The Elephant in the Room - Part 3

The Elephant in the Room - Part 3
Posted by FoM on February 22, 2000 at 11:53:46 PT
By Michael Massing
Source: Salon Magazine
Many Americans are skeptical about the value of drug treatment. This is understandable, given the frequency of relapse. Relapse is so common that the idea has been incorporated into the very definition of addiction: a "chronically relapsing disorder," it's called. Even so, a vast literature has accumulated showing that, dollar for dollar, treatment is the most effective means of reducing drug use. 
A 1994 study by the RAND Corporation, for instance, estimated that, for reducing cocaine consumption, treatment is seven times more cost-effective than domestic law enforcement, 10 times more effective than border interdiction and 23 times more effective than counter-narcotics programs in Latin America. Even if someone relapses immediately upon leaving a program, RAND found, treatment is a good bargain, since the savings from reduced crime, medical problems and other harmful effects far outweigh the cost of the program. (Studies show that no one form of drug treatment is superior to the rest; addicts differ widely in their needs, so it's important to offer a wide range of programs.)Despite the effectiveness of treatment, it is often hard to get. In cities across the country, it can take weeks or even months to find a bed. In Baltimore, one of the nation's most afflicted cities, long-term residential treatment is virtually unavailable. In Washington, hundreds of drug offenders whom judges have mandated to treatment are forced to remain in prison due to the lack of beds. In several states, methadone is completely unavailable, forcing people to drive hours to get it. Even in cities that do have many beds, like New York, the red tape, lack of coordination and insurance requirements can discourage even the most determined addicts.The unavailability of treatment reflects the government's spending priorities. Fully two-thirds of the $18 billion federal drug budget goes for law enforcement, criminal justice and international intervention. Just one-third goes for treatment and prevention. At the state and local levels, the imbalance is even greater. If the government changed its priorities and redirected money from law enforcement and interdiction into rehabilitation, treatment could be made available to all addicts who want it. Cities could also set up "central intake units" offering immediate attention to addicts and quick referral to programs. And more could be done to find addicts jobs after they complete their programs -- a key point on the road to recovery.In a public-health model, more attention would also be paid to prevention. At the moment, drug prevention consists mainly of "This is your brain on drugs"-type messages aired on television or taught in classrooms. Research shows, however, that such messages by themselves rarely work. To be effective, prevention must provide alternatives to at-risk kids, such as after-school programs. Rather than busting kids for smoking pot, as Mayor Rudy Giuliani is now doing in New York, we should convert our schools into around-the-clock community centers offering youths a refuge from the troubled streets around them.Finally, under a public-health model, we would have as our drug czar somebody who actually knows something about drugs. Since the Office of National Drug Control Policy was created in 1989, it has been headed by a moralist (William Bennett), an ex-governor of Florida (Bob Martinez), a police chief (Lee Brown) and a four-star general (Barry McCaffrey). Certainly it's time we had a drug czar who has a background in drug addiction, psychopharmacology or, at the very least, medicine.Once, we did actually have such a drug czar. And the results were remarkable. This occurred during the presidency of Richard Nixon, of all people. Personally, Nixon detested drugs, especially marijuana, which he felt was poisoning the nation's youth. It was Nixon who actually launched the war on drugs. But Nixon was also a pragmatist. During the 1968 presidential campaign, he promised to reduce the nation's crime rate and, once in office, he ordered his domestic policy staff to find a way to do that. Studying the issue, his advisors found that heroin addicts were committing much street crime and that the fastest, most effective way of getting them to stop was to get them into methadone programs or other forms of drug treatment. In 1971, the Nixon White House set up a special-action office to prevent drug abuse and, to head it, named Dr. Jerome Jaffe, a psychopharmacologist widely recognized as the nation's leading expert on drug addiction. Jaffe was given hundreds of millions of dollars to open up treatment facilities around the country, and by the summer of 1972 treatment was available on request. Almost immediately, crime, heroin overdose deaths and hepatitis transmission rates declined. And the treatment network Jaffe had set up was given much of the credit.That network remained intact throughout the 1970s, and the nation's drug problem remained largely under control. In the 1980s, however, the Reagan administration -- believing that the government had no obligation to help addicts -- gutted the federal treatment budget. By the time crack hit, in the mid-1980s, treatment facilities were completely overwhelmed, and the many new addicts who wanted help were turned back onto the street, there to commit more crime and cause more mayhem.While federal spending on treatment has increased some over the last 10 years, it remains entirely inadequate. Nothing could do more to reduce the harm that drugs cause society than to make treatment available on request. That $1.3 billion being proposed for Colombia could fund the creation of many more treatment beds in our nation's cities. Surely it's time to call a halt in the drug war and pursue a strategy that attacks the real source of the problem -- our nation's inexhaustible appetite for drugs. At the very least, it's time for a rousing national debate on the issue. Rather than pester presidential candidates about their past drug use, journalists should begin posing the really important questions about drugs: "Do you think the war on drugs has been a success? If elected president, what would you do differently?" About the Writer:Michael Massing's book "The Fix," a study of U.S. drug policy since the 1960s, will be issued in paperback in March by the University of California Press. | Feb. 22, 2000Copyright  2000 The Elephant in the Room - Part 1 Elephant in the Room - Part 2 Articles:Beyond Legalization: It's Time for Realism Interview with Michael Massing Part 1 & 2
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