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Dispatches from London: “Under Control?” Conference

Updated: Aug 30, 2023

This past weekend alcohol and drug scholars across the globe descended upon London’s School of Hygiene and Tropical Medicine to learn from each other about what they know best, alcohol and drugs.  The interdisciplinary conference does much to encourage scholarship across lines of disciplinary specializations, but also, the nation-state.  Below please find assorted notes from my time abroad:


Perhaps most noted for his work Andean Cocaine, Paul Gootenberg gave a keynote speech addressing the concept of blowback.  Entitled “Controlling Cocaine?  1900-2000,” Gootenberg began with what might be considered an obvious truth for drug historians—that is, that if read from an historical perspective, the term “drug control” is an oxymoron.  Throughout the 20th century, drug control often perpetuates the antithesis of control.  Drug control efforts by the United States have bred more chaos, more illicit trade, more use, and worst of all, more violence.  In supporting his claim, Gootenberg examined the ways in which United States efforts to control the global supply of cocaine produced various unintended consequences.

Originally an economic historian by trade, Gootenberg makes good use of global commodity chains to explain the story of cocaine and attempts at its control.  In framing the long history of cocaine commodity chains and blowback, Gootenberg broke down the century into several distinct phases, each with specific unintended consequences.  In the first forty years of the 20th century, particularly after 1914, the United States attempted to push anti-cocaine measures onto the international agenda.  During this period, Andean trafficking in cocaine remained relatively benign, marginal, and nonviolent.  Between 1948 and 1973, cocaine came to be increasingly criminalized as illicit networks began to shift outward from the Andean region in response to FBN attempts to crush production in the region.  A pivotal moment in cocaine commodity chain development passed in 1960 when traffickers were exiled under the Cuban Revolution.  These exiled traffickers quickly became a Pan-American Network of traffickers, thereby expanding the commodity network for cocaine traffic.  Still though, Gootenberg carefully noted, the trade remained small and fairly peaceful through 1970. 

How then, do we explain the Wild West style violence which would later erupt in Southern Florida and become the stuff of legend with documentaries such as Cocaine Cowboys?  How did Medellin become the murder capital of the world?  How did border violence in Juarez


In the mid-1990s, United States efforts attempted to cut off routes from Columbia to South Florida.  As with any other specific attempt at repression or control, the new emphasis upon trade routes from Columbia to South Florida produced unintended, troubling consequences.  Traffickers responded as we might imagine—they adapted.  Routes began to shift through Central America to California.  These shifts naturally re-located centers of violence and traffic closer to the U.S./Mexico border, to places like Juarez.  The U.S./Mexico border stretches over 2,000 miles making it nearly impossible to control—even with the mind-boggling security measures discussed in recent immigration reform.  An estimated 19 well-stocked semi-trucks can supply U.S. illicit consumption for one year.  Roughly two million unchecked semis cross the border each year.

In short, U.S. intervention has helped form a new and intractable cocaine commodity chain which increasingly bypasses Columbia altogether.  As consumption and traffic networks continue to expand and globalize, the picture for drug control appears grim.  Countries such as Brazil, and other bastions of inequality (like the United States) are consuming more and more cocaine.  Trafficking networks are likely already finding new routes through poor countries that simply do not have the resources to combat the trade.  In places like Honduras, Guatemala, Haiti and Puerto Rico we may see new, increasingly sophisticated trade routes.

The sum parts of Gootenberg’s talk led me to ask: Are over 100 years of disastrous, unintended consequences enough?  Drug historians have long answered this question with a resounding YES.  The time is long overdue for policymakers to take stock of the long history of unintended consequences and change course.

In a well-attended panel on representations of addiction, Ingrid Walker, Robert Stephens, and Steve Earnshaw used art, print, television and film to broaden our understanding of popular narratives surrounding addicts and addiction.  Lending her keen eye for cultural studies, Ingrid Walker began with an exploration into user agency as she questioned the ways in which advertising has shaped images, opinions, and beliefs about addicts and addiction.  In particular, Walker noted the dichotomy between pharmaceutical advertisements and anti-drug advertisements.  Pharmaceutical advertisements—whether they are for birth control, anti-depressants, or even erectile dysfunction—emphasize choice and control while promising both health and pleasure.  Anti-drug ads—comparatively—emphasize destruction, dependence, failure and loss.  Increasingly, anti-drug ads have also turned towards the grotesque to dissuade drug use.  Undoubtedly, such advertisements effect expectations surrounding substance use, health, and agency.

In all, such advertisements have created a framework where there are either “good drugs” or “bad drugs,” or what Nancy Campbell aptly titles, “problem solving” and “problem causing” drugs.  Much of said designations rely on whether the drug in question has been medicalized or criminalized, which leads me to my next question:  Might previously labeled “bad” or “problem causing” drugs find themselves rehabilitated in the public mind should we move towards medicalization?  Would those addicted to said drugs be less stigmatized?

Robert Stephens began his thought-provoking talk by discussing the “visual grammar” of portraying addiction.  In essence, Stephens rightly argues that most all depictions of addicts in film and other assorted media model each other.  In a nod to Walker’s earlier contention, Stephens first presented an anti-drug advertisement which leaves little grey area.  Youth are either drug-free, beautiful and happy, or they are headed down the path to destruction.  Case in point, an anti-drug ad chronicling the case of heroin chic Wendy: “Once upon a time there was a girl named Wendy who was very beautiful and very happy and had lots of friends but then one day she did some heroin and got addicted and lost everything and then she died. The End.”  Well, there you have it folks.  A nuanced, full accounting of the path towards drug addiction.


Stephen’s offered several examples to support his claims.  For the sake of efficiency, I’ll recap one prominent example. In the classic MTV generation film Less Than Zero, Robert Downey Jr. goes through what appears to be a standard, brutal process of heroin withdrawal with one small problem—Downey’s character is purportedly addicted to crack.  For


Ultimately, Stephens offered a few conclusions worth noting.  First, that visual narratives are mostly all the same, constructing a “visual grammar” that future representations are expected to follow (thereby perpetuating the same inaccuracies).  Second, that popular media representations or drugs, drug use, and addiction have enormous power to shape perceptions of addiction and will continue to define the sorts of messages allowed to be portrayed.  Third, audiences appear to demand moral melodrama within these narratives.  As such, we will likely see the persistence of zero-sum narratives where addicts either clean up on the path to redemption or destroy themselves as irredeemable lepers.  Finally, Stephens reiterated that we ought to take movies seriously for their social, cultural, and policy-shaping power.  Indeed we should.


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