Diario de campo.

The phrase, “to blow smoke up one’s ass” derives from the ancient practices of the Aztecs and Incas, who first engaged in the rectal use of tobacco smoke. The practice died out until eighteenth-century Europe, when the exercise was rediscovered and used

to rouse people from “suspended animation” or those who had drowned.1 _{Soon after, a}

bellows-like device which a physician inserted in a patient’s posterior was invented,

increasing the therapeutic force of the “treatment” over the more traditional and gentle

syringe method. There is arguably no more horrifying application of nicotine to privates

than France’s Doctor Buc’hoz, who testified to the effectiveness nicotine smoke treatment for women suffering “hysteria,” administered vaginally. Coming in close second, however, is Adelaide’s Hollingsworth’s 1893 The Columbia Cook Book, which advocated that women who became poisoned should induce vomiting by literally

“blowing smoke” into their anuses.2

Such creative methods of “getting high” span many substances across the entire length of human history. The most common and socially accepted of these include alcohol, nicotine, and caffeine, which all stimulated incredible civilizational changes, including the opening of trade routes and the development of shared social spaces like pubs and bars, smoking parlors, and tea rooms. Researchers located the oldest

cultivated grape vines in Georgia, and carbon dated them to around 7000 to 5000 BCE.3

Coffee was popular in the Islamic world at the end of the fifteenth century, but tea’s

history is longer, since the Chinese people have been widely using the drink since at least the third century BCE. The Aztecs, setting aside their more colorful applications of

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tobacco, practically worshipped the plant. They mixed it into their food and water and taught their young that the goddess Cihuacoatl was made of tobacco leaves. The Aztecs even used tobacco ritually during governmental proceedings, lighting their pipes before the meetings began and keeping them lit throughout the discussion, believing it allowed them to work longer and more efficiently.

Long accompanying the potency and importance of these substances have been official laws, regulations, and taxes, a vital method of extracting revenues for states and empires. Rulers in Babylon and Ancient Egypt created monopolies on drug production to maximize how much they could receive in state profits. In contrast, movements decrying the horrors of drug use are evident in most points in history, the United States’

prohibition in the 1920s and the modern day “war on drugs” being only recent

examples. Earlier and more brutal cases are ample, however. Tobacco users had their lips cut off under the first tsar, while Ottoman sultan Murad IV beheaded them.4 _{In the}

late fourteenth century, the Ottoman emir in Egypt eliminated the use of hashish and imprisoned or executed farmers who grew the crop. Citizens found smoking the herb had their teeth removed.5 _{The imposition of these policies, harsh as they were, are a}

direct response by states and empires to abnormal patterns of drug use.

Historians credit modern addiction medicine to Calvinist theologians, who offered basic explanations for compulsive alcohol consumption later adopted by medical practitioners. For instance, in 1641 Dutch physician Dr. Nicolaes Tulp relied on theological models to explain the loss of control associated various behaviors, giving

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applied Tulp’s basic theory to the progressive loss of control over alcohol consumption

only a few decades later.

The development of psychiatry as a scientific discipline had a profound influence on the development of addiction medicine as well. American physician Benjamin Rush wrote in the eighteenth century about compulsive drinking, attributing the behavior to the innate characteristics of the drink, as opposed to the drinker.6 _{Additionally, in the}

nineteenth century, physicians first introduced medical journals dedicated to the study of addiction. Interested parties first published the Journal of Inebriety in the US in 1876 and the British Journal of Addiction in 1884. The founder of modern psychiatric

medicine, Emil Kraepelin, published psychometric data on alcohol and tea consumption in the 1890s, concluding that chronic alcoholism led to permanent cognitive decline.

Kraepelin’s work laid the groundwork for Freud’s psychological approach to addiction,

an important marker in addiction history. Until Freud, addiction as a monolithic category was unheard of, especially as an expression of a single psychological malady.7

Addiction research in the twentieth century further developed the study of compulsive and chronic behaviors by introducing new diagnostic classificatory systems, engaging in increasingly sophisticated neurobiological research, and incorporating large- scale animal studies that examined the physical effects of addiction on the brain. The modern view is that addiction is caused by a “rewiring” of thebrain’s reward system, conditioning it to see drug intake as mimicking reward cues from more biologically advantageous activities such as food and sex. Additionally, addiction research has revealed that genetic factors play a role in addiction, which interact with the

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environment and other substances in incredibly complex ways. Despite humankind’s

long and storied experiences with intoxicating substances, we have yet to settle critical questions on what addiction is, what causes it, and why it is such a difficult behavior to alter.

Based on this long and complex history, it makes sense that addiction researchers have consistently struggled to define the term, let alone unravel its

mysteries. Historically, the term “addiction” entered the English language in the late

sixteenth century, indicating an inclination for repeated habits or actions, holding both a positive and negative sense. In the nineteenth century the term appeared in medical discourse, taking on a discrete pathological meaning. This pathological meaning has

remained, despite the shift towards terms like “dependence,” which the medical

community implemented to prevent the stigmatizing associations that have developed around addiction and “addicts,” as well as to provide a more broadly applicable term to describe a wide range of chronic behaviors. Additionally, psychological researchers often use the term “addiction” to indicate a compulsive motivational drive. Therefore, as a neutral inclination or habit, as a pathology, or as a compulsive drive, different scholarly perspectives conflate the meaning of addiction.8 _{The lack of an agreed-upon}

“general” theory of addiction, which could explain the mechanisms in play across any given addictive behavior or substance, is a strong indication this phenomenon is deeply entrenched in uncertainty. By extension, how addiction theories treat this uncertainty will lend them different aporetic virtues and vices.

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