Chasing the Scream

Chasing the Scream Plot Summary

Introduction

In a small hospital room in 1959, jazz legend Billie Holiday lay dying, her body ravaged not just by years of drug addiction, but by a system determined to punish rather than help her. Federal agents had handcuffed her to the hospital bed, removed her medical treatment, and stationed themselves outside her door. This scene represents the cruel reality of America's approach to drugs and addiction—an approach that began in the early 20th century and continues to shape our world today. The war on drugs represents one of the most consequential yet misunderstood social experiments in modern history. What started as a crusade led by Harry Anslinger, the first commissioner of the Federal Bureau of Narcotics, evolved into a global campaign that has cost trillions of dollars, imprisoned millions of people, and fueled violence across nations. By exploring the origins of prohibition, the science of addiction, and alternative approaches from countries like Portugal and Switzerland, readers will discover how our understanding of drugs has been shaped more by politics, racism, and moral panic than by scientific evidence or public health concerns.

Chapter 1: Anslinger's Crusade: Birth of the Drug War (1930s)

The modern war on drugs began with a man who needed a mission. Harry Anslinger, appointed as the first commissioner of the Federal Bureau of Narcotics in 1930, faced significant challenges. Alcohol prohibition was crumbling, his department's budget was being slashed, and he needed a new target to justify his agency's existence during the Great Depression. He found it in marijuana, a substance that had been used medicinally and recreationally in America for generations without significant concern. Anslinger was a masterful propagandist who understood the power of fear and racial prejudice. He claimed marijuana caused "white women to seek sexual relations with Negroes" and turned users into violent criminals. His department collected sensationalized newspaper stories about crimes allegedly committed by marijuana users, creating a file he called "Gore," while systematically ignoring medical evidence that contradicted his claims. When thirty doctors wrote to him stating that cannabis was not dangerous, he simply removed their statements from the record. Race played a central role in Anslinger's crusade. He deliberately used the Spanish term "marijuana" rather than "cannabis" to link it with Mexican immigrants, who were already facing prejudice during the Great Depression. Similarly, he targeted Black jazz musicians, compiling a list of hundreds to investigate and writing in internal memos that jazz was "satanic" and that musicians' "lives are examples of abject depravity." Billie Holiday became a particular target after she refused to stop performing "Strange Fruit," her powerful anti-lynching song. Anslinger assigned agents to follow her, eventually arresting her on drug charges that would haunt her until her death. What made Anslinger's approach particularly effective was his ability to internationalize drug prohibition. He leveraged American diplomatic power to force other nations to adopt similar prohibitionist policies, threatening economic sanctions against countries that resisted. When nations like Thailand refused to ban opium, he threatened to cut off foreign aid. His tactics worked – eventually, every nation caved to American pressure. Through his influence at the newly formed United Nations, Anslinger established an international drug control regime that would shape global policy for decades to come. The legacy of Anslinger's moral crusade continues today. He established the template for drug policy that prioritizes criminalization over public health, employs racial targeting, dismisses scientific evidence, and uses foreign policy to impose prohibition globally. What began as one man's bureaucratic empire-building transformed into a worldwide system that would reshape societies and create the conditions for powerful criminal organizations to flourish for generations to come.

Chapter 2: Medical Suppression: Silencing Science and Alternatives

Before prohibition took hold, addiction was primarily viewed as a medical condition rather than a moral failing. In the early 20th century, doctors like Edward Williams operated clinics where people dependent on opiates could receive legal prescriptions for the drugs they needed. The results were promising – patients who had been unemployed physical wrecks were able to return to work, support their families, and function normally. The mayor of Los Angeles celebrated Williams' clinic as a gift to the city, and even the local federal prosecutor acknowledged it accomplished "more good in one day than all the prosecutions in one month." Anslinger was determined to eliminate these medical approaches. He sent "stool pigeons" – desperate addicts paid to trick doctors – into Williams' clinic. When Williams wrote a prescription for one such agent, police burst in and arrested him. This was part of a nationwide crackdown that led to charges against some twenty thousand doctors, with 95 percent convicted. Anslinger declared that doctors "cannot treat addicts even if they wish to," effectively eliminating medical approaches to addiction for generations. Henry Smith Williams, Edward's brother, began investigating why his brother was being persecuted. He discovered that before prohibition, most drug users maintained normal lives. An official government study had found that three-quarters of self-described addicts held steady jobs, and 22 percent were wealthy. But prohibition had created two crime waves: it empowered gangsters to smuggle drugs at inflated prices, and it forced addicts to commit crimes to afford their now-expensive habits. In 1938, Henry published "Drug Addicts Are Human Beings," arguing that the entire policy of drug prohibition was a racket benefiting organized crime. The suppression of medical approaches had profound consequences. It established punishment rather than treatment as the primary response to addiction. It silenced scientific voices in drug policy debates. And it eliminated alternatives that might have demonstrated the failures of prohibition. By the 1960s, Anslinger could falsely claim that doctors had always been his allies in the drug war, erasing the history of medical opposition. This pattern of suppressing scientific evidence continued throughout the century. When the World Health Organization conducted a massive scientific study of cocaine in 1995, finding that "experimental and occasional use are by far the most common types of use," the U.S. government threatened to cut off funding unless the report was suppressed. It was never published and only became known because it was leaked. This systematic silencing of inconvenient facts has prevented public understanding of drugs and addiction from evolving beyond the narratives established during Anslinger's era. The medical model of addiction as a health issue requiring compassionate treatment was replaced by a criminal model that viewed drug users as moral deviants deserving punishment. This shift fundamentally altered how society responds to addiction, with consequences that have reverberated through generations and continue to shape drug policy today.

Chapter 3: The Iron Law: How Prohibition Created Violent Cartels

When substances are banned, the market doesn't disappear—it transforms. This economic principle, known as the iron law of prohibition, explains why drug prohibition consistently makes substances more dangerous while empowering violent criminal organizations. During alcohol prohibition in the 1920s, Americans shifted from primarily consuming beer to favoring hard liquor because it was more concentrated and therefore easier to smuggle and hide. The same pattern emerged with other drugs: coca leaf tea was replaced by powder cocaine, which was later replaced by crack—each iteration more potent and dangerous than the last. Arnold Rothstein, a mathematical genius known as "The Brain," recognized the enormous opportunity created by prohibition. In the 1920s, he transformed the underground drug trade from a disorganized collection of street peddlers into a sophisticated business enterprise with industrial-scale smuggling and distribution networks. Rothstein understood a fundamental economic reality: there would always be people who wanted to get high, and if they couldn't do it legally, they would do it illegally. The profits were astronomical—for every $1,000 spent purchasing, smuggling, and distributing opium, those at the top collected $6,000 or more. With these vast sums, Rothstein pioneered what would become standard practice in the drug trade: corrupting law enforcement. His profit margins were so enormous he could easily outbid the salaries police earned from the state. As one journalist noted, "The police were as gracious to him as they were to a police commissioner." Rothstein also established another enduring feature of the illegal drug trade: the culture of terror. Since drug dealers cannot rely on courts or police to protect their property or resolve disputes, violence becomes the only enforcement mechanism. The end of Rothstein's life illustrated the inherent instability of the criminal drug economy. In 1928, he was shot and killed in Manhattan. His murder triggered a violent scramble for control of his drug empire, establishing a pattern that continues today: prohibition creates valuable illegal markets that can only be controlled through violence, leading to endless cycles of bloodshed. Each time a drug kingpin is killed, a more ruthless version emerges to take his place. As Anslinger himself would later write: "One group rose to power over the corpses of another." This pattern has repeated itself globally, with increasingly sophisticated and violent organizations emerging to meet demand for prohibited substances. From the Italian-American mafia of the 1930s to the Colombian cartels of the 1980s to the Mexican Zetas of today, prohibition has consistently empowered the most ruthless criminal organizations. By 2012, an estimated sixty thousand people had been murdered in Mexico in just five years as cartels fought for control of smuggling routes into the United States. This violence isn't caused by drugs themselves, but by the enormous profits available in prohibited markets—profits that simply wouldn't exist under regulated systems. The iron law of prohibition reveals a tragic irony: policies intended to reduce drug-related harm have instead maximized it, creating a system where the most dangerous substances and the most violent organizations thrive. This economic reality, not moral failing or chemical hooks, explains why the war on drugs has consistently failed to achieve its stated goals while producing catastrophic unintended consequences.

Chapter 4: Human Cost: Communities Destroyed by Enforcement

The human toll of the drug war extends far beyond those who use drugs. In neighborhoods like East Flatbush, Brooklyn in the 1990s, prohibition transformed communities into battlegrounds. Fourteen-year-old Chino Hardin stood on his corner with a pit bull, gold fangs, and a 9mm Smith & Wesson hidden nearby, selling crack to support himself. The economic incentives created by prohibition made drug dealing the most visible path to success in impoverished neighborhoods. As Chino explained, "It gives the gang way more power. You have access to money and resources to buy guns, to be extravagant, to actualize the persona of being a big shot." Violence became an essential business tool in these communities. Since drug dealers cannot call the police if someone steals their product or invades their territory, they must establish a reputation for brutality that deters potential threats. Professor Paul Goldstein's research confirmed this dynamic, finding that over three-quarters of "drug-related" killings weren't caused by drug use but by conflicts over territory and markets—violence caused by prohibition itself. Innocent bystanders were frequently caught in the crossfire, like seven-year-old Tiffany Smith, who was killed by a stray bullet while sitting on her front porch in Baltimore. The war on drugs also transformed policing in these communities. Leigh Maddox, a former Maryland state trooper, described how officers were pressured to maximize drug arrests regardless of their severity. Police departments became financially dependent on asset forfeiture—seizing property from drug suspects—which created perverse incentives to focus on drug crimes rather than violent offenses. Maddox eventually realized that arresting drug dealers actually increased violence by creating power vacuums and triggering turf wars. The racial disparities in enforcement were staggering. While drug use and selling were evenly distributed across racial groups (with white Americans slightly more likely to use drugs), black Americans made up 64 percent of those arrested for drug dealing. This resulted in what Michelle Alexander would later call "The New Jim Crow"—a system of racial control through mass incarceration. By the 1990s, the United States was imprisoning black men at rates far exceeding those of apartheid South Africa. The consequences extended beyond those directly involved in the drug trade. Entire communities were traumatized by constant violence, police harassment, and the removal of large portions of their population to prison. Once labeled a drug offender, a person became virtually unemployable, barred from student loans, evicted from public housing, and stripped of voting rights—creating a permanent underclass of second-class citizens. As former police captain Leigh Maddox discovered when she began providing legal services to former drug offenders: "There are people you can't help... The guy who comes in and he's forty-five years old... and he wants to get his record expunged and [all you can say is] 'Sorry... you're out of luck.'" As both Chino and Leigh eventually realized, these devastating impacts weren't inevitable consequences of drug use but direct results of policy choices. The violence, corruption, and community destruction weren't problems that prohibition solved—they were problems that prohibition created.

Chapter 5: Portugal's Revolution: The Decriminalization Experiment (2001)

In 2001, Portugal took a revolutionary step that defied a century of global drug policy. Facing one of Europe's worst drug problems, with approximately one percent of its population addicted to heroin and HIV rates soaring among users, Portugal decided to decriminalize the possession of all drugs—from cannabis to heroin. This didn't mean drugs became legal to sell, but rather that people caught with small amounts for personal use would no longer face criminal penalties. Instead, they would be referred to "Dissuasion Commissions" staffed by health professionals. The architect of this approach was João Goulão, a family doctor who had witnessed the devastation of addiction firsthand in the Algarve region. Having tried the traditional punitive approach without success, Goulão and a commission of experts concluded that criminalization was making the problem worse by driving users underground and away from treatment. As Goulão explained: "We were spending millions and getting nowhere." Their radical proposal was to treat drug use as a health issue rather than a criminal one, and to redirect resources from punishment to treatment and prevention. The Portuguese model distinguishes between the vast majority of drug users who don't have problems and the minority who develop addiction. For recreational users, the approach is minimal intervention—perhaps a warning about risks and safety information. For those showing signs of addiction, the system offers immediate access to treatment, housing support, and job training. As Nuno Capaz, who oversees the Dissuasion Commissions, explained: "If the person shows up at ten o'clock in the morning, we can schedule them for one o'clock in the afternoon at the treatment facility." This immediacy contrasts sharply with the months-long waiting lists common in countries that criminalize drug use. The results have been remarkable. Contrary to critics' predictions of disaster, drug use in Portugal has remained below the European average. More importantly, problematic drug use, HIV infections among users, and overdose deaths have all declined significantly. The number of problematic drug users in Portugal has been halved, from 100,000 to 50,000 according to the Ministry of Health. Drug-related HIV infections fell from 52% of new cases to 20%. Among teenagers, drug use remains among the lowest in Europe—only 13% of 15-16 year olds report having tried cannabis, well below the EU average. Perhaps most striking is how Portugal's approach has transformed the relationship between drug users and society. Instead of being marginalized, they are encouraged to reconnect. The government gives tax breaks to employers who hire recovering addicts and provides low-interest loans to help former users start businesses. As João Figueira, the former head of Portugal's drug police who initially opposed decriminalization, admitted: "The things we were afraid of didn't happen... We don't see a drug addict as a criminal anymore. He's someone that needs help. And everyone thinks it." Portugal's experiment has proven so successful that it has survived multiple changes in government, with both left and right-wing administrations maintaining the policy. What began as a controversial experiment has become the common sense of the country, with virtually no one advocating a return to criminalization. As Figueira concluded: "What happened here worked. What happened here was a good result and the statistics we have prove it."

Chapter 6: The Science of Connection: Rethinking Addiction

For nearly a century, our understanding of addiction has been dominated by the idea that drugs contain "chemical hooks" that inevitably trap users. This narrative, promoted since Anslinger's time, suggests that exposure to certain substances automatically leads to addiction. However, scientific research has increasingly challenged this simplistic view, revealing that addiction is far more complex than mere chemical dependence. The groundbreaking work of psychologist Bruce Alexander in the 1970s first questioned this paradigm. Alexander noticed that laboratory studies showing rats compulsively consuming drugs were conducted in isolated cages where drugs were the only source of stimulation. He created "Rat Park," a pleasant environment where rats had companions, toys, and activities. The results were striking: rats in this enriched environment largely ignored the drug-laced water, while isolated rats consumed it compulsively. This suggested that environment—not just chemical exposure—plays a crucial role in addiction. Human evidence supports this conclusion. During the Vietnam War, nearly 20% of American soldiers used heroin regularly, leading to fears of a massive addiction crisis when they returned home. Yet follow-up studies found that 95% of these users simply stopped when they returned to their communities and support systems. Similarly, hospital patients regularly receive powerful opiates for pain management without developing addiction. These patterns suggest that drugs alone don't cause addiction—isolation, trauma, and lack of purpose play equally important roles. Dr. Gabor Maté, working with addicts in Vancouver's Downtown Eastside, observed that nearly all his patients had experienced severe childhood trauma. "Not every traumatized person becomes addicted," he noted, "but every addicted person has been traumatized." The Adverse Childhood Experiences Study found that for each traumatic event experienced in childhood, a person is two to four times more likely to develop addiction as an adult. Nearly two-thirds of injection drug use can be traced to childhood trauma—a correlation so strong the scientists described it as "of an order of magnitude rarely seen in epidemiology or public health." This science explains why punitive approaches to addiction have consistently failed. Punishment increases isolation and shame—the very conditions that drive addiction in the first place. By contrast, approaches that restore connection, purpose, and dignity show remarkable success. In Switzerland, a program providing prescription heroin to long-term addicts in a clinical setting led to dramatic improvements in health, reductions in crime, and many participants eventually reducing their dosage voluntarily. As one patient explained: "This program gives you the chance to recover the control you have lost." Professor Ronald K. Siegel's research on animal drug use suggests that the desire to alter consciousness isn't a human weakness or moral failing but a biological imperative shared across species. Over twenty-five years of field research, Siegel documented countless examples of animals deliberately seeking intoxication: elephants getting drunk on fermented fruits, bees consuming numbing nectar, cats sniffing pleasure plants. This led him to conclude that the drive to alter consciousness is "the fourth drive" in all animal minds, alongside hunger, thirst, and sex—a biological impulse as natural as eating or mating. This emerging science points toward fundamentally different solutions than those offered by the war on drugs—solutions focused on healing trauma and building community rather than imposing punishment and isolation. As Johann Hari summarized after studying this research: "The opposite of addiction isn't sobriety. It's connection."

Chapter 7: New Paradigms: Legalization Experiments and Future Directions

The early 21st century has witnessed the first serious challenges to global prohibition since its inception. In 2012, voters in Colorado and Washington state approved ballot initiatives to fully legalize cannabis for adult use—not just decriminalizing possession but creating regulated markets for production and sale. In 2013, Uruguay became the first nation to legalize cannabis at the national level under President José Mujica, a former guerrilla fighter who had spent 14 years in prison during the country's military dictatorship. Watching the devastation caused by drug cartels in neighboring countries, Mujica concluded: "We have for over one hundred years been following the policy of repressing drugs—and after one hundred years we have realized that it has been a resounding failure." These experiments have demonstrated that legal regulation offers several advantages over prohibition. Legal markets provide products of known potency and purity, reducing overdose risks. Age verification requirements make it harder for minors to access drugs—studies show teenagers report easier access to illegal cannabis than to regulated alcohol. Tax revenue can be directed toward education and treatment rather than spent on enforcement. In Colorado alone, legal cannabis sales generated over $1.5 billion in tax revenue in the first five years, with funds directed toward education, public health, and infrastructure. Perhaps most importantly, legal markets eliminate the violence associated with black markets. Contrary to opponents' predictions, Colorado and Washington have not seen increases in crime rates, traffic fatalities, or youth cannabis use. Even John Hickenlooper, Colorado's governor who initially opposed legalization, later acknowledged: "It seems like the people that were smoking before are mainly the people that are smoking now... but we are going to have a system where we're actually regulating and taxing something, and keeping that money in the state of Colorado... and we're not supporting a corrupt system of gangsters." Beyond cannabis, some jurisdictions have begun exploring new approaches to other substances. In Vancouver, a program called NAOMI (North American Opiate Medication Initiative) provided prescription heroin to long-term addicts who had not responded to other treatments. The results mirrored those in Switzerland—participants showed improved health outcomes, reduced criminal activity, and greater social integration. Similarly, several cities have approved supervised consumption facilities where users can take drugs under medical supervision, dramatically reducing overdose deaths. The success of these initial experiments has accelerated reform globally. Since Colorado and Washington voted to legalize, numerous other states and countries have followed suit or are considering similar measures. Former heads of state including Ruth Dreifuss of Switzerland and Fernando Henrique Cardoso of Brazil have joined the Global Commission on Drug Policy, arguing that "The global war on drugs has failed, with devastating consequences for individuals and societies around the world." These new paradigms suggest that the end of global prohibition may be approaching—not through a single dramatic change but through a series of experiments that gradually demonstrate the benefits of regulation over criminalization. As more jurisdictions adopt evidence-based approaches and demonstrate their effectiveness, the century-long consensus around prohibition continues to erode, opening space for policies based on compassion, public health, and human dignity rather than punishment, fear, and moral condemnation.

Summary

The century-long war on drugs represents one of history's most profound policy failures. What began as Harry Anslinger's racially motivated crusade, fueled by bureaucratic ambition and moral panic, evolved into a global system that has imprisoned millions, enriched criminal organizations, destabilized entire nations, and failed to meaningfully reduce drug use or addiction. Throughout this history, evidence contradicting the prohibitionist narrative has been systematically suppressed, while policies have been driven by ideology rather than scientific understanding. The drug war's fundamental contradiction lies in its attempt to eliminate something that appears to be an intrinsic aspect of human nature. From the Temple at Eleusis to modern neuroscience, evidence suggests that the desire to alter consciousness is a biological drive shared across species. Yet prohibition treats all drug use as equally dangerous, despite research showing that the vast majority of users never develop problematic relationships with substances. This misalignment between policy and reality has produced catastrophic consequences: violence in Mexico, mass incarceration in the United States, corruption worldwide, and countless lives destroyed not by drugs themselves but by the criminal justice response to them. The emerging alternatives—from Portugal's health-centered decriminalization to Switzerland's prescription programs to Colorado and Uruguay's regulated markets—point toward a more effective and humane future. These approaches recognize that human connection, not punishment, offers the best path to addressing the real harms of addiction. After a century of failure, we are witnessing what may be the beginning of the end of the drug war—a transformation that offers hope for healing the immense damage caused by treating a health issue as a criminal one.

About Author

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Johann Hari

Johann Hari is an award-winning British journalist and playwright. He was a columnist for The Independent and the Huffington Post, and has won awards for his war reporting. His work has also appeared in the New York Times, the Los Angeles Times, The New Republic, The Nation, Le Monde, El Mundo, the Melbourne Age, El Pais, the Sydney Morning Herald, the Irish Times, The Guardian, Ha'aretz, the Times Literary Supplement, Attitude (Britain's main gay magazine), the New Statesman and a wide range of other international newspapers and magazines.Hari describes himself as a "European social democrat", who believes that markets are "an essential tool to generate wealth" but must be matched by strong democratic governments and strong trade unions or they become "disastrous". He appears regularly as an arts critic on the BBC Two programme Newsnight Review, and he is a book critic for Slate. He has been named by the Daily Telegraph as one of the most influential people on the left in Britain, and by the Dutch magazine Winq as one of the twenty most influential gay people in the world.After two scandals in 2011 involving plagiarism and malicious editing of Wikipedia pages, Hari was forced to return the prestigious Orwell prize he had won in 2008, and lost his position at The Independent.

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