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Dark Paradise: A History of Opiate Addiction in America
In a newly enlarged edition of this eye-opening book, David T. Courtwright offers an original interpretation of a puzzling chapter in American social and medical the dramatic change in the pattern of opiate addiction--from respectable upper-class matrons to lower-class urban males, often with a criminal record. Challenging the prevailing view that the shift resulted from harsh new laws, Courtwright shows that the crucial role was played by the medical rather than the legal profession.
Dark Paradise tells the story not only from the standpoint of legal and medical sources, but also from the perspective of addicts themselves. With the addition of a new introduction and two new chapters on heroin addiction and treatment since 1940, Courtwright has updated this compelling work of social history for the present crisis of the Drug War.
Dark Paradise tells the story not only from the standpoint of legal and medical sources, but also from the perspective of addicts themselves. With the addition of a new introduction and two new chapters on heroin addiction and treatment since 1940, Courtwright has updated this compelling work of social history for the present crisis of the Drug War.
352 pages, Paperback
First published January 1, 1982
About the author
David T. Courtwright
10 books41 followersDavid Courtwright is known for his books on drug use and drug policy in American and world history (Dark Paradise, Addicts Who Survived, and Forces of Habit) and for his books on the special problems of frontier environments (Violent Land and Sky as Frontier). His most recent book, No Right Turn, chronicles the tumultuous politics and surprising outcome of the culture war that engulfed America in the four decades after Nixon's 1968 election.
Courtwright lives in Jacksonville, Florida, and teaches history at the University of North Florida, where he is Presidential Professor. He was educated at the University of Kansas and at Rice University.
Photo credit: David Wilson
Courtwright lives in Jacksonville, Florida, and teaches history at the University of North Florida, where he is Presidential Professor. He was educated at the University of Kansas and at Rice University.
Photo credit: David Wilson
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Displaying 1 - 7 of 7 reviews
July 26, 2025
I found this book to be extremely informative if a bit academic in tone. This edition has two extra chapters covering the seventies and the nineties. I found these chapters the most accessible as they took place during my lifetime.
June 30, 2015
I got this book from the library after seeing it referenced in Sam Quinones's excellent Dreamland. While this book has a much more scholarly flavor, it focuses on the time period before 2000, and it quickly becomes clear how much even the most careful studies is largely guesswork when dealing with illicit drug use a century or more earlier. It's a good overview, and has some useful information, but Dreamland is both vastly more readable, and far more relevant in dealing with current issues.
March 11, 2021
We only stigmatize/punish drug use after the main population of addict has moved into a group that is already stigmatized.
A good, accademic history of Opiate Addiction. He seems to be at his best with opium, and his worst as he gets closer to posing social/political views.
A good, accademic history of Opiate Addiction. He seems to be at his best with opium, and his worst as he gets closer to posing social/political views.
January 15, 2016
A very good social history of opiate addiction in the United States. Basic argument is that the demographics of opiate addiction have changed dramatically over the course of the three-and-a-half great "waves" of opiate addiction, and that this has been the primary driver of the different drug control policies that have followed. "What we think of addiction depends very much in who is addicted" (4).
The first wave, in the late 19th century, was primarily the result of people becoming addicted to medically-prescribed opiates, given for pain and respiratory ailments. These were typically civil war veterans and middle class white women -- though Chinese opium smokers were a significant additional addict population. (Blacks, with less access to health care, were underrepresented.) As the medical attitudes toward drug use changed in the early 20th century, laws criminalizing addiction followed, and opiate addiction dropped off steadily as fewer people became addicts and the existing addict population aged out. Drug use also became associated with psychopathy or other forms of social deviancy that demanded incarceration or other forms of institutional commitment. A punctuation mark came with the "heroin famine" caused by the collapse of supply networks during WWII. (The first edition of the book, published in 1982, ends at this date.)
The second wave came in the late 1940s, as the international networks (especially the French connection) got back up and running. But this time, the users were primarily urban blacks, especially those associated with the jazz scene (where as many as half the musicians were users). That this new user base came from the underclass led to a far more punitive legal response. A third wave of heroin initiation came in the late 1960s, as large numbers of baby boomers took up the drug, often from having been introduced to it in Vietnam, where by 1971, half the enlisted men were using. The Nixon administration took a complex mixed approach to try to control the unfolding epidemic, promoting methodone clinics but also launching the punitive "war on drugs." That war would of course take a much sharper turn in the 1980s, where conservatives would make it a symbolic issue,Mozart of the culture war against the liberal legacy of the 1960s. Finally, there would be the post-crack heroin boomlet of the 1990s, which was simultaneously an urban underclass matter (made famous in "The Wire") and the heroin-chic of GenX white people.
Published in 2001, it did not anticipate the huge new boom in opiate addiction facilitated by the rise of synthetic and prescription opiates, notably Fentanyl and OxyContin, which have driven a huge new wave of problems, associated with poor and rural whites, as well as the urban underclass. This latest wave is a bit back to the future, since it somewhat mirrors the addiction patterns of the late 19th century, in that much of this wave of addiction is an iatrogenic result of the turn of the century revolution in medical philosophy concerning pain treatment, which led to much greater prescription of pain medication, with the result that many more opiates would be in circulation and many more people would develop dependencies. (The number of overdoses today has outstripped any of the previous peaks during earlier waves.) still, Courtwright could have been naming our own moment, when he describes the pattern that led to the prescription drug dependencies on barbiturates, benzodiazepines, and amphetamines in the 1950s: "physicians repeated the cycle of initial enthusiasm, liberal administration, concomitant dependence, and critical reassessment" (146).
The first wave, in the late 19th century, was primarily the result of people becoming addicted to medically-prescribed opiates, given for pain and respiratory ailments. These were typically civil war veterans and middle class white women -- though Chinese opium smokers were a significant additional addict population. (Blacks, with less access to health care, were underrepresented.) As the medical attitudes toward drug use changed in the early 20th century, laws criminalizing addiction followed, and opiate addiction dropped off steadily as fewer people became addicts and the existing addict population aged out. Drug use also became associated with psychopathy or other forms of social deviancy that demanded incarceration or other forms of institutional commitment. A punctuation mark came with the "heroin famine" caused by the collapse of supply networks during WWII. (The first edition of the book, published in 1982, ends at this date.)
The second wave came in the late 1940s, as the international networks (especially the French connection) got back up and running. But this time, the users were primarily urban blacks, especially those associated with the jazz scene (where as many as half the musicians were users). That this new user base came from the underclass led to a far more punitive legal response. A third wave of heroin initiation came in the late 1960s, as large numbers of baby boomers took up the drug, often from having been introduced to it in Vietnam, where by 1971, half the enlisted men were using. The Nixon administration took a complex mixed approach to try to control the unfolding epidemic, promoting methodone clinics but also launching the punitive "war on drugs." That war would of course take a much sharper turn in the 1980s, where conservatives would make it a symbolic issue,Mozart of the culture war against the liberal legacy of the 1960s. Finally, there would be the post-crack heroin boomlet of the 1990s, which was simultaneously an urban underclass matter (made famous in "The Wire") and the heroin-chic of GenX white people.
Published in 2001, it did not anticipate the huge new boom in opiate addiction facilitated by the rise of synthetic and prescription opiates, notably Fentanyl and OxyContin, which have driven a huge new wave of problems, associated with poor and rural whites, as well as the urban underclass. This latest wave is a bit back to the future, since it somewhat mirrors the addiction patterns of the late 19th century, in that much of this wave of addiction is an iatrogenic result of the turn of the century revolution in medical philosophy concerning pain treatment, which led to much greater prescription of pain medication, with the result that many more opiates would be in circulation and many more people would develop dependencies. (The number of overdoses today has outstripped any of the previous peaks during earlier waves.) still, Courtwright could have been naming our own moment, when he describes the pattern that led to the prescription drug dependencies on barbiturates, benzodiazepines, and amphetamines in the 1950s: "physicians repeated the cycle of initial enthusiasm, liberal administration, concomitant dependence, and critical reassessment" (146).
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October 2, 2015The characteristics of the addict population in early-twentieth century America were changing well before any prohibitive legislation. Medical opiate addicts in the nineteenth century were typically aging white women who could afford a physician's services, but by 1900 the concept of problematic addiction tightened medical supply. Publicly remaining users were younger, from lower social classes, and associated with criminal behavior (and in decline). Challenging liberal assumptions, the 1914 Harrison Act (mostly) did not criminalize a population of otherwise law-abiding users.
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January 6, 2012A topic for our time . . . unforunate or not, it is here to stay, like it or not, the cravings will grow ever stronger before it dies.
October 27, 2024
MY favorite book of all time. this is it
Displaying 1 - 7 of 7 reviews