, Volume 5, Issue 1, pp 70–88 | Cite as

How crack found a niche in the American ghetto: The historical epidemiology of drug-related harm

  • Caroline Jean Acker
Original Article


Although neuroscience has produced elegant models of addiction as a brain process, it does not address the incidence and prevalence of conditions like addiction in populations. As incidence and prevalence are the measures of a condition in a society, understanding rates of social problems is critical to controlling them. Nevertheless, not all upsurges in drug use in a population constitute true emergencies. It is useful to distinguish drug eras, new patterns of drug use that emerge in a population and then stabilize or decline from epidemics of drug-related harm. A historical epidemiology of drug-related harm draws from history, science and social science to examine the conditions that produce such epidemics. Compulsive crack use concentrated in American urban neighborhoods characterized by poverty and cultural isolation in the 1980s and the object of lurid media coverage, can be better understood through the lens of the historical epidemiology of drug-related harm. This model holds that serious upsurges in harmful drug use result from the introduction of powerful new drugs or drug forms to populations that lack experience with them and that suffer from multiple dimensions of structural disadvantage.


addiction drug epidemiology crack cocaine drug use patterns history of drug use harm reduction 



I thank Howard Kushner for organizing the conference Addiction, the Brain and Society and all my fellow conferees for stimulating discussion and insights. I thank Naomi Braine and two anonymous reviewers for insightful comments on an earlier version of this article. I thank Sarah Tracy for many conversations that helped inspire the ideas presented here.


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Copyright information

© The London School of Economics and Political Science 2010

Authors and Affiliations

  • Caroline Jean Acker
    • 1
  1. 1.Department of HistoryBaker Hall 240, Carnegie Mellon UniversityPittsburghUSA

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