qforboxes copyYou argue that addiction is a disease. How, physically and emotionally, did cocaine take over Freud’s and Halsted’s mind and body, in other words, how did it progress as a disease?

Most physicians and addiction specialists agree that addiction is a progressive disease with real and predictable consequences.  When reviewing their medical history, it is easy to see how Halsted’s and Freud’s cocaine abuse, (and the physical and psychic results they experienced) caused a series of worsening problems and threats to their health.  Throughout the book, I explore how the progression of the disease affected their thinking and, indeed, their careers.

Today, modern science allows an understanding of why cocaine proved so addictive to Sigmund Freud and William Halsted.  A pharmacological version of the legendary Trojan horse, cocaine brilliantly fools the brain’s pleasure center into sensing a virtual abundance of dopamine, a neurotransmitter or chemical messenger that signals a rush of overconfidence and euphoria.  To be sure, the first several “hits” of the drug are purely voluntary.  But like an immense power switch, once thrown, the cocaine-addicted brain’s pleasure circuitry is hijacked by an insurgency of bad judgment and risky behaviors that are only amplified by cocaine’s seductive ability to induce artificial states of well-being.  This is hardly a metaphor, scientists have used PET scanners and many other technologies to demonstrate the physical damage cocaine causes to the brain and many other organs of the body.  After the high is long gone, this anatomical derailment continues to encourage the addict to pursue his destruction as his body progressively demands greater amounts in exchange for briefer moments of joy along with a cascade of physical and mental health breakdowns.   What begins as a purely pleasurable act of indulgence has the power to end in terrible illness, horrible outcomes, and even death.


PageLines- qforboxes.pngHow has society’s reaction to cocaine and addiction changed since the time of Freud and Halsted?

It has changed in many ways and has, sadly, stayed the same in others.  In Freud and Halsted’s day, of course, no one would admit to having such a problem out of fear of the swift, negative repercussions. Today, people are a bit more forthcoming about addiction although there are many who keep their substance abuse a deeply held secret and are filled with shame and remorse.

Over the past few decades, scientists have uncovered a wealth of information on how the addicted brain is strikingly different from those not exposed to habit-forming substances.  Doctors have also developed a large tool kit in how they go about treating and even preventing such serious health problems.  Unfortunately, there are many who still make harsh, moral judgments about addiction and addicts.  Such critics advocate treating this all too real health problem as a criminal or legal issue, without terribly successful results.

We all have a lot more work to do to in changing not only how health professionals process and treat addiction but also how society views and responds to it.  Most important, we need to accept that a person’s recovery from any addiction is a life-long and arduous process that may include relapses and serious problems along the way.

qforboxes copyHow did the use of cocaine affect Freud and Halsted’s personal and professional lives?

The long way to answer that question is to suggest you read An Anatomy of Addictionsince that is one of the major themes of the book.

The short answer is that cocaine profoundly and negatively affected their lives (as well as those of their relatives, friends and colleagues) even though we consider both of them to be remarkably successful men. Freud abused the drug for more than a decade before claiming to put down his cocaine brush.  Halsted never really quit and along the way picked up an equally nasty addiction to morphine.  When one considers the highs and lows of cocaine abuse as well as the huge psychic costs for living double lives as distinguished physicians in public and suffering cocaine abusers in private, neither man was likely to be easy to live with.

Late in both their lives, each man regretted the opportunities and health he lost to the abuse of cocaine.  What makes Freud and Halsted so different from the majority of substance abusers and addicts is that in defiance of the malady that nearly destroyed them—or perhaps because of their struggle to overcome it– neither man ever lost his zeal in delivering his healing gifts to the world.


PageLines- qforboxes.pngWhat led you to write about cocaine addiction? How did your careers as both a physician and a historian contribute to your exploration into this topic?

My interest in writing about addiction and substance abuse originated—as do most of my good ideas—from conversations with patients.  For more than two decades, I have seen more and more cases of substance abuse problems among children, teenagers, and young adults.  My clinical experiences are hardly unique.  Of all the public health threats facing the United States today, addiction, substance abuse, and alcoholism are among the most deadly and costly.

But because I am also trained as a historian of medicine, I always want to know how the past has shaped the present and how things have changed over time.  Addiction, for example, was not even a bona fide medical diagnosis until the mid-1880s.  The word’s original meaning dates to an edict of ancient Roman law where debtors who could not repay their loans were ordered to be “addicted” as slaves to the lender.

After opium and morphine became commonly prescribed by physicians and abused by patients during the mid-19th century, doctors began seeing more and more people who were habitually using the drug regardless of the consequences.  Eventually the terms “morphine-eaters” and “morphinism” gave way to addict.  In the early 1880s, cocaine was introduced as a miracle drug.  Pharmaceutical houses made a fortune marketing it as a cure for morphine addiction, a sales pitch that helped create thousands of new and improved addicts to both morphine and cocaine.

Finally, as an author always in search of compelling stories to tell, cocaine was especially intriguing because of its fascinating global history, its myriad effects on the brain, mind and body, and the dramatic impact it can have on those who become addicted to it.

qforboxes copyWhy did you choose to focus on Sigmund Freud and William Halsted to help tell the story of cocaine?

They struck me as the perfect figures to illustrate the anatomy of addiction and the remarkable power cocaine has exerted over human beings for centuries.  To begin, both were medical giants who happened to abuse cocaine.  Freud, of course, is the father of psychoanalysis and one of the leading intellectual figures of the 20th century.  Halsted, who is less well known to the general reader, was the father of modern surgery.  Every operation conducted today has its roots in many of the discoveries he made and the surgical techniques he developed.  Among his many life-saving contributions was the invention of the rubber glove to prevent introducing infection into a patient during an operation.

In 1884, when both men were first introduced to cocaine, they were merely ambitious young doctors eager to make their names in the competitive world of medicine.  Convinced of cocaine’s power as a therapeutic agent, both experimented with the drug and served as human guinea pigs for figuring out its dosage, use, and effects. Freud believed that cocaine was a superb cure for morphine addiction as well as for depression and fatigue.  Halsted was impressed by cocaine’s properties as a local anesthetic.   Soon enough, each got “hooked” on the stuff.

No evidence has been found to demonstrate that William Halsted and Sigmund Freud ever met.  Separated by physical and cultural oceans their lives were, nevertheless, intricately braided and shaped by a handful of scientific papers on the medicinal uses of cocaine.  Over the past eight years of writing this book, the more I explored these two men’s experiences with cocaine, the more possessed I became with dissecting and narrating their remarkable stories.