It’s hard to see a policy area that has undergone more ambitiously spectacular failures than drugs and substance abuse. In 2026, we still don’t have a consensus on how to define either addiction or recovery. Benjamin Rush, oft called the founder of American psychiatry, has argued that “habitual drunkenness,” which we might now brand as alcoholism or substance abuse, should be treated as “an odious disease” of one’s will and sanity. We could have had centuries of experimenting with policies, culture, markets, and scientific treatments if we had listened.
Instead, the temperance movements who cited him as an inspiration took a far more moralistic approach which labeled either the drinker or the drink as agents of sin. Sometimes both, and it always failed. Prohibition was a complete disaster, asylums designed for clinicians and researchers to work with addicts in a controlled environment were turned by legislators into prisons for the most vulnerable of our communities, dabbling with eugenics was a horrifying little episode that brought out the worst of elitism in science, the wealthy and powerful were obviously going to use top-shelf drugs no matter what policy was passed, and declaring a war on addicts and their dealers just led to a new crop of addicts and dealers.
Let’s take a look at this war and see how we lost.