Views & Reviews Review of the Week

Decline and fall (the speedy way)

BMJ 2009; 339 doi: (Published 12 August 2009) Cite this as: BMJ 2009;339:b3283
  1. Michael Farrell, reader in addiction psychiatry
  1. 1Institute of Psychiatry, King’s College London
  1. michael.farrell{at}

    Images of flashing blue lights in the night sky, derelict houses, vagrants, toothless “meth heads,” scrawny bodies, and multigenerational addicts flicker across the screen. This is a grim and dark world. Following in the speed fuelled footsteps of Jack Kerouac, Louis Theroux drives into buzzing Fresno and drops into some of the down at heel neighbourhoods. Fresno, in central southern California, is the main producer of raisins for the United States and has a large population of migrant agricultural workers. In its current social crisis it bears echoes of John Steinbeck’s Grapes of Wrath.

    Theroux repeats a format he has used in a number of programmes: to observe how the folk on the wrong side of the tracks live. He has a curious and somewhat detached air but also a genuine feeling of empathy—it means that a variety of people whose lives have been destroyed by crystal meth (methamphetamine) are happy to open up to him.

    Methamphetamine in its smokeable or injectable form is a long acting form of amphetamine that is highly addictive and results in major psychiatric and social problems as a result of such compulsive use. It has been around a long time on the US west coast, but more recently it has become a global phenomenon.

    Countries in the Asia Pacific region, such as Thailand, the Philippines, Malaysia, and Australia, now have a huge problem. Ephedrine, a plant derived chemical, is used in the manufacture of the drug, but much is also made from reprocessing decongestive medicines that contain ephedrine.

    Curiously, very little methamphetamine is used in Europe to date, except in the Czech Republic, where it is legally manufactured under the trade name Pervitin. One major concern is that methamphetamine could be Europe’s next epidemic.

    Theroux says: “I wanted to understand the grip of addiction.” We hear stories of how Fresno has fallen on hard times, and we drive by dust bowl, ghost town streets, and run-down clapperboard houses. We see a police raid where a mother and son are arrested in the grandmother’s house with a large stash of crystal meth. A police patrol arrests a young woman who is as high as a kite, roaring with laughter, but within moments, as Theroux asks about her children, she is weeping remorselessly.

    We hear from a couple who have used crystal meth for nearly 30 years and are caught in a spiral of mutual dependence. The male partner is spooky, dedicated to ongoing meth use and fulsome in his declaration of love for his woman, who instead is distressed about her life and drug use.

    We then visit a large drug rehabilitation unit, which has a frontage not unlike a Baptist or Episcopalian church. The unit houses 255 adults and 55 children. Here we see a very large group of women, many who have children in child protection services and are hoping to get clean and to get their children back. The project leader says that men fall into addiction on the streets, for example through gang life, but that women get involved in this drug through the men they love and then have everything stolen from them. The rehabilitation service’s completion rates are good, but relapse to drug use afterwards is relentless. We get to see one “graduate” who quite quickly ends up in a state prison, and we get a glimpse of the ever growing US prison industrial complex that is rapidly expanding on the back of our modern drug epidemic.

    This same programme could be made in London about misusers of alcohol and cocaine. The stories of multigenerational addiction, children in care, mothers in prison, domestic violence, sexual abuse, incest, and murder would all be there.

    Theroux thoughtfully wonders about the future. Already vulnerable communities are falling prey to major drug epidemics. Economic downturns, unemployment, and poverty are the fault lines that weaken communities, allowing old and new drugs to ravage them. Much of US society is hard to understand, but the depth of the drug problem and the social response to it remains as baffling as ever after this Theroux guided tour of Fresno.


    Cite this as: BMJ 2009;339:b3283


    • Louis Theroux—The City Addicted to Crystal Meth

    • BBC Two, 9 August, 9 pm

    • Rating: ***

    View Abstract

    Log in

    Log in through your institution


    * For online subscription