It is not hyperbole to say that contemporary American society is addicted to drugs. Comprising only 4 percent of the world’s population, Americans consume 80% of the earth’s opioids. One out of six Americans have a psychiatric medication prescription. We spend over half of a trillion dollars every year on pharmaceuticals, and the rate of drug overdose deaths has quadrupled over the past two decades. Americans have been increasingly consuming an ever-increasing range of drugs, from the relatively harmless such as caffeine and marijuana to more dangerous variants of opioids such as heroin and fentanyl. When one accounts for the wide spectrum of benzodiazepines, antidepressants, and antipsychotic medications that Americans take to treat mental illnesses, we can see that America runs on drugs. 

       Yet, throughout America’s storied history with drug use, another unique trend is apparent: the amount of fearmongering and moralizing that has typically defined our discourse about drugs and drug use. Whether through the failure of the 18th Amendment establishing Prohibition or the successive shortcomings of the War on Drugs that started with Nixon, America’s response to drugs has been a never-ending cycle of selectively applied punitive measures followed by periods of normalization. Every drug has a story to tell, and our collective responses to them reveal our values and vices.

       In his 2023 book, Quick Fixes: Drugs in America from Prohibition to the 21st-Century Binge, Benjamin Y. Fong (honors faculty fellow and associate director of the Center for Work & Democracy at Arizona State University) provides a sweeping history of drug production and their use in American society. Far from drug use serving as an indication of personal moral failure, Fong argues that drug use is a side effect of contemporary capitalism, as citizens reach for comfort from increasing levels of stress, alienation, and isolation. Likewise, capitalists have seized the power of drugs throughout history for their own interests, as they seek to make workers more productive and craft drug enforcement policies to imprison specific populations and disrupt anticapitalist organizing.  

Overview:

       Divided into nine chapters each dedicated to a specific drug or classification of chemical compounds, Quick Fixes examines how the shifting demands of American society have shaped our uses and prohibitions of our various pharmacological comforts. While each chapter can be treated as a separate essay concerning the history and use of a specific substance (namely, caffeine, nicotine, alcohol, opiates, amphetamines, psychotropics, psychedelics, cocaine, and marijuana), Fong provides a chronological framework for understanding America’s back-and-forth love-hate relationship with drugs.

       The first stage in the American history of drugs started in the late 19th century when temperance movements sought to clamp down on what had previously been the free use of tobacco, alcohol, and opium throughout much of the previous century. Fong argues that prohibition during this era was fueled by the fears of a growing number of intoxicated, unproductive workers in an age of mass industrialization and urbanization. As capitalism became further entrenched into the fabric of American society, systemic social ills were transformed into moral, biological ones. As such, this focus on productivity in a rapidly industrializing society caused some drugs such as alcohol and opium to be vilified while caffeine was celebrated for its productivity-boosting properties.  

       The second stage takes place during the Fordist-Keynesian period (roughly 1954–1973), when the US occupied the world stage as the hegemon of international capitalism. During this period, there was stable economic growth, and a wide array of amphetamines and barbiturates were utilized to fuel this post-war growth and conform to this Fordist economy and its demands from workers. This era also marked the precipitous rise of the pharmaceutical industry in America, as well as the participation of the US government in the international production and distribution of illicit substances (most notably opium production in the Golden Crescent). 

       The third stage comprises the neoliberal era, in which Nixon declared the “War on Drugs.” The Controlled Substances Act of 1970 created the drug schedule system, which reduced the availability of both legal and illegal drugs. During this time, The Drug Enforcement Agency (DEA) was formed in 1973, and while it curtailed the supply of drugs such as marijuana and heroin, it created a demand for this period’s new drug of choice: cocaine. Utilized by the wealthy for productivity and recreation to give them “an ephemeral jolt of irrational confidence”, cocaine (and its less expensive corollary “crack,” which is simply cocaine cut and heated with baking soda to remove the hydrochloride, which turns it into a solid form to be smoked) became a cudgel to target lower-income neighborhoods under the guise of addressing the drug “epidemic,” which saw many minority and working-class populations imprisoned at a far greater rate than wealthy cocaine users (6). The third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 pushed back against these controls, as several members connected to the pharmaceutical industry created a new paradigm for diagnosing mental illness that could simply be treated with the right SSRI, amphetamine, or benzodiazepine. 

       The fourth and most recent era is the current one we occupy: neoliberalism's fracturing state. Fong argues that we live in an era where traditional categories are breaking down with no seemingly viable alternative in sight to replace neoliberal capitalism. Substances previously labeled as drugs such as ketamine are being used for medicine, while former medicines have become some of the most dangerous drugs, such as fentanyl. Legal drugs such as tobacco have become unpopular and have fallen into disrepute, while illegal drugs are being treated with increasing levels of seriousness for treatment (MDMA and psilocybin). 

       In addition to a rough chronological sketch, Fong provides five central claims that scaffold his larger argument throughout the book. The first is that the typical work structure under capitalism transforms recreational drug use into a dosing regimen. As such, we require the use of drugs (such as coffee or cigarette breaks) just to make it through the average workday and remain a productive worker, and our drug use only becomes labeled as “abuse” when it interferes with our productivity. 

       The second is that “psychopharmacology [using medicine to treat mental illness] is the science of treating atomization” (12). By this, Fong argues that life in America causes us to feel isolated and disempowered, and instead of cultivating collective solutions, the medical establishment prioritizes individual, perpetually ongoing treatments to cope with the loneliness of contemporary living. Fong writes, “Why do people take drugs? Because they like their experience at least a little bit better on drugs than not. If we accept that explanation, all the interesting follow-up questions have to do not with drugs, but with experience” (22, emphasis in original). 

       The third organizing principle is that drug producers are typical capitalist organizations. Far from a benevolent sector, the pharmaceutical industry mimics other capitalist interests by lobbying and bribing politicians to draft policies in their favor. They also work tirelessly to curry favor with the public by marshaling expert opinions and squashing negative media. Drug companies also stimulate demand by advertising directly to the consumer, and work to crush their competition by maintaining exclusive patents. 

       Fourth, Fong argues that the main difference between licit and illicit drugs is a class distinction, as who is consuming the drug is often more important when it comes to our perception of drugs rather than the inherent danger of the drug itself. This class distinction is also evident in the waves of fear and paranoia around particular immigrant communities and tying them to disreputable drug use. These associations have often been racialized throughout history, such as associating marijuana with Mexicans, opium with the Chinese, cocaine with black Americans, alcohol with Irish and German immigrants, and tobacco and opiates with the contemporary white working class (19). The Food and Drug Administration (FDA) and the Drug Enforcement Administration (DEA) also uphold this class distinction between licit and illicit drugs. Drugs sought by the DEA are illicit, while drugs produced by large pharmaceutical companies are regulated by the FDA and immune from moralistic propagandizing.

       Finally, the fifth organizing principle is that the drug policies that are passed are not just about the drugs themselves, but rather about controlling “surplus populations.” Drug policies are less about policing the drugs themselves, and more about fears surrounding racialized minorities and class distinctions, as Fong writes, “The ‘drug menace’ is ideological cover for the continuing offenses of Big Pharma, the demonization of already oppressed racial groups, the rollback of the welfare state, the enhancement of security apparatuses, and the erosion of civil liberties” (20-21). We can see this in the conviction rate and sentencing disparities between the wealthy and poor consumers of similar drugs, which was epitomized in Nixon’s War on Drugs. Fong argues that this continual state of drug wars creates states that are over-militarized and punitive. “Appropriately, perhaps,” Fong muses, “drug war makes paranoid states'' (172, emphasis in original). We’ve witnessed politicians and the media use certain drugs as scapegoats for these social ills and as a justification for mass incarceration. If you can blame poverty and inner-city violence on drugs, then you can draw attention away from crumbling infrastructure, insufficient social welfare, failing school systems, and economic inequality. 

       According to Fong, none of the drugs that he covers have fulfilled the promises their proponents proposed. Drugs are not inherently liberatory, yet neither are they the weapons of mass societal destruction that their detractors claim. Simply decriminalizing, legalizing, or reforming drug policies alone is not sufficient. Legal drugs such as tobacco and alcohol are two of the deadliest drugs in America. At the same time, the decriminalization of marijuana has led to the cannabis industry prioritizing profits over the welfare of its consumers. Instead of the “quick fixes” of liberalization or prohibition, Fong insists that we must address the societal roots of drug use and undercut the reasons why people take drugs in the first place. As such, he proposes policies such as Medicare for All and a federal public jobs program to provide the economic resources that people need to survive, as well as invest in infrastructure and community building as a way to combat social alienation. While human beings will never stop consuming drugs, Fong argues that these steps will be much more effective (both in economic cost and qualitative outcomes) than the failed War on Drugs, and will help ease the compulsion we feel to take drugs in the first place. 

Commendations: 

       Quick Fixes possesses several notable strengths. First, the book is organized into nine chapters, each centered around a specific drug or classification of drugs. Since each chapter is self-contained and focused on one particular drug, it is easy to pick it up and read a chapter or two at a time without losing the overall argument. While larger narrative themes are present throughout the book, each chapter serves as a microhistory of a specific drug, allowing readers to see Fong’s thesis through multiple prisms. 

       Despite the emotionally heavy content, Fong occasionally dips into a touch of humor, primarily regarding the hypocrisy of the US government’s wild pendulum swinging between punitive prohibition and active participation in peddling drugs. He also includes a wide array of illustrations such as advertisements for coffee and cigarettes, as well as PSA posters that have all aged terribly. As such, Fong’s accessible and breezy writing style makes for a quick and episodic read as he provides a brisk tour of the history of drug use and production in the United States.

       Additionally, as opposed to treating drug consumption as an individualist moral failing, Fong astutely diagnoses the social roots of drug consumption and mental illness. Fong eschews any kind of moralizing toward drug consumption, instead focusing his attention on drug consumption as a reflection of changing social and economic conditions. As Fong writes, “We all want to know what’s wrong with us, and when the word ‘capitalism’ is illegible as an explanation for our generally uncomfortable state of being, easy substitutes must be ready at hand. Drugs provide pharmacological relief, but perhaps more importantly, they provide explanatory relief” (127). This pivot toward the social and economic roots of drug consumption allows us to ask more interesting and pressing questions regarding the nature of drug consumption in America, and what these trends tell us about ourselves 

       Fong astutely diagnoses our fervent drug consumption as a response to the pressures, isolation, and dysfunction engendered by capitalism. Rather than glorifying or vilifying their use, Fong takes a balanced stance toward drugs, examining the reasons why people choose to take drugs. While arguing that they more often do more harm than good, Fong sympathizes with those who feel the need to take drugs to feel relief from the exhaustion of contemporary society or to numb the pain of disconnectedness and social isolation. 

       Yet, he is also clear-eyed in asserting that these promises of happiness and meaning that the proponents of drugs offer are often false, even if they do make life just a little less miserable, if only for a moment. As such, Fong walks a fine line between those who advocate full liberalization of drug use and those who wish to suppress all drug use. Fong believes that both of these stances are simply “quick fixes” naive to the reality and history of drug use in America. He instead proposes that the best way to fight against the drug epidemic is to remove the reasons why people feel the need to take them in the first place. To this end, he argues that by fighting poverty, providing people with agency and meaning as a way to combat social alienation, and providing free health care services,  the compulsion to consume drugs will ease. While this solution might come across as too simplistic in some regards, it is undoubtedly a large piece of the puzzle when it comes to solving our overreliance on drugs. 

Fong also holds no punches when it comes to lambasting Big Pharma and their culpability in perpetuating suffering to rake in ever-larger profits. He brilliantly illustrates the material interests of multi-billion dollar pharmaceutical companies and points us toward their shady dealings as they utilize the mechanisms of the state to further their interests. While the Sackler family is an easy example to illustrate the truly horrific lengths that pharmaceutical companies will go to line their own pockets at the expense of the average consumer, Fong rightly makes the argument that they are not the exception, but the norm. 

When it comes to the prevalence of SSRIs and other treatments for mental illnesses, Fong presents a thought-provoking set of data points to consider. He argues that over the past several decades, there has been a marked shift in how we view and treat mental illness. While there has been a growing acceptance and recognition of mental illness, it has been accompanied by a reductionistic, biological view of the brain where neurotransmitters and hormones such as dopamine, norepinephrine, and serotonin can be manipulated with the aid of pharmaceutical drugs to achieve an ideal balance for the individual. 

Fong argues that the DSM is guilty of pathologizing completely normal human behavior and that while the medical establishment used to recognize societal factors in diagnosing conditions such as anxiety and depression, this was largely elided during the 1980s in favor of a biological view that prioritizes imbalances in brain chemistry. He supports this view by citing double-blind studies showing that placebos (in the form of sugar pills) were shown to be just as effective (if not more effective) than Prozac and other similar antidepressants. Fong argues that due to its side effects and relative ineffectiveness at treating the symptoms of depression, Prozac and other similar antidepressants do not cure chemical imbalances in the brain, but rather introduce chemical imbalances to the patient’s brain, and thus “imbricates its users in the drug’s justificatory framework after the fact” (130). While I’m not wholly convinced of Fong’s strong stance here, it is still interesting to consider. 

Fong also reveals how our responses to the various drug panics throughout history have shaped policies that further hurt and alienate the communities that are most affected by drug addiction. Through a litany of examples from the Smoking Opium Exclusion Act of 1909 to the Comprehensive Crime Control Act of 1984 and the Anti-Drug Abuse Act of 1986, Fong reveals how these policies both explicitly and implicitly targeted specific racial and socioeconomic communities. These latter two examples introduced harsher penalties for possession and introduced civil asset forfeiture. This allowed state and local police departments to share proceeds made in asset seizures in collaboration with the federal government, leading to even larger budgets for policing. As Nixon's domestic policy advisor, John Ehrlichman admitted in an interview in 1994, 

The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I'm saying? We knew we couldn't make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.

Fong rightly points out the cynical weaponization of the War on Drugs to target minority communities, leading to our current regime of mass incarceration. By unsettling our common notions of drug use and social disorganization, Fong introduces a chick or egg scenario: do drugs cause poverty and crime, or do poverty and crime generate the opportunities for drugs to flourish, both as an escape from a degraded existence and an underground market? Fong stands firmly along the latter answer. 

Finally, in addition to the countless historical facts within this volume, I appreciated Fong’s many philosophical interventions. In a larger sense, Fong’s overall structure of unveiling the fantasies that we’ve constructed around drugs to reveal a deeper truth about American society deeply appealed to the psychoanalyst in me. Our fantasies often speak more truthfully about what we fear and value than what we openly confess, and Fong’s interrogation of these fantasies proves to be a fruitful line of inquiry throughout the book. 

Speaking of psychoanalysis, as opposed to the current popularity of psychiatric approaches to mental illness, Fong advocates for the talking therapy treatments of Cognitive behavioral Therapy (CBT) and psychoanalysis, which prove to be more effective than medicine alone. He also applies psychoanalytic theory to the demonization of drugs, as he writes, “Although drug ‘menaces’ are built up into unqualified evils for the sake of ratings and political gain, and though the ravages of physical dependency and long-term use are real, it is this basic capitalist antipathy to undeserved pleasure that undergirds the category of ‘illicit drugs’” (20, emphasis in original). Similarly, he quotes Alasdair MacIntyre’s assessment of the conservative objection to marijuana use that is was a “source of pure pleasure which is available for those who have not earned it, who do not deserve it.” This concept of depriving the imagined Other of enjoyment is central to the function of contemporary politics, and this analysis should be applied more broadly to other phenomena to examine the central role of enjoyment as a political stance (an idea that Todd McGowan has explored in Enjoyment Left and Right). As such, Fong’s philosophical asides provide fertile ground for further inquiry and consideration. 

Critiques: 

On the other hand, Quick Fixes suffers from a few shortcomings. Due to its brief length, there is little room for deep analysis or nuance in his historical reconstruction. While it serves as a good overview of the topic, if you are already familiar with the history of drugs in America, then there’s not much new here. Also, while each chapter is interesting and reads quickly, I found myself wanting more by the time I got to the last page. Fong doesn’t dive too deeply into any one subject, but he provides plenty of resources for the curious reader who wishes to read more about each substance. 

Furthermore, Fong tends to make bold, declarative statements without backing them up with hard data. For example, when discussing the ineffectiveness of SSRIs, Fong writes, “There is scant evidence for the psychiatric conception of depression, according to which the root cause is a chemical brain imbalance. What is certain is that once a depressed patient ingests Prozac or similar drugs, they will have a chemical imbalance in their brain” (130, emphasis in original). While he does not deny that some people have been helped by SSRIs, he insists that this is almost wholly due to the placebo effect. 

This is an incredibly one-dimensional perspective on the use of SSRIs to treat conditions such as anxiety and depression and wholly ignores any concept of risk/benefit analysis or how medicine works as a scientific discipline. Surely, Big Pharma has a huge part to play in the pervasiveness and damage that prescription drugs have wrought. Also, Fong is correct in pointing out that we still have much to learn about exactly how these medications work. Fong, however, almost swings too far in the opposite direction, coming close to saying that taking any sort of prescription drug for mental illness is wrong, especially SSRIs. While I agree that there may be an issue in overprescribing as a quick fix as opposed to longer, more expensive treatments such as talk therapy, this should not diminish the effect that these medications can have on improving the quality of life for some people. SRRIs such as Prozac can never claim to be a cure, but if we’re looking to mitigate harm, I’m not convinced Fong’s narrow vision is always the most helpful. 

Additionally, while Fong’s book is well-resourced, much of the sources are secondary and often come from carefully selected sources (such as relying heavily on Lauren Slater’s Blue Dreams for his analysis of SSRIs). Instead of including statistics on drug use and consumption or qualitative interviews with those who consume drugs, Fong relies primarily on political and philosophical theory to ground his arguments. While this makes for an interesting perspective when considering the roots of why people consume drugs, it often is detached from the reality of drug addiction that has been so devastating to so many individual lives and families. 

While I agree that the alienation and exhaustion that capitalism brings is a large factor in drug consumption, it is difficult to determine what exactly makes this a specifically American phenomenon. By analyzing data from other OECD nations over a similar period, we could investigate whether these problems persist in other countries, or if other contributing factors make America an exceptional case when it comes to drug consumption. While capitalism is undoubtedly an immense factor, Fong tends to eschew other contributing factors to drug addiction in favor of his larger grand narrative. This comes across as too narrow and unbalanced, despite Fong’s otherwise insightful critiques. 

Furthermore, Fong’s analysis of the War on Drugs and the criminalization of surplus populations could have benefitted by incorporating various theories from the field of criminology, such as social disorganization or general strain theory. For example, according to social disorganization theory, crime is a result of weak social bonds and can be predicted by high ethnic heterogeneity, poverty, and residential mobility (neighborhood turnover). These factors can all be found within specific moments of American history and could provide a useful framework for understanding the pervasive nature of deviancy and drug use specifically in America. Additionally, according to subcultural theory, selling and using drugs might be deviant within the larger culture, but is a norm within a particular subculture. By analyzing how drugs are either pervasively used or internally restricted within various subcultures (such as the punk movement and the response to drug use from the Straight Edge subculture), a wider case could be made for the social roots of drug consumption and prohibition, even within anti-establishment/anticapitalist spaces. 

Finally, when it comes to what we should do about the current drug epidemic we are facing, Fong’s prescription is a bit lacking in substance. Only on the last few pages does Fong attempt to construct a meaningful alternative vision to ease the pain of drug abuse across the country, and even then it falls back on the common social democratic line of fighting poverty by providing greater social safety nets, access to jobs and healthcare, and prioritizing community building to alleviate social alienation. While these are all undoubtedly important in addressing our reliance on drugs, this seems to be a rather shallow and reductionist solution. After spending a great bulk of the book describing how the structures of power within the US state have allowed pharmaceutical companies to prey on the sick for profits and how it facilitates the drug trade to further its imperial interests, Fong offers only a few policy reforms as a potential solution. Like so much of contemporary Leftist theory, 99% of the book (rightly) critiques our current condition while offering only 1% of space to vague potential solutions. These shortcomings are primarily due to the book’s brevity, and Fong tries to do too much in such a short space. While I deeply appreciate Fong’s insights throughout these largely entertaining and informative chapters, a longer, more balanced treatment would have benefitted the work immensely. 

Conclusion:

Overall, Quick Fixes is a thoroughly enjoyable and informative historical tour of how Americans have consumed and prohibited drugs over the past two centuries. While it can occasionally be one-dimensional in its diagnosis of the roots of drug abuse and often sacrifices depth for the sake of breadth, Fong’s account is an accessible and thought-provoking examination of capitalism’s culpability in the complex issue of drug consumption. By focusing on the alienation, exhaustion, and ennui that capitalism brings to the average worker, Fong presents an intriguing and plausible explanation for why Americans consume drugs at such an exorbitant rate. As such, Quick Fixes serves as a thoroughly informative and entertaining introduction to the history and social roots of drug use and trade in America.