Carrots, Sticks and Children: A Revolution in Drug Policy
For the first time in the nation’s various wars on drugs, the scientific, political and spiritual stars are aligned for a revolution to balance and strengthen all four legs of this country’s effort to tackle substance abuse and addiction: research, prevention, treatment and law enforcement.
For decades our efforts to curb drug abuse and addiction have been mired in denial and despair. Politicians have tried to interdict, indict and imprison their way out of this scourge, chanting like a Gilbert and Sullivan chorus, If all the king’s horses and all the king’s men can’t put Humpty Dumpty back together again, then give us more horses and give us more men!
We have looked at the problem of addiction through the peephole of illegal drugs, a view so narrow that we didn’t see the relationship of nicotine and alcohol to marijuana, heroin and cocaine. We’ve made addicts the lepers of modern-day America, initially ignoring them and eventually caging them in an out-of-sight, out-of-mind attempt to prevent the plague from spreading.
Instead of trying to prevent and treat the problem, we have poured resources into shoveling up after it. Almost $100 billion was spent by states on substance abuse and addiction in 2000, but out of each dollar, 96 cents went to pay for the wreckage in health care, prison, welfare and social service costs and only four cents went to prevention and treatment.
The National Institutes of Health spend more than $7 billion a year for research on cancer, cardiovascular disease, AIDS and disabling respiratory illness, but less than $1 billion on the largest single cause and exacerbator of those ailments: drug, alcohol and nicotine abuse and addiction.
We Know Better Now
Recent social science research, biomedical discoveries, creative use of our justice system and increased recognition of the importance of family and spirituality point the way to an unprecedented opportunity to conquer this Public Health Enemy Number One.
CASA (The National Center on Addiction and Substance Abuse at Columbia University) has identified the statistical relationshipespecially among young teensbetween smoking, drinking and smoking marijuana and the move to harder illegal drugs. Teens who have drunk alcohol and smoked nicotine cigarettes in the last month are 30 times likelier to smoke pot; those who have done all three are more than 16 times likelier to use drugs like cocaine, heroin and LSD. These relationships are far greater than those the surgeon general initially found between smoking and lung cancer (nine to 10 times likelier) or that the monumental Framingham heart study found between high cholesterol and heart disease (two to four times likelier).
Recently, scientists at Scripps in California, at Brookhaven on Long Island and at research centers in Europe have uncovered good reason for this snug statistical relationship: all substancesnicotine, alcohol, marijuana, cocaine, heroin, hallucinogenssimilarly affect brain levels of dopamine (the substance that gives us pleasure). Biomedical research has also shown that addiction is a tenacious, chronic, often recurring disease and that an addicted brain is different from a normal brain.
Medically speaking, addiction is more like diabetes and high blood pressure than a broken arm or pneumonia. It cannot be fixed or cured in one round of therapy. Like the daily need of diabetics for insulin and hypertensive patients for pills, addicts need continuing care, such as that provided by attending Alcoholics Anonymous meetings.
To grasp the tenacity of addiction and the difficulty of staying sober, think about the will power it takes to lose weight and keep it off, or to give up candy or ice cream for Lent. Multiply that by a million to get some sense of what it takes an addict to make the initial commitment to recovery and stick with it forever.
Add to this newfound understanding of addiction CASA’s trinity of conclusions based on nine years of research: (1) an individual who gets through age 21 without smoking, using illegal drugs or abusing alcohol is virtually certain never to do so; (2) parent power is the most underutilized tool in the battle against substance abuse; and (3) spirituality and religion are keyfor many, decisivefactors in prevention and treatment. The combination of these three findings calls for a revolution in the way we perceive the problem of substance abuse and addiction and act to combat it.
It’s Addiction, Stupid
First, we must shed our drug-of-the-month mentality and stop ricocheting from nicotine to alcohol to marijuana to LSD to heroin to cocaine to crack to ecstasy. The problem is addiction, not any particular substance. In research, that calls for a National Institute on Addiction that combines the current fragmented Institutes on Drug Abuse (nicotine and illegal drugs) and Alcohol Abuse and Alcoholism. Such a combination would follow the example set when Congress created the National Cancer Institute in 1937, committing the resources and expressing the national commitment that has led so many of our brightest biomedical researchers to devote their lives to unraveling the mysteries of this confounding disease.
Carrots and Sticks
Next we must recognize the need to use every possible carrot and stick to get those who are hooked to enter treatment and stay there. Policies that forfeit such incentivesthose that lock up addicts without providing any reason or opportunity to enter treatment and those that legalize drugscommit the cardinal sin of despair. The lock-em-up and legalization extremes fly in the face of the Holy See’s admonition that exerting all efforts to rehabilitate drug addicts falls within the Christian obligation to help individuals fulfill the potential with which God endowed them. Putting that papal pronouncement into practice requires us to use all the carrots and sticks we can bring to bear in order to induce those who are addicted to seek treatment, stay the course and continue in aftercare.
That is why the extremes of mandatory sentences and legalization are counterproductive. Where the entire mandatory sentence must be served, the carrot of early release is not available to encourage an addicted prisoner to enter treatment. Where there is no parole, the stick of immediate return to prison is lost as an incentive to continue treatment and aftercare upon release.
Neo-legalization that removes the stick of punishment as an incentive to enter treatment and stay sober also misses the mark. In many cities, young men and women are arrested for possession of illegal drugs like marijuana and cocaine several times without even a slap on the wrist. Mayor Richard Riordan of Los Angeles told me of his concern that failure even to threaten such individuals with some punishment lets many descend into the quagmire of drug addiction. Other neo-legalization practicessuch as the disastrous needle park experience in Switzerland or providing drug injection rooms where addicts can shoot upare, as the Holy See put it, ethically unacceptable because they abandon individuals to the despair of self-destruction.
That is the fatal defect of California’s Proposition 36, which effectively eliminates even the threat of punishment for those found with marijuana, cocaine, heroin or any other illegal drug until after their third arrest for possession. By taking away the stick of possible punishment, Proposition 36 removes the straw that often breaks the back of an addict’s refusal to enter treatment. By letting a user sink deeper into the abyss of addiction, Proposition 36 is three-strikes-and-you’re-out with a perverse vengeance.
Drug courts strike an appropriate balance of carrots and sticks. Like the American eagle with olive branches in one claw and arrows in the other, these courts hold out the threat of punishment in one hand and the reward of freedom (with no criminal record) in the other in order to encourage addicts to enter treatment and return to work or school. The program called Drug Treatment Alternative to Prison, devised by Brooklyn’s district attorney, Charles J. Hynes, offers defendants with drug abuse problems and no violent felony convictions the option of deferring prosecution and entering residential drug treatment for 15 to 24 months. D.T.A.P. defendants who complete the program have the charges dismissed; dropouts are prosecuted. D.T.A.P. graduates have much lower recidivism rates than comparison groups.
Demand Reduction Now
President George W. Bush acknowledged in his May 10 speech at the White House that drugs come into the United States by invitation, not by invasion. The problem we’ve neglected, he admitted, is reducing demand. Americans are about 5 percent of the world’s population, but they consume 50 percent of the world’s cocaine. That raises troubling questions about our society and its values in general; but for those crafting drug policy, it sends one clear message: it’s time to target demand reduction with the same intensity we have devoted to supply reduction.
The opportunity for the most immediate demand reduction is among captive audiences where substance abuse is concentrated: the prison population and welfare mothers and other recipients of public assistance programs, such as parents of children in the child welfare system. CASA has found that well over one million of the two million adults in prison are drug and alcohol abusers and addicts who can benefit from treatment; yet precious little is available and what is available is not very good. Since each addict commits at least 100 crimes a year, successfully treating just 100,000 such inmatesless than 10 per centwill prevent 10 million crimes annually. Another opportunity is to require individuals with drug and alcohol problems to enter treatment as a condition of receiving public benefits such as welfare, Medicaid, public housing or other assistance.
Since availability is a significant factor in use, law enforcement is vital to reduce demand. Stephen Gaghan, the screenwriter of the movie Traffic and a recovering addict, bears eloquent testimony on this point. The weekend when his dealer, his back-up dealer and his back-up back-up dealer were arrested was when he hit that place, as he put it, and in desperation finally sought treatment.
All About Children and All in the Family
Ultimately, the struggle for a drug-free society is all about getting children through age 21 without smoking, using illegal drugs or abusing alcohol. That means the long-term keys to a drug-free kingdom are all in the family. As Pope John Paul II has said, strong families give young people the affective security they need for their spiritual and psychological growth.
CASA has found that the more engaged parents are in their children’s lives, the less likely their children are to smoke, drink or use illegal drugs. The most basic parental involvementeating dinner with their childrenhas an enormous impact in reducing their child’s risk of drug use. For children, it is particularly important to focus on all substances including alcohol and nicotinenot just illegal drugs. Prevention efforts that target only illegal drugs are like aiming at the monkeys and ignoring the raging gorillas.
The lesson for law enforcement is to concentrate on making illegal drugs less available to kids and to expand the policing horizon. For teens, illegal drugs are the tip of the iceberg and at the end of the substance abuse journey. Beer and other forms of alcohol are implicated in far more teen violence, suicide and deadly accidents than are all illegal drugs. Locating a teen on marijuana who didn’t learn to inhale on nicotine cigarettes is tougher than finding one particular grain of sand in the Sahara. Laws prohibiting the sale of alcohol and cigarettes to minors should be toughened. Police and prosecutors should exert far more energy enforcing those laws and punishing violators.
Looking in the Mirror
It is time to stop looking out the window and start looking in the mirror. Such a look offers a reminder that each of us is a creature of God, made in God’s image and entitled to exercise our free will to be all that God intended us to be. It may move us to offer a hand up, instead of just a slap in the face to those struggling with substance abuse and addiction.
The clergy should get out their own mirrors. I often ask parish priests, What’s the biggest problem among your parishioners? The response is usually family breakup, the culprit usually alcohol or drugs. Then I ask, How many sermons have you given on substance abuse? The answer is usually, None. A year before he died, Cardinal John O’Connor said with regret, [Substance abuse] is so common a sickness that I should have been writing and preaching about it for years.
On the July weekend when I began working for President Lyndon Johnson, he drove me around Johnson City in his big white Lincoln convertible with the top down. As we rode along a hot and dusty road, there was a man lying on the ground, unshaven, red-faced, bottle in hand, obviously hitting bottom. The president held the wheel in his left hand. He turned to me in the seat next to him, jutted his right thumb and forefinger just a hair apart in front of my face, and said, So long as you work for me, don’t you ever forget that the difference between him and you and him and me is that much.
If each of us remembers that, we will have more balancedand more effectivesubstance abuse policies that can return our nation to the day (as it was in the early 1960’s) when only two percent of Americans had ever tried an illegal drug, as compared with 28 percent today.