One of the key questions of contemporary drugs policy is whether there is a way to end the perma-war on drugs without a widespread legitimation of all forms of drug taking. America, and consequently the rest of the world, seems trapped between two extremes: either all drugs are bad, and so a relentless crusade is justified, or all drugs are fine, and we should swallow the libertarian pill and legalise them all. As Ben Fong details in his immensely engaging and useful history of twentieth-century American drug usage, Quick Fixes: Drugs in America from Prohibition to the 21st Century Binge, it is this ambivalence about the power of drugs that has been at the core of American drug policy in the past century. In part this is because of the dominance of what Fong calls the inherent illness paradigm – through the combined forces of the pharmaceutical industry and the biological revolution in psychiatry, we have been encouraged to distrust our own feelings of wellness and reinterpret our experience through the language of brain chemistry. We have now reached the stage where what the philosopher Ivan Illich called the ‘medicalization of social problems’ has become so widespread that drugs are not just a part of our life, but a lens through which we see our lives. In other words, we do not see ourselves as healthy but rather as inherently or incipiently ill and so at all times in need of chemical modification.

The dominance of drugs in American life can be seen readily in the levels of American drug use, which Fong shows are quite staggering: despite being only four percent of the world’s population, Americans take 80 percent of its opioids and 83 percent of its attention deficit hyperactivity disorder (ADHD) medication, spending $500 billion each year on pharmaceuticals and $150 billion on illegal drugs. Little wonder, as one in six Americans is on psychiatric medication and one in three suffers from anxiety, depression, or both. America is a uniquely drugged and unwell society, with consumption of almost all drugs massively increasing in the twentieth century. As Fong sees it, the situation is more dire for America today not just because the opioid crisis has turned America into something resembling a giant palliative care unit but because something more fundamental has changed in the relation of the idea of America to drug usage: ‘Postwar polydrug use reflected a fundamental belief, however coerced and driven by an underlying anxiety, that America was worth it.’ That belief is clearly in question today.

Fong’s argument is also more nuanced than this. He contends, through a series of short chapters on each drug, that different drugs are essentially different aspects of a social theory of the present – coffee, cigarettes, alcohol, opiates, amphetamines, psychotropics (as a wide term for the drugs produced by the pharmaceutical industry), psychedelics, cocaine, and marijuana each represent some key quality of contemporary American life. While the chapters on the big three – coffee, booze, and smokes – show how it is impossible to understand these daily American habits without the social history of their usage in the twentieth century, it is in the later chapters of the book where the real picture of twenty-first century America emerges.

In Fong’s account, amphetamines are perhaps the drug that is most representative of American life in the twenty-first century. Characterising them as representing ‘inappropriate perseverance’, Fong contends that they fit our experience of a capitalism that ‘has accelerated social life to near breaking point’ with speed acting as the drug that we turn to ‘to help us keep up’. It is also through amphetamines that we glimpse the possibility of a drug-fuelled achievement of the American Dream: full of pep, smarter, and thinner, the functioning speed-freak is a jittery copy of the ideal American citizen, keeping up the American hustle. Opiates, in this type of reading, offer relief to pain understood as widely as possible; rather than just relieving physical pain, opiates are a response to a range of problems we experience as deep boredom or dissatisfaction, or as a deeper spiritual pain. In other words, and as many have pointed out before, opiate use is a social malaise, and opiate addiction at the societal rather than the individual level must have a social cause.

Ultimately this is where we can find the political solution to that central question of drug policy: how to withdraw from this war without leaving a failed state of uncontrolled drug usage behind. Drugs make us feel good only because we lack other sources of social and collective meaning, with each major drug ministering to a specific (though often overlapping) lack. More than that, drugs come to be constructed as a necessary and just solution to this lack of social and collective meaning constructed as an illness. As the medicalization of social problems Illich wrote about has shifted into the medicalization of everyday life, the forces constructing drugs as the appropriate solution to our contemporary malaise have widened.

This is how the opioid epidemic’s origins lie in large part in the pharmaceutical industry’s ability to construct pain as a “hidden epidemic”; through this process any dissenters to mass drugging came to be presented as callously “condemning” people to a lifetime of pain and suffering. The demand to be drugged, in other words, took on the language, form, and approach of a social justice campaign. Of course, the OxyContin pills were not designed to provide anything other than symptomatic relief to physical pain, rather than its physical, social, or spiritual causes; responses to the opioid crisis were also unable to grasp its deep origins in the changing patterns of the American economy and working class life.

For Fong, then, both drug usage and especially drug policy in contemporary America represent examples of that most American of solutions: the quick fix. As Fong puts it, a quick fix is ‘[a]nything that covers over, that allows some resumption of “normalcy”, that prevents a full reckoning’ and adds, ‘that’s been the stuff for us, for well over a century’.

Fong’s conclusion is that real solutions to drug problems, and most centrally to the American-led world war of drugs, cannot just be about drugs. A quick fix is one that focuses on whether drugs are “good” (and so should be completely legalised) or “bad” (and so completely banned, or at best their harms offset); as Fong outlines, a true solution would focus on the social problems (centrally around jobs and healthcare in the US) that lead to drug taking. Instead, the liberal approach of awareness and destigmatization, which leaves fundamentally untouched the social causes of Americans’ gargantuan drug consumption, seems much more likely to continue to be the dominant approach. Perhaps America’s near future of drug usage is doomed to look much like its present, though with increased use of psychedelics (often in small quantities) to take the edge off an increasingly psychedelic reality. Without mastering the social acceleration that necessitates a turn to amphetamines, the inherent illness paradigm that leads us to psychotropics, or the despair that prompts opioid use, the American addition to quick fixes is sure to remain.