Chapter One

Between 1920 and the early 1960s, illicit drug use in the United States declined significantly from the levels it had reached early in the century, although few appreciated it at the time. Americans had feared psychoactive drugs for a long time-opiates and cocaine in the early part of the century, then nearly exclusively heroin, especially after World War II-and that fear persisted even though, by the 1950s, use was minuscule compared both to the historical high point and to the surge in substance abuse that lay in the future. Still, the drugs were a minor problem, dealt with to the satisfaction of most Americans, and the debate that began to develop late in the 1950s among medical and legal professionals over how best to deal with what was mostly a problem of inner-city heroin addiction was at first a fairly low-key affair. The controversy, then as now, pitted advocates of law enforcement, who believed that the decline in drug use was directly attributable to the application of stringent legislation, against critics of this approach, who pointed out that the problem had not gone away in spite of vigorous prohibitory enforcement. The debate grew more heated and its participants more numerous as drug use levels rose; by the early 1970s drug abuse would emerge as one of the top concerns of the nation (though usually outranked by fears of war, racial unrest, or economic troubles).

Even the most superficial memories of the period we now refer to as the Sixties include the controversy over the Vietnam War, assassinations, violence, and the breakdown of traditional norms of beh