Select Examples of Shifting Perceptions
of Harms and Benefits of Addictive Substances in the U.S.Tobacco. Cigarette smoking generally was frowned upon at the turn of the 20th century.^141 However, highly
effective marketing campaigns conducted during the early and mid-20th century by the major tobacco companies
tremendously enhanced the appeal of smoking for men and women alike. The image of the cigarette smoker
projected by such campaigns--and by the entertainment media--was that of glamour, sophistication and even fitness.
Some medical professionals even signed on to the health message; tobacco advertisements featured physicians and
some appeared in medical journals.^142 In 1950, a landmark study linking smoking to lung cancer was published in
the prestigious Journal of the American Medical Association.^143 Over the next decade, more than 7,000 articles were
published linking smoking with lung cancer and other life-threatening diseases.^144 In 1964, the first U.S. Surgeon
General’s Report on Smoking and Health was published, concluding that smoking was hazardous to health and that
immediate action was warranted.^145 It spurred a major, highly successful public health effort to reduce smoking and
other tobacco use. The truth about the dangers of smoking and the health consequences of second-hand smoke,
finally reached the public through unmistakable health evidence and powerful anti-tobacco health and legal
campaigns. Perceptions of smoking (and smokers) largely turned negative, public policy shifted toward widespread
bans and restrictions on smoking, and smoking rates have declined significantly.
Alcohol. The duality of alcohol--as a staple for celebrations, religious rituals or relaxing with family and friends, and
on the other hand as an underlying driver of crime, poverty, family dysfunction and illness--has a very long history.
Alcohol was considered in early America to be helpful for curing ailments, natural and healthy when used in
moderation, as an important source of nutrients and as a healthier alternative to water which often was
contaminated.^146 The 19th and early 20th centuries saw a change in attitudes wherein excessive alcohol use was seen
as an impediment to worker productivity and as a contributing factor to problems such as domestic violence, poverty
and crime.^147 The initial push for moderation in alcohol use (temperance) soon became a push for prohibition.^148
Once the futility of prohibition became apparent and the law ultimately repealed, alcohol has been both extolled
through ubiquitous marketing and condemned for its tremendous societal and health-related costs. Conflicting views
on the dangers versus benefits of alcohol use persist with a growing list of scientific findings that the health and
social risks of excessive alcohol use and dangers of underage drinking outweigh any ostensible health benefits of
non-excessive drinking.
Marijuana. In colonial America, marijuana was a major commercial crop alongside tobacco and was grown for its
fiber much like cotton. In the 1920s, the recreational use of marijuana began to catch on, particularly among
entertainers. Marijuana use at this time was not illegal and was not considered a social threat. Between the mid-19th
and 20th centuries, marijuana was even prescribed for various medical conditions including labor pains, nausea and
rheumatism. In the 1950s, marijuana use became increasingly popular and, in the 1960s, it became a symbol of
rebellion against authority. In the Controlled Substances Act of 1970, the federal government classified marijuana
along with heroin and LSD as a Schedule I drug--having the highest abuse potential and no accepted medical use--
formalizing its illegality and highlighting its potential for addiction. The 1980s and early 1990s saw the passage of
strict laws and mandatory sentences for possession of marijuana as well as the development of stronger strains of the
drug.^149 In recent years, a growing number of states have enacted laws bypassing the established process of bringing
drugs to market in the U.S. which assures safety and efficacy and permitting the use of marijuana as “medicine.”^150
Opioids. The prescribing and dispensing of opioids by physicians and pharmacists were the major causes of the
increase in narcotic use (and addiction) that occurred in the 19th century.^151 Opium and morphine were believed to
cure a variety of health conditions.^152 At the turn of the 20th century, the Bayer Pharmaceutical Company promoted
heroin as “the sedative for coughs.”^153 At this time, there was some concern about the “moral degradation” caused by
opioid use, but drug users were not subject to legal sanctions.^154 Increased concern about the spread of opioid
addiction prompted the passage of several Acts restricting the use and distribution of narcotics and making their non-
medical use illegal.^155 Since that time, perceptions of narcotic/opioid use diverged dramatically, with prescription
opioids marketed as beneficial and illegal opioids seen as a scourge. In the late 1990s, the growth in the use of
prescribed pain relievers, tranquilizers and stimulants resulted in a widespread epidemic of prescription drug misuse
and addiction among people of all ages, which now pose an even larger addiction problem than their illegal
counterparts.^156 In response, efforts to control this misuse have led, in some cases, to the under-treatment of pain.^157