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September 17, 1982

Dark Paradise: Opiate Addiction in America Before 1940

JAMA. 1982;248(11):1395. doi:10.1001/jama.1982.03330110079041

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


For anyone willing to read through the enormous amount of information, this book can be a fascinating experience. It details the transition from the medical addict of the early 19th century—middle-class, usually female, and usually respectable—to the "hustling mainline junkie" we know today.

From an era of genteel tolerance to one of prohibition, the author-historian has done a careful, painstaking job of collecting information; nearly half the book consists of notes and bibliography. He shows a limited understanding of epidemiology principles both in the use of data and in inference, rarely distinguishing between incidence and prevalence or among point, period, and lifetime prevalence. He takes an advocate's approach to history, lacking in some ways the sensitivity of the social scientist or clinician. His exposition lacks modern theoretical insights into substance abuse, ignoring most if not all recent clinical and experimental studies of addiction.

The author is most interesting as a