Monday, December 01, 2008

Alternatives to the War on Drugs - The (Uncomfortable) Third Way

CrimProf blog tells us what anybody should already know - the "war on drugs" as presently fought is an extraordinarily costly failure, and the drug situation is not likely to improve unless we focus on demand instead of supply. But it's simplistic to suggest that treatment programs are the key to winning the drug war. Unless you're going to expand the meaning of "treatment" beyond the comfort zone of a lot of Americans.

Drug treatment is remarkably ineffective, not because we don't now have some pretty good programs and models for treating addicts, but because until an addict is ready for sobriety the odds of successful treatment are close to zero. If you're not an addict, this is really hard to grasp. I still can't quite fathom why somebody would spend time in a jail or prison, be completely broken from any physiological addiction to cigarettes, but then light up the moment they get out. It doesn't make sense, but that's addiction at work.

In a "war on drugs" parallel, a couple of years ago I met an addict who was in the process of detoxing from heroin, who described how he had previously spent a full year in a very expensive residential treatment center - about $30,000 per month. He had agreed to drug treatment as part of a one year drug diversion sentence for possession. His dad had picked up the tab to keep him out of jail. He indicated that although he was "clean" for the full year and passed all of his drug tests, he spent the entire year waiting for the moment his year was up. Within an hour of the court appearance at which he was discharged as having "successfully" completed the diversion program, he had a needle in his arm. He was back in treatment because he had been arrested again. My guess is that he's since again relapsed.

Meanwhile in Switzerland, they're experimenting with prescription heroin, administered in a clinical setting for a class of addicts for whom all else has failed. It's a bit jarring, but in fact if you want to reduce the demand for street drugs, sometimes you have to make their equivalent available in a clinical setting. This approach offers some benefits that may not be immediately apparent, including providing the addict with pharmaceutically pure drugs (the poisons and toxins in street drugs can carry serious health consequences), and opening the door to drug education, counseling, and the possibility of treatment. The U.S. has moved uncomfortably into the drug substitution and maintenance model, through methadone clinics, but an addict's participation in that type of program is often a result of desperation - they've reached a point in their addiction where their need for drugs exceeds their supply - and not about recovery.

Like it or not (and I don't), addiction is a part of human nature, and a consequence of human biology. There's not a country in this world that doesn't have a "drug problem", and there never will be. It makes sense to move into a model of a "war on drugs" that involves a sensible use of resources, and as much as possible removes the criminal element from the drug trade while treating addiction as a public health problem. But if the only tools we apply to the problem are "drug treatment" and "cutting off supply", we should not expect the situation to improve.


  1. What is it that you are actually proposing?

    Replace methadone clinics with heroin clinics?

    I concur that the current system isn't much, but I'm unclear on what alternatives you are pushing? (Especially since you acknowledge that "rehab" without motivation is useless.)


  2. I proposed nothing of the sort. I simply noted the fact that if you want to reduce demand for illegal drugs, that will necessarily entail making legal alternatives available to addicts who are not interested in recovery.

    Methadone is an example of a legal drug offered as a substitute for an illegal drug. It's possible to use other drugs while taking methadone, as well as to "boost" the effect of methadone, and many people who participate in methadone programs do both.