medical treatments available) are unintelligible without knowledge of the changing demographic and social backgrounds of the users themselves. Although this narrative focuses primarily on opiate and cocaine addiction and treatment, there is also a brief discussion of other drugs, especially alcohol. Often told separately, the histories of drug and alcohol use in America are in fact intertwined, perhaps never more so than in the last decade.
During the nineteenth century there was virtually no effective regulation of narcotics in the United States. Various preparations and derivatives of opium were freely available and widely used. Several states had statutes governing the sale of narcotics, and many municipalities forbade opium smoking, but these laws were only sporadically enforced. In practice just about anyone could secure pure drugs with little bother and at modest cost. Pharmacists even delivered drugs, dispatching messenger boys with vials of morphine to houses of high and low repute. Some customers were actually unaware of what they were purchasing: proprietors of patent medicines were notorious for slipping narcotics into their products, which before 1906 bore no list of ingredients on their labels. Doctors, too, frequently overprescribed narcotics. Opiates were among the few effective drugs they possessed, and it was tempting to alleviate the symptoms (and thus continue the patronage) of their patients, especially those who were chronically ill.
The result of all this was a narcotic problem of considerable dimensions, with perhaps as many as 300,000 opiate addicts at the turn of the century, plus an unknown number of irregular users.2 Today there are perhaps as many as 500,000 narcotic (mainly heroin) addicts in the United States, but the country's population is also much larger. On a per capita basis, narcotic abuse was certainly as bad and probably worse in the late nineteenth century.
Victorian Americans were much less worried about drugs, however, than they were about drink. An influential reform coalition, consisting mainly of native-born, white, middle-class Protestants, attacked alcohol as the principal source of social problems. Drinking was wrong because it led to drunkenness, and drunkenness led to battered wives, abandoned children, sexual incontinence, venal voting, pauperism, insanity, early death, and eternal damnation. Drinking was also objectionable because it was associated with groups whose morality was highly suspect: Catholic immigrants, machine politicians, urban blacks, demimondaines, criminals,