Distinctions between medicinal and nonmedicinal, legal and illegal substances, are the result of a long and continuing debate about the morality of consciousness alteration, the intrinsic dangers of particular substances and the costs and benefits of various regulatory schemes. Including colonial regulation of taverns and alcohol sales to Native Americans, America has had some form of drug policy for over 300 years. The tensions in American drug policy—and recent objections to its application abroad—derive from longstanding conflict about the wisdom of prohibitions.

The template for American drug control was established by the regulation of alcoholic beverages. Until the 1850s or so, Americans drank huge quantities of alcohol, mainly in the form of distilled spirits, beverages with very high alcohol content (usually 40 percent or more). Per capita consumption was much higher than it is today Men drank far more than women, and there is ample evidence that women suffered greatly from the whiskyand rum-related aggression of men. Indeed, the nineteenth-century temperance movement, arguably the most successful mass movement in American history did not begin as an alcoholprohibition movement, but as an anti-spirits campaign. Rooted in Protestant anxieties about self-control and sexual expression, women’s dread of male violence, and the personal discipline required for success in an emerging market regime, the temperance movement successfully stigmatized the consumption of alcohol, particularly in its highly concentrated forms and especially in misogynist settings like the old-time saloon (the “anti-home,” as temperance enthusiasts called it). By the end of the nineteenth century abstinence (or extreme moderation) was a hallmark of middleclass respectability in America and, even today roughly one-third of Americans do not drink alcoholic beverages. They are disproportionately women and are concentrated in regions of the country with long traditions of Protestant temperance agitation (the so-called “Bible belt” of the Midwest and South).

The temperance movement turned resolutely towards a Prohibitionist (rather than suasionist) position after the Civil War (1861–5). Long before the Volstead Act created a national prohibition of the manufacture and sale of alcoholic beverages (effective in 1920), many local and state governments adopted similar measures or created selective prohibitions against sales to minors, Native Americans, slaves, or drunkards. With the repeal of national Prohibition in 1933, a few states and some jurisdictions within states remained “dry”; virtually all retained a selective prohibition against sales to minors and installed or revived systems to oversee the liquor industry and regulate drinking places (to prevent the return of the saloon). Today a few states (notably Pennsylvania) still operate state monopolies of wholesale and/or retail distribution of alcohol. Wholesale monopoly protects state revenues from alcohol sales, whereas retail monopoly (more common) also addresses problems of public order and sales to minors and intoxicated persons. Most states, however, only regulate wholesalers, license premises for on-site or off-site sales and investigate complaints. Since the late 1980s, a national drinking age of twenty-one has been imposed for all alcoholic beverages; most states have tightened their drink-driving laws; some have passed “server liability” laws (which impose civil penalties on irresponsible hosts) or imposed cheap-drink (“happy hour”) restrictions. This recent movement towards closer alcohol regulation has gone under the banner of “neotemperance,” although many of its critics, notably those in the alcohol beverage industry have referred to it (incorrectly) as “neo-Prohibitionist.” The nineteenth-century temperance movement’s turn towards political prohibition profoundly influenced policy towards other consciousness-altering substances.

Particularly as pharmacists and physicians discovered the extraordinary prevalence of morphine addiction during the last decades of the nineteenth century (much of it the result of medical treatment), many states moved to regulate the sale of opiates and cocaine by the mechanism of a doctor’s prescription. In 1914 the Harrison Narcotic Act created a federal registration system for dispensers of opiates and cocaine that was used in conjunction with state legislation to prohibit effectively the non-medical use of these drugs and their furnishing to addicts by physicians. Although its crude distinctions among substances have been greatly elaborated by subsequent federal legislation, the regulatory scheme erected by the Harrison Act has remained fundamental to American drug policy Most contemporary proposals for policy reform—whether concerning the medicinal use of cannabis or the prescribing of methadone or even heroin to opiate addicts—rely on the mechanism of an expert intermediary usually a physician. Even more radical proposals— for the legalization of cannabis, for instance—retain the long-established selective prohibition against consumption by minors that is applied to alcohol and tobacco. Most also incorporate a commodity tax modeled on those applied to alcohol and tobacco.

Current American distinctions between legal and illegal drugs cannot be understood on pharmacological grounds. (For example, no experts doubt that alcohol and tobaccodelivered nicotine are far more addictive and intrinsically dangerous to health than cannabis.) Rather, the legal status of various consciousness-altering substances must be seen in the context of the country’s experience with Prohibition, which was not a happy one. Although alcohol consumption and alcohol-related problems declined during the first few years of Prohibition, the gradual organization of illicit supply and the unregulated nature of the illicit market, provided both ample (if often impure) liquor and tremendous opportunity for criminal entrepreneurs. Moreover, after decades of disreputability hard drinking became a mark of sophistication and rebellion among young people of the 1920s in much the same way that the consumption of cannabis and hallucinogens signified cultural dissent during the 1960s and 1970s. Further, the loss of alcohol tax revenue was a major blow to government, particularly during the Great Depression. By the late 1920s, even many women’s organizations thought of Prohibition as a failure and favored a return to the older principles of moderation and a suasionist form of temperance.

The lessons of Prohibition did not extend immediately to policy concerning consciousnessaltering substances other than alcohol, however. Primarily this had to do with alcohol’s status as America’s traditional intoxicant. (Even Harry Anslinger, ironfisted Chief of the Federal Bureau of Narcotics from 1930–62, was quite fond of Jack Daniels, a Kentucky whisky.) Other substances were exotic, associated with suspect groups like Mexicans (cannabis) or the Chinese (smoking opium). Moreover, the temperance and medical crusade against morphine, a very widely used substance, changed the social locus of its use. Whereas the typical morphine addict of the late nineteenth century was a middle-aged, rural woman using the drug on a doctor’s order, changing medical practices and cultural mores increasingly isolated the use of morphine (and later, heroin) in “sporting circles” and among nightlife afficianadoes. By the First World War, it had become a drug of young, lower-class men (mainly) and cultural fringedwellers— groups against which sumptuary legislation could easily be directed, especially in the name of moral upliftment. As a practical matter of enforcement, until the 1960s, relatively few Americans used substances other than alcohol. The movement for the decriminalization or outright legalization of cannabis could arise only when that substance became popular among middle-class, white young people.

After Repeal, then, American drug policy incorporated substances developed specifically for medical use into a prescription regime; legalized or kept legal such commonly used substances as alcohol and tobacco (subject to regulation, selective prohibition and taxation); and criminalized or left illegal exotic substances consumed for “non-medical” reasons by small minorities. During the postwar era, international treaties, cemented with financial aid and linked to anti-communist political objectives, internationalized the American model of Prohibition, though it was applied with variable enthusiasm and honesty.

In the twenty-first century Americans may need to relearn the lessons of temperance history In its suasionist form, the temperance movement had a lasting impact on what Americans drank, and how much they drank under what circumstances. In its Prohibitionist expression, the temperance movement supported unenforceable laws that undid many of its accomplishments by creating unregulated manufacture, sale and consumption, and by undermining respect for law and individual restraint. Disillusioned alcohol Prohibitionists recognized that America could not be made alcohol-free, and that responsible regulation was the only practical method for managing its presence in society Many disillusioned drug Prohibitionists now promote a similar message: it is better to reduce the harm associated with the inevitable use of now-proscribed substances than to perpetuate what has become an international system of banditry and political oppression.

The future shape of American drug policy remains to be seen, but the growing number of states that have passed “medical cannabis” laws, the growing interest of policy-makers in needle exchanges, physician prescription of methadone and even heroin, and the first discussion of safe-injection rooms—all increasingly common features of Central European drug policy—suggest that the American policy model is in decline.