Highs and Lows and In-Betweens

I recently toured a friend around the East Village as part of his first-ever, long-awaited pilgrimage to New York City. As we roamed along St. Mark’s Place, I pointed out the old Club 57, one of the fixtures of the downtown scene in the late 1970s and early 1980s, where Madonna, Jean-Michel Basquiat, Keith Haring and others showcased and honed their talent. Quite unironically, the building is now a drug treatment program. 

Substance use of all kinds is common in New York City, whatever the scene. People who live here generally drink alcohol and smoke tobacco at rates lower than the national average, but whatever poison is your pleasure, we probably have it here. And although drug use in this city is often publicly lamented, it’s also celebrated just as vigorously, though perhaps more often in private. 

I have spent the past three decades bearing witness to the ways in which people’s anguish can be dramatically exacerbated by drug use, and by our social response to their drug use. But it is impossible to work toward minimizing these harms without also reckoning with the perceived good that alcohol and drugs do for many people. Pain and suffering are not the inevitable cause or consequence of drug use. Among the myriad reasons people use, there are positive ones. There is also a desire for the pleasure and human connection offered by drug and alcohol use and — for most people, most of the time — a titrated self-management of the effects. 

I came to the city’s nightlife in the early 1990s, a whole decade after Club 57 and that era had faded. The club kids were already getting tired, gentrification was beginning its long slow march from Manhattan into Brooklyn, and AIDS had devastated the creative vanguard of a generation. Still, I made my rounds through the spots, dancing away late nights, early mornings and Sunday afternoons.

By the end of the decade, these loose, joyful social spaces were disappearing fast. Rudy Giuliani’s quality-of-life campaign effectively banned dancing at all of the smaller venues downtown by reviving enforcement of the dusty old 1926 Cabaret Law. His crackdowns on cannabis squashed public use of the drug, as well as under-the-counter sales at many shops around town. It seemed there was nothing left to do but drink, and the new millennium brought an exploding bar and restaurant scene to the city, affording us plenty of options.

Not that we’ve ever suffered a dearth of good watering holes in this city. I suspect most people who spend some part of their 20s or 30s in New York City and enjoy a drink now and then can name at least one favorite haunt, whatever the reason: the great jukebox, the cute bartender, the interesting crowd, the trivia night or the memories they’ve already made there, like meeting a future spouse. 

And the social life of bars in New York City often includes other drugs, too. I remember being impressed once by a candid prosecutor who assured me he knew he could walk into any bar downtown and easily find a contact to get him some blow. We’ve been a cocaine town for a long time, maybe because we like to talk fast and stay up late. We do pride ourselves on working and playing equally hard.

Before the law successfully intervened, smoking was also an intractable element of the drinking scene, and could provoke a natural intimacy between strangers — sharing a light usually led to conversation, and who knows where that spark might land. The laws and policies aimed at reducing the incontrovertible harms of smoking  were also effective in making socially unacceptable what was previously status quo behavior.  

This is the great challenge of policymaking on drugs: what are the costs and what are the benefits, who is harmed and who is helped and how can we strike the right balance. It is a dynamic policy landscape because science and popular sentiments are always evolving, and together these can drive political will. In 2021, cannabis use was legalized in New York State. A psychedelic renaissance is underway, driven largely by clinicians incorporating these drugs into their practice. Meanwhile, the number of smokers clustering outside bars in New York City has declined precipitously in the past two decades, mirroring the citywide decline in cigarette use. 

Acknowledging the pleasure factor is wholly compatible with reckoning with the real and considerable harms that drugs, including alcohol and tobacco, can cause when the circumstances are ripe. We are in the midst of the worst overdose crisis in this country’s history, driven largely by fentanyl, which can be deadly with one use. For most drugs, chronic or heavy use increases the risk of injury or disease, and unmanaged, some can kill almost instantly. For some people, drug use comes with an especially high risk of developing addiction, whether due to genetics, psychological or physical trauma history or any combination of complex circumstances and contexts. But a drug use disorder is not a static diagnosis: People change their relationship to drug use all the time. Effective public policies and accessible supportive services must make it easier for people to make changes that improve their health and their relationship to drug use.

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This piece was edited post-publication.