my quiz: it's number four (perhaps you saw this episode). The Knick is described by Emily Nussbaum in The New Yorker this way: "The dialogue felt hacky, and I was bugged by what seemed like anti-hero clichés; worse yet, I sensed, beneath the show's surgical gore, a smug preachiness."

Nussbaum changed her mind after seeing the final three episodes of the series, including the pharmacy break-in (episode nine). But isn't it the best example of all of smug preachiness and hackneyed, anti-hero cliché? Isn't this our standard approach to drugs—to warn everyone about the inevitable consequences of drug use? Put simply, you are not allowed by the liberal, supposedly drug-using, permissive media to know the real epidemiology, the typical profile, of drug users. Such knowledge might be bad for you. So they lecture us: Drug use is bad because it's unavoidably addictive.

Historians like Markel achieve renown as factotums who industriously labor within the shifting official paradigm: that is, addiction to heroin, make that to heroin and cocaine, make that to heroin and cocaine and marijuana, make that to heroin and cocaine and marijuana and gambling, comprise a unique brain disease. But Markel mistakes what is plain in front of him. People may become engaged in intense involvements with love, sex, drugs, alcohol, caffeine, nicotine, gambling, spending, video games, et al. that can impair them and cause them distress, and then just as often reverse their behavior when they feel up to it, and the harm to their lives from their habit becomes clear to them.