Did Nixon Get the War on Drugs Right? Michael Massing's The Fix

The dirt jacket of Michael Massing's The repair summarizes his thesis in bold pink letters: "underneath the Nixon management, the usa Had an powerful Drug policy. WE ought to restore IT. (Nixon changed into proper)." that may be a pretty high-quality declare to make concerning an management that received workplace in massive component through the "Southern method" that had at its coronary heart Nixon's declaration of a "conflict on pills" and whose rules created the cocaine epidemic that prompted such a lot of new concerns a decade later. At maximum, i would agree that the Nixon management's pursuit of a basically horrific policy included a few profitable efforts that have been devalued through each subsequent management. This turned into no longer because Nixon or his closest advisers had been proper approximately drug policy however because Nixon become more interested in overseas policy troubles and his benign overlook of domestic policy allowed a number of fine tendencies to blossom in the midst of the mire of incompetence and corruption that characterized his presidency.

Perceptively concluding that "regulations being formulated in Washington these days endure little relation to what's taking place on the street," Massing tries to depict the real outcomes of drug coverage at the street degree. lamentably, he would not rely on the epidemiologic proof or examine the careful analyses performed by using researchers like myself who have systematically examined what's really taking place on the road. instead he is predicated at the journalist's common -- and usually deceptive -- device of dramatic anecdotes.

Massing's anecdotal case is presented through 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 largely just a cramped workplace in of an otherwise abandoned tenement wherein Flores and his workforce recommend and assist addicts who want to get into remedy. Given the fragmented nation of drug abuse treatment in big apple metropolis, and in most other American communities, it's miles no easy assignment to connect addicts with suitable care and even tougher to connect them with adequate aftercare. Massing writes, "If a holiday hotel is complete, it's going to as a minimum name the Ramada down the street to see if it has a vacancy. now not so two remedy programs"

Yvonne Hamilton is a crack addict looking to get her lifestyles collectively. Massing describes her trials and tribulations as she copes with her infection and makes her manner through ny city's remedy non-device. it is an affecting tale and well instructed. the writer affords it as a controversy for remedy and perversely as a controversy against decriminalization or legalization. however she is one of the many examples that display that prohibition does no longer prevent addiction. And upgrades in her drug hassle seem to have much less to do with the treatment she did acquire than with modifications in her existence scenario.

these  lives offer a touchstone to which his narrative will later return. The middle third of the e-book shifts dramatically in tone as Massing chronicles the evolution of the conflict on drugs in Washington. in the course of Nixon's tenure, the authorities spent extra money on remedy (the "call for" side) than on stopping drug trafficking (the "supply" facet), which he argues brought about declines in both drug overdoses and crime charges. As successive presidents felt strain to emphasize the "warfare" instead of remedy, he asserts that the wide variety of continual addicts skyrocketed. in the 0.33 and closing segment Massing returns to Spanish Harlem, where Hamilton maintains a tough war to stay drug-unfastened and Flores struggles to keep his middle afloat and to maintain from falling into addiction himself.

it is the second part of the e book that is the heart of Massing's thesis. it's far a tale that is familiar to those people who are active within the discipline of drug coverage and, similarly to students, different journalists have advised it earlier than -- Dan Baum (1996) and Mike grey (1998) doing so especially nicely -- but i'm able to summarize (with some information Massing overlooked or neglected) the records of drug coverage beneath Nixon for the reader who isn't acquainted with the tale.

In 1968, as Richard Nixon changed into making his comeback run for the presidency, he followed the "Southern approach" that has been the key to Republican victories in presidential races ever because. for the reason that end of Reconstruction each Democratic presidential candidate had been able to rely upon the votes of the "strong South" but the Northern Democrats' support for civil rights were the cause of growing disaffection within the South, as epitomized by Strom Thurmond's impartial run for President against Truman in 1948. Then, in 1964, Alabama Governor George Wallace's bid for the Democratic nomination for President showed that racism gained votes in the North as well as the South. Nixon desired to win the South, in addition to racists' votes inside the North, with out offending greater traditional Republican electorate by an openly racist marketing campaign. the solution Nixon and his advisers observed was to marketing campaign towards crime, which maximum individuals quite falsely equated with minorities. So what if the crime price was in reality declining, people appear to continually believe that crime is growing just as they appear to constantly blame it on cultural or racial outsiders.

Even better than campaigning in opposition to crime, the Nixon team soon realized, changed into campaigning against tablets. maximum individuals, again falsely, equated drug users with violent criminals. better nevertheless, for that super "silent majority" whose votes they sought a marketing campaign against pills symbolized a marketing campaign against each Blacks and much hated hippies and anti-conflict protestors. whilst Nixon declared "warfare on tablets" he was attractive to the basest elements of the american voters and it labored, simply because it has worked for other candidates due to the fact that.

The success of his anti-crime/anti-drug campaign provided Nixon with a critical predicament while he took workplace - human beings were waiting for results. at the beginning his management considered admitting that constitutionally crime control was a kingdom duty and offering to act through guide of schooling packages and supply-in-useful resource to state and nearby police forces, however his technique had little political pizzazz and become largely deserted after it failed to impress the general public. Nixon had a few ideas of his very own, together with a nationwide obligatory loss of life penalty for promoting tablets - a method that has been attempted in purple China and in Singapore and has surely failed in both international locations - but fortunately he become greater interested in foreign policy and left the search for a technique to the drug problem inside the arms of John Ehrlichman and the White house home coverage Council.

within the domestic coverage Council Egil "Bud" Krogh Jr., a younger attorney who's better remembered as the man who headed the White residence "plumbers" of Watergate repute, changed into charged with obligation for locating a manner to visibly impact tablets and crime before the 1972 election. Massing portrays Krogh as some thing drawing close the tragic hero of the tale, however i'm no longer sure that many apart from Massing and Krogh himself maintain this type of fantastic view of his public service. anyways, it's far true that Krogh performed a key function in shaping both the best and the awful in the Nixon management's drug rules.

In one in every of his different roles as liaison to the government of the District of Columbia, Krogh had turn out to be familiar with psychiatrist Robert Dupont who turned into jogging one of the early methadone protection programs in DC. Krogh become reluctant to accept a maintenance approach to dependancy however he did see that it changed into the one approach that clearly had a few proof of effectiveness. In June of 1970, Krogh despatched the Council's youngest attorney Jeffrey Donfeld to go to methadone packages in ny and Chicago, along with the first such software, which became directed by way of Vincent Dole and Marie Nyswander of Rockefeller college, and a "combined modality" version advanced by means of college of Chicago psychiatrists Jerome Jaffe and Edward Senay.

Donfeld was doubtful approximately the claimed effectiveness of methadone treatment and even extra doubtful about its political acceptability - in phrases that have on the grounds that come to be acquainted, he questioned if it'd send the wrong message. Donfeld located Jaffe especially to be "politically touchy" to the emotional problems worried in methadone upkeep. Donfeld believed that the "mixed modality method," which he called "extraordinary strokes for distinct parents", through presenting various remedies that protected detoxification, drug-unfastened, and renovation approaches, correctly masked the methadone software from political grievance.

a lot as Raphael Flores is the hero of the first part of the e-book, Jerome Jaffe is Massing's hero for the second component. Jaffe has defined his assembly with an essentially clueless Nixon. He sidestepped Nixon's idea of the death penalty for dealers and suggested that the one fee of regulation enforcement might be in pushing up the street charge of medicine and therefore encouraging greater addicts to seek remedy - this idea was later taken up by way of Peter Reuter of the Rand organization but his research showed that the impact of aggressive regulation enforcement on supply became basically nil and on charge become tiny.

Jaffe attempted to make four points in his assembly with the President an d every changed into to undergo fruit in shaping the destiny of drug policy beneath Nixon. the first changed into the need for more studies and evaluation of treatment. The expansion of a small division in the national Institute of mental health right into a national Institute on Drug Abuse and a countrywide Institute on Alcoholism and Alcohol Abuse grew in component out of this recommendation. 2d, he stated that currently there have been a dozen distinct federal agencies funding treatment that failed to even communicate to each different. He felt that coordination of some of these efforts was wanted in pursuit of a coherent country wide strategy. This led to the introduction of the unique motion workplace for Drug Abuse Prevention, which he changed into startled to locate himself appointed director of, as the nation's first "drug czar". 0.33, given the extent of heroin addiction, he advised that methadone protection need to not be restricted to three small research tasks however ought to be made widely available. Fourth, he urged that funding for treatment be dramatically expanded. these closing  points have been at the coronary heart of what Massing refers to as "The restore".

Jaffe's first huge White residence task become to broaden a plan for controlling the skyrocketing incidence of heroin use amongst U.S. servicemen in Vietnam, which involved 10 to 15 percentage of all GIs in Vietnam if no longer greater. Pentagon coverage was that heroin use was against the law and that any serviceman who used heroin should be arrested and prosecuted. The result of this became an over-pressured army justice gadget however no discount in heroin use. Jaffe urged that the Pentagon have to undertake a treatment approach as opposed to a punitive one.

Massing indicates that Jaffe's solution relied for its effectiveness at the GIs' overpowering preference to return to america. He recommended the Pentagon to issue all GIs to urinalysis earlier than shipping them domestic. GIs who examined tremendous for heroin might ought to live in Vietnam for detox. The navy's reaction to his plan become to item that it'd play havoc with the complicated logistics of troop motion, to which Massing reviews that Jaffe responded, "I cannot consider that the mightiest navy on earth cannot get its troops to piss in a bottle" when his plan changed into applied, Massing reviews that the share of GIs the usage of heroin quick dropped by means of more than 1/2.

Jaffe himself tells it quite in another way. It seems that as an educational and researcher he became privy to the growing evidence that maximum heroin customers do now not grow to be addicted and the early comply with-americashowing that maximum of the troops who have been addicted to heroin in Vietnam abstained efficaciously, and usually with none remedy, after returning domestic (Jaffe and Harris, 1974). He didn't idiot himself into believing that the urine screening software certainly deterred heroin use some of the troops at the same time as serving in Nam. What he predicted turned into that when word of the urinalysis got round heroin using GIs who weren't addicted could stop the usage of for the ultimate weeks before rotation home and simplest the without a doubt addicted would be unable to accomplish that and therefore fail the urine test. that is reputedly what came about however it gave the politically useful appearance of a far greater fulfillment. The conventional follow-up have a look at by way of Robins, et al. (1980) showed that most of the GIs who became addicted to heroin at the same time as serving in Vietnam recovered completely and permanently after returning to the usa and also found that recovery costs have been not advanced by way of receiving treatment - a finding the implications of which i discussed in several publications of that length (Duncan, 1974, 1975, 1976 & 1977).

I accept as true with that the speedy restoration of Vietnam addicts demonstrates that for maximum of the GIs who became addicted, heroin use served as a coping mechanism for coping with the pressure of serving in a struggle quarter. the relief they obtained through using heroin served as a bad reinforcer and poor reinforcement produces powerful habituation. when they returned domestic their heroin using conduct extinguished in an environment in which for most of them it became no longer being bolstered. individuals who persisted in their dependancy, according to Robins, et al. (1980), were those who back to conditions of poverty, an alcoholic discern, and so on. - precisely the ones who would keep to need a stress reliever. treatment was a long way much less applicable than environmental exchange, which is what Moos and his coleagues have determined to be genuine for alcoholism treatment (Moos, Finney, & Cronkite, 1990; Finney & Moos, 1992).

As Massing reviews, Jaffe changed into capable of convince the Nixon management to growth funding for drug abuse remedy eightfold over what it had been while Nixon took workplace. For the best time to date considering that the us began its failed experiment with drug prohibition, the treatment budget become large (twofold) than that for drug law enforcement. Massing attributes a decline in narcotics-related deaths and in crime fees to this finances boom and a extra than 300 percent boom inside the wide variety of individuals in remedy. it'd be first-class for treatment advocates like me if that become authentic but no knowledgeable analyst is in all likelihood to agree that it is.

while more addicts in remedy in all likelihood played some function in decreasing the numbers of narcotics-related deaths, there had been two other elements that probable played a far more function. First, became the introduction in 1971 of naloxone (Narcan®), a complete narcotic antagonist, which replaced nalorphone (Nalline®), a partial narcotic antagonist, as the drug of preference for treating narcotic overdoses. 2nd, turned into the growing popularity of amphetamines and different stimulants resulting in them changing heroin as the primary drug of addiction in the usa. this may additionally have contributed to the decreasing loss of life price in a tertiary style by using decreasing call for for heroin and consequently decreasing the fee and increasing the purity of heroin on the street which could lessen deaths that often result from hypersensitive reactions to the impurities in illicit heroin.

There is strong proof that the provision of methadone upkeep in a network with big numbers of heroin addicts will bring about a discount in rates of belongings crimes, mainly the burglaries and petty thefts that addicts most often interact in to elevate cash to assist their dependancy. it is very likely that the growth of this modality under Nixon and Jaffe did decrease crime rates. Crime costs, however, have been already trending downward and the continuation of that trend became probably extra important than any government coverage.

The gravest defect of The fix lies in its tacit assumption that the general direction and intention of our kingdom's current drug coverage is exceptional and simply desires some tinkering with its finances priorities so as to "restoration" it. well, Nixon failed to restore it, nor will or can any destiny president. The purpose of getting rid of recreational drug use has by no means been finished anywhere nor is there any true reason why society need to be better for reaching this sort of goal.

I directed one of the early remedy facilities to utilize the "mixed modality" method that Jaffe encouraged and that i retain to believe in its value. The fragmented state of maximum remedy offerings these days, so nicely illustrated through Massing's two examples, absolutely is a extreme barrier to the effectiveness of remedy. So i might in reality consider Massing that the usa would advantage greatly from both a go back to more funding for remedy and the usage of multimodality treatment. however no public health problem may be effectively managed via remedy, or secondary and tertiary prevention as we in public health choose to name it. it is most effective through number one prevention that a problem as big as drug addiction can be meaningfully reduced. It simply can not be decreased by way of operating a machine in which among a third and two-thirds of the cutting-edge sufferers don't want any remedy at all due to the fact their drug use is recreational and no longer addictive.

powerful number one prevention of drug abuse, but, must be something far specific from telling human beings to "simply say no" and telling prophylactic lies to youngsters in D.A.R.E. lessons. to start with, effective prevention (primary, secondary or tertiary) need to focus at the real trouble of addiction as opposed to on all use of sure decided on drugs. maximum users of any of the broadly used capsules, except for nicotine users, are not addicted, are not at fantastic hazard of becoming addicted, are not doing any large harm to themselves, and aren't harming all and sundry else by using their use of the drug. Even a small percentage of tobacco smokers aren't addicted and are not harming themselves by means of smoking. Society has no valid interest in stopping drug use but a completely clean interest in stopping dependancy.

2nd, number one prevention cannot be performed by scaring humans -- least of all by scaring them with lies. applications like D.A.R.E. make a robust influence on many preadolescents and early youth who swear they're in no way going to use tablets but via their mid-young adults most of them have learned via commentary that a whole lot the D.A.R.E. officer instructed them was lies and they may be no longer simplest ready to test with capsules but cynical in viewing any valid warnings they might get hold of from adults approximately real risks. powerful prevention need to be based totally on statistics now not scare testimonies. instead of insisting that kids ought to stay drug-loose for all time, which clearly no one in our society is or ought to be, we have to be coaching them how to responsibly determine pills and situations of use so one can select accurately what and when and the way concerning drug use.

Criminalizing capsules and drug use makes all tiers of prevention extra tough. No drug user or abuser is going to be higher off for being arrested. treatment inside the crook justice system is a great idea for people who are arrested for actual crimes inclusive of robbery or attack however remedy in the crook justice device is always preventing an uphill conflict towards the harm executed by way of the gadget. severa studies have shown that any shape of punishment for drug use increases the probability that the drug person will become or persist in being addicted.