Chapter 5: Historical Context and Environment

Psychoactive substance use long predates modern criminal law. While substance misuse is a contemporary social problem, the story of humans experiencing problems related to psychoactive substances is at least 4,000–10,000 years old (Hanson et al., 2015; Howard et al., 2013; Singer, 2012). During the nineteenth and early twentieth centuries, alcohol, opiates, cocaine, and other psychoactive substances were widely embedded in medical treatment, commercial products, and everyday life (Courtwright, 2001). Morphine became heavily used during the Civil War for pain management, and dependence later emerged as a recognized consequence. Heroin was subsequently marketed as a “non-addicting opiate with greater analgesic potency than morphine” (Kornetsky, 2007, p. 96) before its addictive potential became more widely understood. By the late nineteenth century, roughly two-thirds of Americans experiencing opium or morphine addiction were women, in large part because physicians often prescribed opiates to address a wide variety of complaints (Blumenthal, 1998). During this same period, many over-the-counter remedies contained alcohol, opiates, or stimulant compounds that today would be tightly regulated (Plant, 1997; Straussner & Attia, 2002).

As concerns about addiction increased, public attitudes toward substance use began to shift. Temperance movements framed alcohol use as a moral and social threat tied to crime, poverty, family instability, and declining public morality (Levine, 1978). Substance regulation increasingly reflected moral reform efforts rather than medical concern alone (Berridge, 2013; Levine, 1978). The question was no longer only whether substances were harmful. It became a question of whose behavior required control and what role government should play in enforcing social order.

Early federal regulation emerged within this shifting climate. The first federal policy prohibiting distribution and non-medical use of a drug was the Opium Exclusion Act of 1909 (Vakharia & Little, 2020). Opium used for medical purposes remained legal, but opium prepared for smoking no longer was. At this point in history, large numbers of immigrants from China were working in the United States and opium smoking was associated with this population. An indicator of the racist ideology that sometimes underlies drug policy, the common medicinal use of opium was not outlawed — only the form prepared for smoking, which was associated with Chinese immigrants (Drug Policy Alliance, n.d.; Vakharia & Little, 2020).

The Harrison Narcotics Tax Act of 1914 further expanded federal involvement by requiring registration and taxation for producers and distributors of opium and cocaine products (Drug Enforcement Administration Museum, n.d.; Vakharia & Little, 2020). Officially framed as a taxation and regulatory measure, the law accelerated criminalization by restricting access outside medical supervision. Cocaine was targeted, in part, because of growing concern over its increasing popularity within Black communities, particularly across the Southern United States, even though most individuals using cocaine at the time were white (Vakharia & Little, 2020). Taxation became the legal mechanism, but prohibition increasingly became the practical outcome. The Harrison Narcotics Act represented early prohibition efforts and laid the foundation for much of the substance-related policy enacted in the United States afterward, including marijuana and alcohol control efforts (Vakharia & Little, 2020).

As federal regulation expanded, substance policy became increasingly tied to criminalization and social control (Musto, 1999). Public fears surrounding immigration, race, crime, and morality heavily influenced policy development. Substances were often associated with specific racial or ethnic groups, allowing drug policy to function not only as regulation of substances but also as regulation of populations.

Alcohol prohibition became one of the most significant policy experiments in United States history. The Eighteenth Amendment to the United States Constitution, commonly known as Prohibition, banned the manufacture, sale, or transportation of intoxicating liquors, and many states had already enacted their own local prohibition laws (Hanson et al., 2015). The Volstead Act, passed in October 1919, provided for the enforcement of the Eighteenth Amendment (Library of Congress, n.d.). Supporters viewed prohibition as a solution to crime, poverty, and moral decline. In practice, prohibition contributed to black market expansion, organized crime growth, and widespread enforcement challenges. You might find it interesting to pursue historical literature documenting the intersections of alcohol and drug policy with trends such as the temperance movement, women’s suffrage, immigration, organized crime, classism, and racism (see Straussner & Attia, 2002).

The Twenty-First Amendment repealed federal alcohol prohibition in December 1933 (Library of Congress, n.d.). Repeal did not eliminate regulation. Alcohol control shifted largely to state and local governments, creating licensing systems and regulatory structures that continue today. Some states continue to have communities restricting the sale or distribution of alcohol.

Cannabis prohibition followed a similar path. During the 1920s and 1930s, many states developed prohibition-style policies about marijuana, and the federal government got involved in 1937 with the passage of the Marihuana Tax Act (U.S. Customs and Border Protection, n.d.). Federal penalties escalated sharply during the 1950s. The Boggs Act of 1951 (Pub. L. No. 82-255) set mandatory minimum sentences of two to five years for a first offense and barred probation on repeat offenses. The Narcotic Control Act of 1956 (Pub. L. No. 84-728) raised those minimums further and removed parole eligibility for most narcotic and marihuana offenses. The word marijuana came from Mexico, and its use in U.S. policy is increasingly recognized as having racist and propagandist connotations (Malcolm, 2020). Historical roots of marijuana prohibition reveal racial and ethnic bias about Mexican immigrants and African Americans that parallel earlier opium and cocaine policies regarding Chinese immigrants and Southern Black workers (Malcolm, 2020; Vakharia & Little, 2020).

These early policies established a recurring pattern in U.S. drug policy. Substance regulation frequently operated alongside efforts to control marginalized populations through criminalization, surveillance, and exclusion.

Drug policy shifted dramatically during the late twentieth century as substance use became increasingly framed as a criminal threat requiring aggressive enforcement. The term “War on Drugs” began to appear around 1971, referring to stepped-up drug criminalization and law enforcement efforts (McNeece & DiNitto, 2012; Schori & Lawental, 2013). The Controlled Substances Act of 1970 had already established the modern federal drug scheduling system and centralized drug control authority under federal law, marking the beginning of a major expansion in policing, sentencing, and incarceration practices.

Political rhetoric during this period emphasized crime control, public fear, and social disorder. Drug use became strongly associated with criminality and urban decline within public discourse. During the 1980s, federal and state governments expanded mandatory minimum sentencing laws and intensified drug enforcement efforts. These policies contributed significantly to rising incarceration rates and widened racial disparities within the criminal legal system (Drug Policy Alliance, n.d.). One criticism of the War on Drugs has great relevance to social work and disciplines concerned with social justice: the War on Drugs contributed to extreme racial and gender inequities in the nation’s incarceration rates (Bush-Baskette, 1999; Chesney-Lind, 1997). By the early 1990s, 74 percent of individuals serving prison sentences for drug possession were Black, despite accounting for only 13 percent of individuals who use drugs (Kilty & Joseph, 1999).

One of the most documented examples of racialized drug policy during this era involved the sentencing disparity between crack and powder cocaine. Federal law established penalties 100 times more severe for crack cocaine offenses than for equivalent amounts of powder cocaine. Because crack cocaine was more prevalent in Black communities while powder cocaine was more commonly associated with white communities, this disparity produced dramatic racial inequities in prosecution and incarceration rates. Disparities in incarceration of persons of color were further stimulated by differential sentencing for crack cocaine compared to powdered cocaine (Lloyd & Fendrich, 2020). The War on Drugs also helps explain the relative explosion of women in prison for non-violent drug possession charges during the late 1980s and 1990s (Bloom et al., 1994).

Drug policy also became increasingly institutionalized through expanding federal agencies, enforcement budgets, and anti-drug campaigns. The fiscal year 2020 federal budget request of $34.6 billion for National Drug Control Program agencies illustrates the long-term scale of federal investment in drug enforcement and control systems (Office of Management and Budget, 2019).

At the same time, criticism of purely punishment-based approaches gradually increased. Drug courts emerged during the early 1990s as reform-oriented responses intended to divert some individuals with substance-related offenses toward structured treatment and judicial supervision rather than incarceration alone. As of December 2024, 4,276 treatment courts were operating in the United States, including 1,868 adult drug courts (National Treatment Court Resource Center, n.d.). Although drug courts represented movement toward treatment-oriented responses, they continued operating within criminal legal systems rather than outside them.

The War on Drugs era reshaped public attitudes toward substance use for decades. Substance use became increasingly connected to fear, criminality, punishment, and social stigma, particularly within communities already experiencing structural inequality and over-policing.

The distance between stated purpose and measured result runs through the entire history of the War on Drugs. Policy in this era was written in the language of public safety and public health, yet the outcomes fell heaviest on communities that were already policed most closely. The enforcement expansion that followed the 1971 declaration did not produce a lasting reduction in drug use or trafficking, and it drove levels of incarceration that reshaped families and neighborhoods for a generation. Holding that distance in view is what allows a practitioner in any discipline to read current policy proposals critically rather than accepting the terms in which they are offered.

Contemporary drug policy reflects both change and continuity. Public attitudes toward some substances, particularly cannabis, have shifted substantially during the past two decades. Many states now permit medical or recreational cannabis use, while federal law continues to classify most cannabis as a Schedule I substance. In May 2024, the Department of Justice proposed transferring marijuana from Schedule I to Schedule III following a recommendation from the Department of Health and Human Services (U.S. Department of Justice, 2024). That original proposal was never finalized in its broader form. In April 2026, the Department issued a narrower final rule placing marijuana drug products approved by the Food and Drug Administration (FDA), and marijuana subject to a state medical marijuana license, into Schedule III, while marijuana in any other form remains a Schedule I substance (Drug Enforcement Administration, 2026a). The Department also terminated the original rescheduling hearing, which had been stayed since January 2025, and convened a new hearing that ran from June 29 to July 15, 2026 (Drug Enforcement Administration, 2026b). The ongoing conflict between state legalization and federal prohibition remains one of the defining tensions in modern drug policy.

The opioid epidemic also altered public discussions surrounding addiction and treatment. At the same time, contemporary responses continue to combine enforcement and reform. Federal agencies have expanded penalties and scheduling efforts targeting fentanyl-related substances and emerging contaminants such as xylazine (Drug Enforcement Administration, n.d.). Simultaneously, states and federal systems have explored decriminalization, diversion programs, harm reduction services, and expanded access to treatment and overdose prevention.

Several states have decriminalized the production, distribution, possession, and/or use of cannabis for medical and/or recreational purposes. Some hypothesize that decriminalization of substance possession or use reduces economic incentives for illegal production and distribution of drugs, allowing government entities to increase revenue through taxation (McNeece & DiNitto, 2012). Decriminalization is contested, however, as potentially contributing to increased rates of substance use disorders and other health risks, as well as related problems such as driving under the influence and community safety. Oregon’s Measure 110, approved in 2020, represented one of the most visible modern decriminalization efforts by reducing criminal penalties for possession of small amounts of controlled substances. However, several implementation challenges led Oregon to substantially roll back the measure in 2024. These included insufficient treatment infrastructure, limited coordination between systems, and inadequate funding. The experience shows that legislative reform alone does not guarantee effective outcomes when the broader systems required to support it remain underdeveloped.

Contemporary equity-focused reforms have also acknowledged the long-term consequences of criminalization. Advocating for “smart decarceration” often means advocating for less punitive and more treatment-oriented responses for low-level and non-violent drug involvement (Pettus-Davis & Epperson, 2015). Executive actions involving marijuana possession pardons and expungement efforts reflect growing recognition that earlier enforcement strategies disproportionately affected communities of color. The Fair Sentencing Act of 2010, which reduced the crack-to-powder cocaine sentencing disparity to approximately 18 to 1, represented a partial but meaningful legislative acknowledgment of those disparities.

Drinking age legislation

Drinking age legislation in the United States currently aims to restrict alcohol use by persons under the age of 21 years. Higher drinking age minimums are associated with better public health outcomes. The Community Preventive Services Task Force recommends maintaining current minimum legal drinking age laws on the strength of evidence linking them to reduced alcohol-related crashes (Community Preventive Services Task Force, 2000). The National Institute on Alcohol Abuse and Alcoholism rates retaining the age-21 standard as a higher-effectiveness strategy with broad reach, based on longitudinal research addressing traffic deaths, suicide, and violence (National Institute on Alcohol Abuse and Alcoholism, n.d.). Additionally, the drinking age law attempts to reduce the potential harms of exposing the still-developing young adult brain to alcohol. Major changes in brain structure and function begin early in puberty and continue well into early adulthood (Spear, 2000). Raising the legal age to 21 reduces alcohol dependence and eliminates confusion about enforcing alcohol-free zones in high schools and many parts of college and university life. Drinking age policy is determined at the state level; however, federal highway funding is tied to state drinking age policy, governing a uniform decision to support a minimum legal drinking age of 21 years.

Treatment access and the Affordable Care Act

Improving access to treatment for substance misuse and substance use disorders represents one of the most significant areas of contemporary policy reform. A considerable gap exists between the need for substance misuse treatment services and the numbers of individuals and families able to receive them. The Affordable Care Act (ACA), first implemented in 2013–2014, offered important expansions in access to mental health and substance use disorder treatment services. Under the ACA, young people could remain on a parent’s insurance plan until age 26. This is a critical protection, because ages 18 to 25 are when the greatest number of individuals engage in substance misuse. The ACA also eliminated annual and lifetime benefit limits for behavioral health services and made that care more affordable by ensuring co-pays could not exceed those for physical health services. It also protected coverage for people with a history of a substance use disorder, which could no longer be treated as a pre-existing condition. The federal Mental Health Parity and Addiction Equity Act of 2008 further regulated the health plan and insurance industry regarding benefits for individuals with substance use disorders.

In July 2016, Congress passed the Comprehensive Addiction and Recovery Act (CARA), followed in December by the 21st Century Cures Act. These laws authorized appropriations for grants that expanded access to naloxone for overdose reversal and funding to train clinicians to provide pharmacotherapy for opioid use disorder (Congressional Budget Office, 2022).

Modern drug policy therefore reflects an ongoing tension between punishment and reform. Although approaches have evolved, many contemporary debates continue to reflect historical patterns involving morality, public fear, political pressure, race, and social control.

Criminalization. The process of making the use or possession of a substance a crime, shifting the response from health care toward the justice system.

Decriminalization. Removing or reducing criminal penalties for a substance, often redirecting the response toward treatment rather than punishment.

Diversion. Programs that route people with substance-related offenses toward treatment and services instead of jail or prison, at any point from police contact through sentencing.

Drug policy. The body of laws and government decisions that control which substances are legal, how they are regulated, and how their use is treated or punished.

Harm reduction. An approach that aims to reduce the negative consequences of substance use rather than requiring abstinence as the only acceptable goal.

Mass incarceration. The large-scale imprisonment of a population, driven in part by drug-related sentencing, that disproportionately affected communities of color.

Prohibition. A policy that bans the production, sale, or use of a substance outright.

Racialized enforcement. The pattern in which drug laws are applied unevenly, so that some racial groups face arrest and punishment far more than others despite similar rates of use.

War on Drugs. The set of aggressive enforcement and sentencing policies, beginning in the 1970s and 1980s, that greatly expanded arrests and imprisonment for drug offenses.

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