The dust jacket of Michael Massing’s The Fix summarizes his thesis in bold red letters: “Under the Nixon Administration, America Had an Effective Drug Policy. WE SHOULD RESTORE IT. (Nixon Was Right).” That can be a pretty extraordinary claim that they can make regarding an administration that gained office mostly through the “Southern Strategy” which in fact had at its heart Nixon’s commitment of a “War on Drugs” and whose policies came up with cocaine epidemic that caused numerous new concerns several later. At most, I would agree how the Nixon administration’s hunt for a fundamentally bad policy included some worthwhile efforts which have been devalued by every subsequent administration. This was not because Nixon or his closest advisers were right about drug policy but because Nixon was keen on foreign policy issues with the exceptional benign neglect of domestic policy allowed several positive developments to blossom in the middle of the mire of incompetence and corruption that characterized his presidency.
Perceptively concluding that “policies being formulated in Washington today bear little regards to what is going down on the street,” Massing tries to depict the genuine effects of drug policy in the street level. Unfortunately, he doesn’t make use of the epidemiologic evidence or look at the careful analyses conducted by researchers like myself who’ve systematically examined what’s truly going on on the street. Instead he depends on the journalist’s usual — and often misleading — tool of dramatic anecdotes.
Massing’s anecdotal case is presented with the stories of Raphael Flores and Yvonne Hamilton. Flores runs Hot Line Cares, a drop-in center for addicts in Spanish Harlem. Hot Line Cares, which Flores founded in 1970, is basically just a cramped office in of an otherwise abandoned tenement where Flores with the exceptional staff advise and assist addicts who would like to get into treatment. Given the fragmented state of drug use treatment in New York City, plus in most other American communities, go for easy task in order to connect addicts with appropriate care and also harder to get in touch them with adequate aftercare. Massing writes, “If a Holiday Inn is full, it can at least call the Ramada across the road to see if it features a vacancy. Not so two treatment programs”
Yvonne Hamilton is really a crack addict hoping to get her life together. Massing describes her trials and tribulations as she copes back with her illness and makes her way through New York City’s treatment non-system. It is an affecting story and well told. The author presents becoming an argument for treatment and perversely as your firm stand out against decriminalization or legalization. But jane is one with the many examples that relate that prohibition doesn’t prevent addiction. And improvements in her own drug problem appear to have less with regards to the treatment she did receive as compared to changes in her own life situation.
These two lives give you a touchstone which his narrative will later return. The middle third on the book shifts dramatically in tone as Massing chronicles the evolution with the war on drugs in Washington. During Nixon’s tenure, the us govenment spent additional money on treatment (the “demand” side) compared to stopping drug trafficking (the “supply” side), that they argues ended in declines in drug overdoses and crime rates. As successive presidents felt pressure to stress the “war” in lieu of treatment, he asserts which the number of chronic addicts skyrocketed. In the third and last section Massing returns to Spanish Harlem, where Hamilton continues a hard struggle to remain drug-free and Flores struggles and keep his center afloat and and keep from falling into addiction himself.
It could be the second part from the book that could be the heart of Massing’s thesis. It can be a tale that’s familiar to the people of us who’re active inside field of drug policy and, along with scholars, other journalists have told it before — Dan Baum (1996) and Mike Gray (1998) doing this particularly well — but I will summarize (with many details Massing missed or ignored) a brief history of drug policy under Nixon for that reader that is not knowledgeable about the story.
In 1968, as Richard Nixon was making his comeback run for that presidency, he adopted the “Southern Strategy” that is the key to Republican victories in presidential races from the time that. Since the end of Reconstruction every Democratic presidential candidate have been able to count on the votes on the “solid South” however the Northern Democrats’ support for civil rights ended up the cause of increasing disaffection within the South, as epitomized by Strom Thurmond’s independent run for President against Truman in 1948. Then, in 1964, Alabama Governor George Wallace’s bid with the Democratic nomination for President established that racism won votes within the North along with the South. Nixon desired to win the South, and also racists’ votes inside the North, without offending currently established Republican voters by an openly racist campaign. The answer Nixon and his awesome advisers found would have been to campaign against crime, which most Americans quite falsely equated with minorities. So what in the event the crime rate was really declining, Americans appear to always think that crime is increasing just like they manage to always blame it on cultural or racial outsiders.
Even a lot better than campaigning against crime, the Nixon team soon realized, was campaigning against drugs. Most Americans, again falsely, equated drug users with violent criminals. Better still, to the great “silent majority” whose votes they sought a campaign against drugs symbolized a campaign against both Blacks and a lot of hated hippies and anti-war protestors. When Nixon declared “war on drugs” he was irresistible to the basest elements from the American electorate also it worked, equally as it has worked for other candidates since.
The success of his anti-crime/anti-drug campaign presented Nixon having a serious dilemma when he took office – everyone was expecting results. At first his administration considered admitting that constitutionally crime control would have been a state responsibility and proposing to do something through support of coaching programs and grant-in-aid expressing and local police forces, but his approach had little political pizzazz and was largely abandoned after it did not impress the population. Nixon had a few ideas of his or her own, for instance a nationwide mandatory death penalty for selling drugs – a strategy that’s been tried in Red China plus in Singapore and has now clearly failed in nations – but fortunately he was interested in foreign policy and left searching for a solution for the drug problem within the hands of John Ehrlichman plus the White House Domestic Policy Council.
Within the Domestic Policy Council Egil “Bud” Krogh Jr., a little daughter lawyer who’s better remembered as being the man who headed the White House “plumbers” of Watergate fame, was convicted of responsibility to find a way to visibly impact drugs and crime prior to 1972 election. Massing portrays Krogh as something approaching the tragic hero in the tale, but I’m not sure that lots of other than Massing and Krogh himself hold a real positive look at his public service. In any case, it’s true that Krogh played an essential role in shaping their good plus the bad within the Nixon administration’s drug policies.
In one among his other roles as liaison on the government with the District of Columbia, Krogh had become familiar with psychiatrist Robert Dupont who has been running one on the early methadone maintenance programs in DC. Krogh was hesitant to accept a maintenance way of addiction but he did observe that it was one approach that had some proof effectiveness. In June of 1970, Krogh sent the Council’s youngest lawyer Jeffrey Donfeld to check out methadone programs in New York and Chicago, such as first such program, that was directed by Vincent Dole and Marie Nyswander of Rockefeller University, plus a “mixed modality” model manufactured by University of Chicago psychiatrists Jerome Jaffe and Edward Senay.
Donfeld was dubious concerning the claimed effectiveness of methadone treatment and also more dubious about its political acceptability – in terms which have since become familiar, he wondered if this would send the incorrect message. Donfeld found Jaffe especially to be “politically sensitive” on the emotional issues associated with methadone maintenance. Donfeld believed how the “mixed modality approach,” that they called “different strokes for various folks”, through providing a range of treatments that included detoxification, drug-free, and maintenance approaches, effectively masked the methadone program from political criticism.
Much as Raphael Flores would be the hero with the first part with the book, Jerome Jaffe is Massing’s hero with the second part. Jaffe has described his selecting an essentially clueless Nixon. He sidestepped Nixon’s idea in the death penalty for dealers and suggested how the one worth of law enforcement may be in pushing in the street valuation on drugs therefore encouraging more addicts to search for treatment – this idea was later absorbed by Peter Reuter from the Rand Corporation but his research showed which the effect of aggressive police officers on supply was essentially nil as well as on price was tiny.
Jaffe experimented with make four points in his choosing the President an d each were to bear fruit in shaping not able to drug policy under Nixon. The first was the advantages of more research and evaluation of treatment. The expansion of an small division in the National Institute of Mental Health right into a National Institute on Drug Abuse and also a National Institute on Alcoholism and Alcohol Abuse grew partially out of this recommendation. Second, he noted that currently there are a dozen different federal agencies funding treatment that didn’t even consult each other. He felt that coordination coming from all these efforts was needed in hunt for a coherent national strategy. This generated the creation in the Special Action Office for Drug Abuse Prevention, that they was startled to discover himself appointed director of, because nation’s first “drug czar”. Third, due to the extent of heroin addiction, he urged that methadone maintenance must not be restricted to some small research projects but really should be made accessible. Fourth, he urged that funding for treatment be dramatically increased. These last two points were on the heart of the items Massing identifies as “The Fix”.
Jaffe’s first big White House assignment ended up being to develop a arrange for controlling the skyrocketing prevalence of heroin use among U.S. servicemen in Vietnam, which involved 10 or 15 percent coming from all GIs in Vietnam or maybe more. Pentagon policy was that heroin use would be a crime which any serviceman who used heroin must be arrested and prosecuted. The result of this was an over-burdened military justice system but no decline in heroin use. Jaffe urged which the Pentagon should adopt care approach instead of an punitive one.
Massing demonstrates that Jaffe’s solution relied because of its effectiveness about the GIs’ overpowering prefer to return on the United States. He advised the Pentagon to subject all GIs to urinalysis before shipping them home. GIs who tested positive for heroin must stay in Vietnam for detox. The military’s response to his plan ended up being object it would play havoc with all the complex logistics of troop movement, that Massing reports that Jaffe replied, “I cannot believe that this mightiest army on Earth can’t get its troops to piss in a very bottle” When his plan was implemented, Massing reports the percentage of GIs using heroin quickly dropped by expenditures.
Jaffe himself tells it quite differently. It appears that as a possible academic and researcher he was aware in the growing evidence that a majority of heroin users will not become addicted along with the early follow-ups showing that most in the troops who have been addicted to heroin in Vietnam abstained successfully, and, sometimes without any treatment, after coming back home (Jaffe and Harris, 1974). He didn’t fool himself into believing how the urine screening program actually deterred heroin use on the list of troops while serving in Nam. What he expected was once word in the urinalysis got around heroin using GIs who weren’t addicted would stop using for your last weeks before rotation home in support of the truly addicted could be unable to do so therefore fail the urine test. This is apparently so what happened but it gave the politically useful appearance of any far greater success. The classic follow-up study by Robins, et al. (1980) confirmed that most on the GIs who became dependent on heroin while serving in Vietnam recovered fully and permanently after returning for the US and as well found that recovery rates weren’t improved by receiving care – a locating the implications that I discussed in many publications of these period (Duncan, 1974, 1975, 1976 & 1977).
I believe which the rapid recovery of Vietnam addicts implies that for most on the GIs who became addicted, heroin use served as being a coping mechanism for dealing using the stress of serving within a war zone. The relief they obtained by employing heroin served to be a negative reinforcer and negative reinforcement produces powerful habituation. Once they returned home their heroin using behavior extinguished within an environment where for the majority of of them that it was no longer being reinforced. Those who persisted of their addiction, based on Robins, et al. (1980), were individuals who returned to conditions of poverty, an alcoholic parent, etc. – exactly individuals who would always need a stress reliever. Treatment was much less expensive relevant than environmental change, that’s what Moos and his awesome coleagues have found to get true for alcoholism treatment (Moos, Finney, & Cronkite, 1990; Finney & Moos, 1992).
As Massing reports, Jaffe was capable of convince the Nixon administration to boost funding for substance abuse treatment eightfold over what it ended up being when Nixon took office. For the only time up to now since America began its failed research drug prohibition, process budget was larger (twofold) than that for drug law enforcement officials. Massing attributes a decline in narcotics-related deaths along with crime rates for this budget increase plus a more than 300 percent boost in the volume of persons in treatment. It could be nice for treatment advocates much like me if that was true but no knowledgeable analyst is probably going to agree which it is.
While more addicts in treatment probably played some role in lessening the numbers of narcotics-related deaths, there are two additional circumstances that probably played a far larger role. First, was the introduction in 1971 of naloxone (Narcan®), a complete narcotic antagonist, which replaced nalorphone (Nalline®), a partial narcotic antagonist, because drug of choice for treating narcotic overdoses. Second, was the growing use of amphetamines along with other stimulants leading to them replacing heroin because the primary drug of addiction in America. This may also have contributed towards the decreasing death rate in a very tertiary fashion by reducing requirement for heroin and as a consequence reducing the price and enhancing the purity of heroin in the pub which would reduce deaths that always result from allergic reactions for the impurities in illicit heroin.
There is strong evidence that this availability of methadone maintenance in the community with many heroin addicts brings about a decline in rates of property crimes, particularly the burglaries and petty thefts that addicts usually engage in to improve money to back up their habit. It is very likely which the expansion of this modality under Nixon and Jaffe did lower crime rates. Crime rates, however, were already trending downward as well as the continuation of their trend was probably more essential than any government policy.
The gravest defect of The Fix is based on its tacit assumption that this general direction and goal in our nation’s current drug policy is okay and just needs some refining its budget priorities so as to “fix” it. Well, Nixon didn’t repair it, nor will or can any future president. The goal of eliminating recreational drug use hasn’t been achieved anywhere nor perhaps there is any good reasons why society really should be better for achieving this kind of goal.
I directed one in the early establishments to utilize the “mixed modality” approach that Jaffe advocated and I still believe in its value. The fragmented state of the majority of treatment services today, so well illustrated by Massing’s two examples, certainly is really a serious barrier towards the effectiveness of treatment. So I would definitely agree with Massing that America would benefit greatly from both a go back to greater funding for treatment along with the use of multimodality treatment. But no public health issue can be adequately controlled through treatment, or secondary and tertiary prevention even as in public health choose to call it. It is only through primary prevention that the problem as large as drug addiction may be meaningfully reduced. It certainly can not be reduced by operating a head unit in which coming from a third and two-thirds from the current patients don’t require any treatment whatsoever because their drug use is recreational but not addictive.
Effective primary prevention of abusing drugs, however, has for being something far completely different from telling website visitors to “just say no” and telling prophylactic lies to kids in D.A.R.E. classes. First of most, effective prevention (primary, secondary or tertiary) must focus around the actual problem of addiction rather than you are on all usage of certain selected drugs. Most users of any on the widely used drugs, using the exception of nicotine users, usually are not addicted, are certainly not at potential risk of becoming addicted, aren’t doing any substantial injury to themselves, and aren’t harming someone else by their use in the drug. Even a small proportion of tobacco smokers will not be addicted and aren’t harming themselves by smoking. Society doesn’t have any valid fascination with preventing drug use but an extremely clear curiosity about preventing addiction.
Second, primary prevention are not achieved by scaring people — least of by scaring all of them lies. Programs like D.A.R.E. come up with a strong impression on many preadolescents and early adolescents who swear they can be never going to use drugs but by their mid-teens most of which have learned through observation a whole lot the D.A.R.E. officer said excitedly was lies and they aren’t only ready to test out drugs but cynical in viewing any valid warnings some may receive from adults about real risks. Effective prevention need to be based on facts not scare stories. Instead of insisting that children should stay drug-free forever, which without any one in our society is or needs to be, we must be teaching them how you can responsibly assess drugs and situations people so that they can choose wisely what when and how regarding drug use.
Criminalizing drugs and drug use makes all quantities of prevention more challenging. No drug user or abuser is going for being better off if you are arrested. Treatment within the criminal justice system is really a good idea for those that are arrested for real crimes including theft or assault but treatment within the criminal justice product is always fighting an uphill battle contrary to the harm created by the system. Numerous studies show that any form of punishment for drug use raises the likelihood that this drug user becomes or persist in wanting to bo addicted.