How crack found a niche in the American ghetto: The historical epidemiology of drug-related harm

Abstract

Although neuroscience has produced elegant models of addiction as a brain process, it does not address the incidence and prevalence of conditions like addiction in populations. As incidence and prevalence are the measures of a condition in a society, understanding rates of social problems is critical to controlling them. Nevertheless, not all upsurges in drug use in a population constitute true emergencies. It is useful to distinguish drug eras, new patterns of drug use that emerge in a population and then stabilize or decline from epidemics of drug-related harm. A historical epidemiology of drug-related harm draws from history, science and social science to examine the conditions that produce such epidemics. Compulsive crack use concentrated in American urban neighborhoods characterized by poverty and cultural isolation in the 1980s and the object of lurid media coverage, can be better understood through the lens of the historical epidemiology of drug-related harm. This model holds that serious upsurges in harmful drug use result from the introduction of powerful new drugs or drug forms to populations that lack experience with them and that suffer from multiple dimensions of structural disadvantage.