Last month, the New York City Department of Health and Mental Hygiene made a startling recommendation: Every resident should carry Narcan, a medicine that can reverse an opioid overdose, at all times. Commissioner Ashwin Vasan admonished Gothamites: “Any time you see someone who looks like they might not be conscious, who might not be breathing, who might look more sleepy or tired than usual, think overdose.” It was a blunt acknowledgement of a new normal characterized by rampant consumption of hard drugs in the Big Apple and other cities. The recommendation also reflected the new consensus around decriminalization and “harm reduction.” Instead of cracking down against, and trying to prevent, drug use, leaders now focus on mitigating its worst outcomes.

Benjamin Y. Fong’s new book, Quick Fixes: Drugs in America from Prohibition to the 21st Century Binge, situates recent shifts in both attitudes and policies within a historical overview of drug use going back to the late 19th century, and attempts to account for repeated vacillations between punitive and permissive approaches with an analysis inspired by Marxian political economy. Because the author sees drug abuse as rooted in the exigencies of capitalism, he mostly offers common-sense reforms, such as free health care and good jobs. In terms of drug policy per se, he clearly favors libertarian policies over the prohibitionist ones, which he sees as both futile and harmful. While he critiques some of the consequences of a permissive approach lightly, he comes down clearly on the side of decriminalization. In this sense, despite the usefulness of the historical perspective it offers, Quick Fixes ratifies the current consensus.

The book doesn’t dwell long on these premises, which few today question. Instead, Fong takes the reader through the history of drug use by way of nine of the most common intoxicants, in this order: coffee, cigarettes, alcohol, opiates, amphetamines, psychotropics, psychedelics, cocaine, and marijuana. In Fong’s telling, drug usage and acceptance have shifted along with the succession of distinct “historical modes” of capitalist society: from the dawn of the industrial age and the emergence of the proletariat as a class to the Fordist-Keynesian period of stability, and from the neoliberal turn beginning in the 1970s to the torturous collapse of neoliberalism—the period we find ourselves in today.

Roughly, these four periods corresponded with an alternation between punitive and permissive approaches. For example, the beginning of industrialization saw the rise of mechanized work and a drive for ever greater efficiency, which was incompatible with the high alcohol consumption of the proletariat that crowded growing cities. The response culminated in a period of prohibition, a framework and set of policies that shape drug control to this day. But the Fordist-Keynesian ethos of consumerism “broke the temperance cause for good,” as Fong notes, and saw the proliferation of amphetamines, barbiturates, benzodiazepines, and cigarettes as means of breaking the boring repetition of standardized work. In the next phase, neoliberalism, the degrading welfare state was substituted with “cheaper, punitive measures, justified in part by the scourge of dangerous drugs and associated violence”—namely, the War on Drugs. This brings us finally to the present phase, the “breakdown” period of neoliberalism, in which attitudes have again shifted drastically: “Legal drugs have become disreputable (tobacco), and the illegal ones reputable (psychedelics).”

That drug use and abuse are rooted in the dynamics of the capitalist economy isn’t an altogether original point; Friedrich Engels himself came to a similar conclusion. Fong’s approach is distinctive for the level of detail he offers to bolster his case, even if the results are at times tenuous. The chapter on cigarettes, outlining their emergence following an innovation in the way tobacco leaf was dried, is one of his strongest. This innovation in leaf drying, the author shows, enabled the industrial production of cigarettes to take off, with an accompanying growth in the working-class consumer base, which found the relatively mild and quickly consumed cigarette the perfect drug to enjoy during short breaks.

“Illicit drug use post-prohibition was uncommon prior to the 1960s.”

Other connections between political economy and drug use are more tenuous. For example, a well-known sea change in drug use occurred in the 1960s, massively expanding the variety of drugs consumed and the numbers of people who consumed them, which, in turn, lessened social stigmas around them. Fong counts this episode as a “countercultural backlash” within the Fordist era. But why did an important cultural shift, in this instance, emerge prior to a requisite shift in the structure of capitalism? He doesn’t say. Fong also gives the reader the impression that the use of drugs was a significant aspect of American culture at all times. But it is clear that illicit drug use post-Prohibition was uncommon prior to the 1960s, and that it declined again in the years following the War on Drugs. If Fong is correct that socioeconomic conditions determine drug use, why doesn’t consumption track the unemployment rate at all?

Libertarians often argue that drug restrictions don’t work: People will find ways to take drugs regardless. But the same applies negatively to Fong’s economic explanation: Some people will choose to consume drugs, while others will choose not to, regardless of their circumstances. At one point, he remarks that we see drug abuse among the very rich and the very poor, since they both lack jobs—hence, his contention that reducing inequality and improving job prospects are the best remedies. But if this is so, why is it that the majority of those suffering from poverty and unemployment, notably women, are able to avoid addiction? Moreover, while the condition of the American poor is often dire, it is also incomparably worse in the nations of the Global South—yet in many of these places, issues like alcohol abuse are all but absent. Certainly, as Fong states, giving a person good reasons (such as having a decent job) not to take drugs makes it less likely they will do so. A variety of external conditions affect the likelihood of drug use—but ultimately, it will always also be a matter of individual moral decision-making.

Fong correctly states that “drug policy is not about drugs.” Instead, it is about morals. Do we collectively believe people should be able to choose to take particular drugs, whatever their stated or unstated reasons for doing so? All of this complex theory, both scientific and political, obscures this simple question. For libertarians, the answer is yes. For prohibitionists and temperance activists, the answer was no. Fong has no kind words to spare for the latter group, whom he considers a bunch of middle-class, hysterical fools who have failed on their own terms. But he also explicitly rejects libertarianism, while adopting all its milder stances, such as the relaxation of drug enforcement and decriminalization, which lead mostly to the same practical results.

Contrary to Fong’s suggestions throughout the book, drug use in the community at large was never a major concern of the bourgeoisie on purely economic grounds. Capitalists have other tools to prevent intoxication on the job itself: namely, the power to fire workers at will, which is perhaps part of the reason those with jobs are less likely to become addicted. Indeed, a trigger for the temperance movements in Britain was the passing of the liberalizing Beer Act of 1830, which was supported by many capitalists but resisted by many middle-class and working people alike due to the destructive effects alcohol abuse had on their communities. In places where prohibition was put to a popular vote, it typically won by solid margins.

Prohibition in the United States was doubtless a flawed policy that failed on its own terms due to the fact that demand was left untouched: Possession of alcohol was never criminalized, only manufacture, transport, and sale. Even so, as Fong grudgingly acknowledges, the policy did yield dramatic results. Alcohol consumption was halved, and alcohol-driven deaths declined steeply. Many in the labor movement thought that inebriation would hold back the labor movement and supported temperance and prohibition accordingly. Many of Prohibition’s cultural effects have endured into the present: Authorities continue to highlight the dangers of alcohol consumption in pregnant women, ban the use of beer as wages, prohibit the serving of alcohol to children, and limit sites of sale. These and numerous other laws and policies have drastically improved society. That addressing alcohol abuse left capitalism intact didn’t dissuade labor activists from taking the common-sense position that people are made better when given the fullest use of their reason.

Certainly, while striving for an ideal, one will always fall short. But this doesn’t negate the rightness of the ideal. I am sure Fong would accept that drunk driving is best eliminated from society—and it has been, to some extent, through consistent application of sensible laws. If we were to find that the application of this law was “failing” to completely end drunk driving, would it make sense to decriminalize drunk driving? Obviously not.

Fong concludes that “what we need … is a free relation to drugs: not only a clear understanding of their benefits and harms, uncolored by overbearing moralizing, but much more importantly, less compulsion to use drugs—less stress, less misery, less oppression—so that their use is really a freely made choice.” Relying on individual consent as the only arbitrator of moral decisions, he seems to believe that drug users can be entrusted to make their own decisions about the rightness or wrongness of drugs, as long as they have decent jobs and health care.

“We are currently engaged in a massive social experiment of expanding access to cannabis.”

However, the historical sections of Fong’s book point in another direction, showing time and time again how destructive drugs are and how little benefit they yield beyond fleeting pleasure for users and profit for those who produce and purvey them. We are currently engaged in a massive social experiment of expanding access to cannabis and other substances, while treating widespread addiction to deadly substances like fentanyl as the inevitable cost of individual freedom—a price, we are told, that at best can only be “managed.” Unlike Prohibition and the temperance movement, which forged a healthier culture around intoxicating substances and left us thousands of beautiful temperance halls, the current permissive paradigm will leave behind only ravaged lives and decrepit cities.

Leila Mechoui, a writer and researcher based in Ottawa, is a columnist for Compact.