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Addiction Policy and Unintended Consequences

by | Oct 22, 2018

I returned today from two days in the Chicago area, in conjunction with the American Board of Psychiatry and Neurology. The return flight to Hawaii is 8-1/2 hours if you don't count surface transport and hours lingering in the terminal to assure that, if the plane is missed, it is the airline’s fault, not mine.  Pressed up against the coach window, looking down on the brilliantly sunlit Midwest and near-West for a day, I had plenty of opportunity to ruminate on how one political course of action can unintentionally affect another.  It is the sort of consideration for which Malcolm Gladwell is famous. 

In 1862 the most famous of the Federal Homestead Acts was enacted. Until then, as new territories opened up, the question of who could buy or have access to land had been solved piecemeal and state-by-state.  The coming of the Civil War raised acuity, and so in the Act a free title of 160 acres was given to anyone - including freed slaves, single women, and recent immigrants - who was willing to live on the property for five years and improve it substantially.  This was for many a wonderful thing, but one consequence of it was to restrict the size of villages and towns that would normally serve as places of residence, of government, or as markets for the farms. Instead of the farmer dwelling in the village and going out to her/his own fields daily, as in European or Asian rural communities, the settler and family were compelled to dwell on the 160 acres.  In the village, support but also intimate knowledge of each other were at arm’s length.  By contrast, 160 acres forms a square 2640 feet on a side, for a 2 miles perimeter.  This meant that most households were, and remain to this day, 1/2 mile apart.

When the question arises of why drug manufacturing, particularly of methamphetamine, is so prevalent west of the Appalachians, this provides some of the answer. Whether in a barn or household, a laboratory is far enough from the next closest neighbor that any foul smell, explosion or fire could go unremarked. But, more importantly, traffic and industrial haulage to and from the manufacturing source would not be particularly noticeable. Enforceability of drug controls and distribution is nigh impossible in such a setting, until the inadvertent placement of a flask of ether or of a corroded propane tank results in a grand “boom.”  It is agrarian anonymity.  Rural America long had this distinction from its European cousins, that, except for the enforced socialization of churches and the advent of the automobile, most folks lived apart, far apart.

With the increasing dominance of factory-farming, and the coalescence of former family farms into whole counties under single commercial agencies, this pattern is less the rule yet still persists.  The view from my aircraft suggested this order to things still, blocks of arable land, mostly planted, variably tan or verdant, with a single, central home and outbuildings:  each alone, each suggestive of the loneliness of the person with addiction.

-W. Haning, MD