Beyond the Drug War: Drug Policy, Social Interventions, and the Future

Beyond the Drug War

This week I reached a turning point. The drug war is over for me. It’s immoral, it’s destructive, and worse, it’s not effective.

Supporting it, when legal drugs are both regulated and destructive and we make good efforts to figure out how to balance costs and benefits, is a fool’s errand. So figuring out what options we have besides “legalization” is an important task we must take on.

We need better alternatives. If making drugs illegal is both wrong and carries enormous costs, what can we do differently?

The Drug War Report

On Thursday June 2nd, The Global Commission on Drug Policy declared that the “global war on drugs has failed.”

The global war on drugs has failed, with devastating consequences for individuals and societies around the world… Fundamental reforms in national and global drug control policies are urgently needed.

Vast expenditures on criminalization and repressive measured directed at producers, traffickers and consumers of illegal drugs have clearly failed to effectively curtail supply or consumption… Government expenditures on futile supply reduction strategies and incarceration displace more cost-effective and evidence-based investments in demand and harm reduction.

Rather than repressive measures, the Global Commission recommends the end of criminalization and marginalization of users who do no harm to others, experimentation by governments to see what works between the balance of organized crime and public health, increasing health and treatment services across the board, harm reduction measures aimed at syringe use and infectious disease, and investing in activities that help both small-scale producers (e.g., farmers) and small-scale users (e.g., adolescents) with other viable life options.

In one sense, it is everything one might hope from such a report – internationally respected figures weighing in on the problem, the use of scientific research (including citations!) to back up what they say, and a comprehensive range of recommendations written in clear and accessible language. You can even get the audio from the press release which features the high-profile former heads of states who spearheaded this report.

As the Wall Street Journal summarizes:

The report calls for drug policies based on methods proven to reduce crime, lead to better health and promote economic and social development. It said the U.S. must change its anti-drug policies from being focused on anti-crime approaches to ones rooted in health care and human rights.

But as many of us know, such reports have been written before. That the drug war is failing has been common knowledge for two decades. That there are other options that could work better was right there in the initial critiques of this overarching policy. A science-based, politically expedient report isn’t enough.

As Tom Chivers writes in The Telegraph, The nonsense of a ‘War on Drugs’: The Wire’s writers get it, governments consistently don’t. He captures the immediate response of governments to such a report.

[A British Home Office] spokesperson said: “We have no intention of liberalising our drugs laws. Drugs are illegal because they are harmful – they destroy lives and cause untold misery to families and communities… We are taking action through tough enforcement, both inland and abroad”…

[However] the evidence seems to suggest that there is no link between how harsh the drug laws are and how many people take drugs. Three studies, one by the Cato Institute looking at Portugal, one by the World Health Organisation, and one in the British Medical Journal found that by every measure, intelligently applied regulation of drugs is better than prohibition…

The evidence seems, overwhelmingly, to suggest that prohibition is not just failing to fix drug problems, it is aggravating them… A systematic review in the International Journal of Drug Policy in March of this year… recommended that “since drug prohibition has not meaningfully reduced drug supply, alternative regulatory models will be required if drug supply and drug market violence are to be meaningfully reduced.”

As for an enlightened US response, here is a White House spokesman:

“Making drugs more available, as this report suggests, will make it harder to keep our communities healthy and safe.”

Over at The Atlantic, Conor Friedersdorf writes in response:

It’s been 15 years since William F. Buckley declared in National Review that the war on drugs is lost. We’re living under our third consecutive president who admitted using drugs in youth. Countless law enforcement personnel are willing to acknowledge the folly of prohibition. But the failed policies of old continue anyway against all evidence and common sense.

Common sense isn’t enough. We need to face the problem of the drug war right in its face.

Mexico and the Drug War

Mexico shows the ravages of the drug war. Until this week, I hadn’t really made my mind up about the over-riding emphasis on criminalization and interdiction of drugs worldwide. I had been the good scientist, waiting for more evidence, and the good anthropologist, waiting for something that makes better sense.

Certainly, open legalization is not what I advocate – releasing drugs to the unfettered powers of the capitalist market is not a good option. If they can’t even handle mortgages, what would happen with drugs? Put in that frame, embracing a move towards better policy requires something of a leap of faith. Or, more importantly, the fundamental recognition that something is deeply wrong with what we are doing. Something morally wrong.

I had stayed studiously on the fence until this week. Intellectually I’d gone over it many times. Criminalization doesn’t work. The costs of the present “war” outweigh the costs of how greater access to illegal drugs will lead to an inevitable blip in use and abuse rates. But despite years of living in Colombia, I’d never really come face-to-face with the costs of the drug war there. I had read about, heard about, talked with people about it. But the devastation it causes, the destruction of people’s lives for money and control and profit, I hadn’t stood face-to-face with that. I hadn’t had my “plata o plomo” moment. I never had to choose.

Then I saw these photos of what the drug war means in Mexico, along with the accompanying interview with the photojournalist Claudia Daut who has to edit such an incredible flow of violent images and acts, in Mexico. Here is the reality, captured in horrid violence and utter loss, captured in the moment, and in that photo, we can’t squirm away, we can’t simply forget or say it’s not so bad. It is that bad. These photos show it.

I will only reproduce one here, the one that hurt me the most, the one that captures the human costs of such a war. A grandmother protecting her two grandchildren, and all of them shot dead. Here’s the caption:

A dead woman cradles the bodies of two dead children at a house in Acapulco March 15, 2011. Hitmen stormed the house and shot dead the 70-year old woman and two boys aged six and three years, whom she had tried to protect from the bullets, according to local media.

It would be easy to say the “drug traffickers did this.” But that’s such a poor story. The drugs they traffick flow almost exclusively to the United States. The demand comes from here. And for too many years, the Mexican government treated drug trafficking like just another corruption, manageable and profitable for those in power. And now the violence has hit as a storm of torture, death, and gruesome display.

Nik Steinberg, writing in The Nation, shows that with his excellent journalism in The Monster and Monterrey: The Politics and Cartels of Mexico’s Drug War. Monterrey, the leading financial and industrial center of Mexico, has been run over by drug trafficking and violence. Steinberg eschews the easy story, that the traffickers are all to blame. There is a story here of a corrupt and complicit government that didn’t really know what they were dealing with. I saw the same thing in Colombia, and it cost incredible blood and money to break the cartels’ grip there.

How could thriving Monterrey, the “Sultan of the North,” which only years earlier had been deemed one of the safest cities in Latin America, descend so quickly into chaos? If it could happen here, was anywhere in Mexico safe for long?

Yet what from the outside looked like a sudden collapse was in reality decades in the making. At its root was the decay of the institutions entrusted with providing law and order, ones that, despite their chronic dysfunction and corruption, had been able to contain drug violence in the old state-run system. But when that system crumbled, and when, in the face of “the monster” of organized crime, Monterrey’s elite, politicians and public turned to those institutions to rescue them, they found them rotten to the core.

Legalization

The United States government is supposedly made of sterner stuff. Their corruption is not easy money and institutional decay. It’s the sheer rigidity of their approach – an approach of annihilation and denial eerily reminiscent of drug users themselves. It is tyrannical more than puritanical. A war can never be lost, no matter the cost, even when the enemy (demand) comes from our own people…

Indeed, when declarations like the “drug war has failed” come along, many assume that the only option is capitulation, an unholy union of legal approval and immoral hypocrisy wrapped in one. With the framing of a drug war, losing it means giving free rein to drugs.

Nothing could be further from the truth. Almost everyone recognizes the dangers of drug use, and if they don’t, it doesn’t take that much evidence to convince them – just look at the damages associated with alcohol and tobacco. The either/or mentality – either fully legal or stiff prison sentences – is just useless in trying to deal with drugs.

Of course not everyone thinks legalization should even be an option. When drug policy came up on Fox News recently, host Sean Hannity said this about treating drugs as a public health issue, not a criminal one:

How do you get the conservative base, a lot of which are Christian conservatives — the idea that America would legalize or go down this road is repugnant to me. I don’t think government should have that role in the moral destruction of a human soul, which is predictable by giving them those drugs.

The legalization folks have tended to be rather inflexible when they argue for de-criminalization. The counter-argument is so easy – that’s immoral, or as we saw above, drugs destroy communities. Together, those make an easy argument for drug use as something criminal. How dare you even think of permitting something like that? What are you, soft on crime?

Yet I believe legalization has to be on the table when discussing drug policy. Prescription drugs, alcohol, cigarettes – these are all addictive substances that can destroy communities. And they are legal, and we know a lot about regulating them. So thinking seriously about legalization is important.

So here are some counter-argument to the immoral dismissal of drug legalization.

-Sean Hannity, you’re the one soft on crime. You’re giving these criminal organizations their blood money, and they use it to kill people. Let’s get hard about organized crime, and also crimes that drugs users do commit, like assault or robbery.

-Sean Hannity, you like making people sick, don’t you? Instead of getting people treatment, you’d rather throw them in jail, and spend millions of people’s tax dollars on keeping them in a cell.

-Sean Hannity, I thought we were beyond “separate but equal” in the United States. Someone rich and famous can get off if they get caught with cocaine, but be a poor black kid with crack, and it’s off to jail.

-Sean Hannity, I never realized you were so in favor of big government, of government telling us what we should do on our private time, and creating all this bureaucracy that is just adding to the national debt.

The counter-arguments are easy to develop. And like good politicians everywhere, they don’t address the specific issue raised – they work to their own talking points.

A Problem-Based Approach

Full legalization is not even on the table anyway. Drugs are controlled substances, like lots others that we deal with on a daily basis. Does making possession of that substance a crime solve the problem of addiction? No. Does it create other problems, some of them terrible in nature? Yes.

So, what do we do? The first step is to get away from thinking that there is only one answer – that drugs are a “one size fits all problem” either legal or illegal. One-size policy is a terrible idea for drugs.

For example, even though Portugal has recently gone through a successful decriminalization of drug use, I wouldn’t suggest the same approach for the US as a whole, certainly not as a federal initiative. Rather, states and cities should have the ability to experiment for themselves, to find out what works for their local communities. At the same time, this experimentation will help us better figure what sorts of policies are effective in different situations, paving the way to more innovative approaches over the long-term.

Developing ideas and evidence for policy is crucial. A more local approach also avoids another major mistake in the US drug war approach – a top-down, hegemonic approach, where policy is dictated by the federal government eager to maintain its powerful grip over chemicals of all sorts and to also have policy that supports foreign influence and intervention at various levels. But the top-down approach is also problematic for two related reasons.

First, legalization, particularly at the level of state-controlled trade and decriminalization of possession, is not a panacea. Just look at alcohol and alcoholism, tobacco and cancer, prescription drugs and overdoses – legal drugs are problematic. Many frame these problems of legal use as “public health” problems. As Don Weatherburn (2009) writes in Dilemmas in harm minimization:

Some of the harms associated with drug use are not, in any meaningful sense, ‘public health’ harms (e.g. loss of public amenity, poor school performance, theft). Rather than adopt any general guiding principle [like “public health”], it would make more sense to try to reach agreement on the specific drug problems we want to reduce and make their reduction the goal of illicit drug policy.

Thus, instead of saying we want to minimize the harm associated with injecting drug use, we might (for example) simply say that we want only to minimize the number of new recruits to injecting drug use, encourage more injecting drug users into treatment, reduce the crime committed by injecting drug users and improve public amenity in areas where injecting drug use is prevalent.

A problem-focused approach avoids the either/or of the drug legalization debate, while permitting us to focus ideas from different arenas on tackling specific problems related to legal and illegal drug use.

Second, with an approach that maintains drugs as illegal, there are a variety of policy options which can make a difference. In other words, there are ways to change how we approach the problem of drug use right now.

Here are four ideas. These are based on my own experiences. There are more out there, and I’ll cover some of them in the section below on Social Interventions. But these are ones that I think matter in the context of doing legal work and making a criminal justice approach more effective than it presently is.

-Fairness in drug laws. This change is happening right now in the United States, in particular with the different sentencing that has happened for decades with cocaine possession versus crack possession. There should not be different laws based largely on social class and social control; similar drugs should be treated in similar manners. Being fair in application, and thus emphasizing justice in the law over moral and social condemnation of different types of users, should be a cornerstone of any legislation.

-Focusing on the consequences that come with excessive drug use, rather than on simple possession. While alcohol remains legal over individuals over 21, policy has maintained a decades-long crackdown on drunk driving, which puts other people at risk and punishes people for the negative consequences of their behavior, rather than use itself. Similar policies that target harmful behaviors users commit is an utter necessity.

-Mandated treatment and social restitution, rather than jail. Jail doesn’t fix an addict. It does punish them, and often that worsens things. Ramping up court-ordered programs and forcing users to face what they have done through making amends, as many innovative drug courts are doing, is an approach that fulfills one of the cornerstones of the criminal justice system – the long-term protection of the community and the rehabilitation of individuals found to commit acts in counter to commonly established laws.

-An emphasis on small costs to drug users, things that are immediate and that provide feedback to users about their behavior. A jail sentence is rather like swinging to hit it out of the park, and with drug users, current policy is simply striking out. A switch to small ball, to a focus on what can help more in changing their behavior, is an important next step. Confiscation of drugs without further consequence, fines for possession, obliging users to show up in court and face social judgment, the development of short-course treatment programs (from a one day intensive program, to a series of short-term interventions over weeks), and one or two day jail sentences are all ways to generate change using a criminal justice approach.

Addiction and Social Interventions

Social interventions for addiction need continued development. Prevention programs are fairly well-developed but not particularly efficacious, especially over the long-term and with high-risk populations. Policy development is good with regards to tobacco but less so with alcohol and even less with illegal drugs. Besides tobacco control, the other well-developed intervention is targeting injection drug use and HIV transmission.

Prevention programs largely focus on trying to reduce individual risk factors, particularly on providing individuals with knowledge about the dangers of drugs and training in skills to refuse drugs. In other words, prevention approaches have been largely cognitive-behavioral in approach, with some additional focus on families. The main message from examination of prevention interventions is that well-designed one can work (even though popular ones like D.A.R.E do not), but that their effects fade over time and “booster shots” are often needed. In other words, prevention needs to be a continual process.

Here is one example, Spoth et al. (2008), Long-term effects of universal preventive interventions on prescription drug misuse. This program focuses on family and school programs that help reduce prescription drug misuse over a year, but do not necessarily produce permanent effects. For more about the program, you can see the Iowa Strengthening Families Program, especially this page on the program for families and youth ages 10-14.

However, this type of prevention research has also been critiqued for not being rigorous enough to show that prevention really does its job: Midford, Is this the path to effective prevention? and and Gorman & Conde, Drawing reasonable conclusions about prevention.

Addressing risk factors has been less successful, as many of the most powerful factors are social and impact broad arenas of health – for example, childhood adverse experiences, or delinquency and school failure during adolescence. Targeted intervention efforts to target specific risk factors for addiction, for example, early initiation into drug use, have not really been done, as either these same individuals face a suite of social problems or this type of effort gets wrapped up in a larger, more diffuse prevention effort.

For more general information, head over to the Guide to Community Preventive Services, with science-based reviews and recommendations on alcohol, obesity, and tobacco, as well as a range of other health problems.

Harm reduction and harm minimization have been reasonably well received. A good overview of public health and harm reduction is in this 2010 annual review article by leading addiction researcher Alan Marlatt and Katie Witkiewitz, Update on Harm-Reduction Policy and Intervention Research.

The major focus has been on reducing HIV transmission due to injection drug use, including needle exchange programs and the provision of cleaning materials to sterilize equipment. This paper on HIV & injection drug use, Auerbach (2009), Transforming social structures and environments to help in HIV prevention, covers how this approach works, and how social policy and institutional engagement are a necessary part of this type of approach.

The best evidence for social interventions is with smoking. Policy change (e.g., taxes, access, public spaces), health information (warning labels, disseminating evidence on links to cancer), and social change (stigmatization) came together to drive major reductions in smoking in the United States. But the core group of smokers remaining is, not surprisingly, the most socially marginalized, where inequality and stress/trauma come together and where smoking still works as a social marker of identity.

Here’s a recent review of what smoking interventions might work best for “social inequalities in smoking” – Thomas et al. 2008, Population tobacco control interventions and their effects on social inequalities in smoking: systematic review. Also, a review of smoking cessation and socioeconomic status, Hisock et al. (2011), Social inequalities in quitting smoking: what factors mediate the relationship between socioeconomic position and smoking cessation? This paper highlights the role of quitting treatment in not sticking with quitting, but then doesn’t ask the obvious question of why poorer people don’t stick with treatment. This sort of research is sorely needed, linking social context and embodied risk with the factors epidemiology reveals to make a difference at the micro-level.

Thankfully, Tim Rhodes’ (2009) excellent paper does just that – Risk environments and drug harms: A social science for harm reduction approach.

Harm is contingent upon social context, comprising interactions between individuals and environments… The relations between individuals and environments impact on the production and reduction of drug harms, and this is reflected by broader debates in the social epidemiology, political economy, and sociology of health…

Social epidemiology takes us beyond a focus on individual risk factors, while political economy us the tools to understand how and why risk is spread differently across contexts. Public health isn’t merely for the public good, but also a way to govern populations – something that can hamper how social interventions are developed and instituted. And the everyday habits and practices of users help us to understand how these “structural risk environments” get incorporated into experience

.

This use of social theory and research to augment our thinking about social interventions is important. Equally important is building evidence-based approaches to social interventions. This too is a field in development, and a suite to recent articles focus on the methods and evidence needed to establish that these types of efforts make a difference. In doing so, they also cover studies that document good social interventions in a broad array of areas, so it’s a win-win.

Brownson et al. (2009), Evidence-based public health: A fundamental concept for public health practice

Ogilvie et al. (2005), Systematic reviews of health effects of social interventions: 2. Best available evidence: How low should you go?

Braveman et al. (2011), When do we know enough to recommend action on the social determinants of health?

Bambra et al. (2010), Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews

In the end, thinking about targeting communities and targeting policy is a very different way of thinking than how most prevention people and medical doctors work. Moreover, government officials are largely focused on monetary policy in one way or another, from taxes to funding schools to social security.

Community-based policy, with social interventions that take place outside the rubric of determining funding for programs and provisioning information and skills to individuals, has not been part of what institutions do – these institutions fear they cannot control it and have little experience with it. But with drugs, this type of societal approach is desperately needed.

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17 Responses to Beyond the Drug War: Drug Policy, Social Interventions, and the Future

  1. Maia Szalavitz says:

    Mandated treatment is a terrible road to go down. If you are going to say that addiction is a disease or disorder or medical problem like diabetes or anything else, you can’t have judges or police interfering in medicine or medical judgment. If you are going to end the drug war, you’ve got to end the idea that addicts need to be punished.

    Mandated treatment gives treatment providers a free, ongoing supply of customers without options who are not actually their clients: the justice system is the client. Who goes to jail if treatment fails? Not the drugs counselor! Not the guy who runs the program! Who is held accountable if the patient is abused? No one. In fact, abuse is good because it is punitive.

    What you want to mandate (if you insist on using the justice system) is abstinence from the drug involved (or maintenance on an appropriate legal supply with either the drug of choice or one that works better for that particular person). That way, those who don’t need treatment don’t have to waste their time or our money, the treatment providers have to work to be user-friendly (which the evidence shows is more effective) and the client of the system is the patient, which is how it should be. If you mandate treatment, you basically turn treatment programs into prisons and counselors into cops. You wind up with all manner of stupidity like “no maintenance allowed” even when maintenance is the best supported option.

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  2. malcolm kyle says:

    Some simple facts:

    #1. Many people will always feel the need to use drugs such as heroin, opium, nicotine, amphetamines, alcohol, sugar, caffeine, etc.

    #2. Due to Prohibition, the availability of mind-altering drugs has become so universal and unfettered, that in any city of the civilized world, any one of us would be able to procure practically any drug we wish within an hour.

    #3. The massive majority of people who use drugs do so recreationally – getting high at the weekend, then up for work on Monday morning.

    #4. A small minority of people experience drug use as problematic.

    #5. Throughout history, the prohibition of any mind-altering substance has always exploded usage rates, overcrowded jails, fueled organized crime, created rampant corruption of law-enforcement and whole governments while invariably causing thousands of deaths.

    #6. It’s not even possible to keep drugs out of prisons, but prohibitionists wish to waste hundreds of billions in a wasted attempt to keep them off our streets.

    #7. Prohibition kills more people and ruins more lives than the prohibited drugs have ever done.

    #8. As with torture, prohibition is a grievous crime against humanity. If you support it, tolerate it, or simply look the other way while others commit it, then you are an accessory to a very serious crime.

    #9. America re-legalized drug use in 1933. The drug was alcohol, and the 21st amendment re-legalized its production, distribution and sale. Both alcohol consumption and violent crime dropped immediately as a result, and, very soon after, the American economy climbed out of that same prohibition engendered abyss into which it had previously fallen.

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  3. The War on Drugs failed Billions of dollars ago! This money could have been used for outreach programs to clean up the bad end of drug abuse by providing free HIV testing, free rehab, and clean needles. Harmless drugs like marijuana could be legalized to help boost our damaged economy. Cannabis can provide hemp for countless natural recourses and the tax revenue from sales alone would pull every state in our country out of the red! Vote Teapot, PASS IT, and legalize it. Voice you opinion with the movement and check out my pro-cannabis art at http://dregstudiosart.blogspot.com/2011/01/vote-teapot-2011.html

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  4. Pingback: Should we legalize marijuana? – Houma Courier : TOP MOBS

  5. Jaap Timmer says:

    Great piece and I can only add that it would be wise to learn from decades-long experimentation with drug policies in my most favourite city, Amsterdam. Unfortunately the Dutch experience with drugs should alter the state of consciousness of many in this world. As an exemplar it is well-known but there’s a tendency among policy-makers to remain (perhaps deliberately) oblivious to it. Unfortunately much is changing in the Netherlands recently, largely because of growing right-wing thinking and EU pressure that is also affected by the kind of policy-making tendencies pointed out in your blog. Wikipedia has a good overview of the Dutch drug policies (and I recommend this page realising that I discourage my students to rely on Wikipedia for their research and essay-writings): http://en.wikipedia.org/wiki/Drug_policy_of_the_Netherlands

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  6. Mark Flanagan says:

    I enjoyed the article and thought it had some fantastic points to make, particularly about the high cost of implementing a non-local drug control policy. If we do not describe the “how” of drug use in the context of a particular culture, we have very little chance of discovering sustainable interventions that meshes with the people that are using.

    Also, many of the problems associated with excessive consumption of drugs have to do with the purpose and context with which it is ingested. Tobacco smoking served a very different purpose for Native Americans than it does for modern Americans. These purposes, as you have thoroughly discussed, are related a capitalist mode of production. Blaming or banning the drug itself (except in some salient cases) does little to rectify why problems are arising in the first place.

    Outlawing the taxation and regulation of drugs, like other commodities, creates a vacuum that has been filled time and time again by strong-arms. Prohibit alcohol, fund the mafia. Prohibit marijuana, fund the Gulf Cartel. When you restrict access to forbidden fruit, a snake will come to provide for you. While I don’t agree with blanket legalization (for instance, I would be hard pressed to find a culture that has not been devastated by meth), I do think that restriction should be reserved for those drugs that are most devastating in and of their induced physiological effects on the body.

    I have a slightly different take on mandated treatment as well. You write:

    “Mandated treatment and social restitution, rather than jail. Jail doesn’t fix an addict. It does punish them, and often that worsens things. Ramping up court-ordered programs and forcing users to face what they have done through making amends, as many innovative drug courts are doing, is an approach that fulfills one of the cornerstones of the criminal justice system – the long-term protection of the community and the rehabilitation of individuals found to commit acts in counter to commonly established laws.”

    I agree that jail doesn’t fix an addict. In many cases, it heightens the disorder. However, I’ve also found through interviews of prescription drug addicts — one of whom was my friend I had known since middle school — that mandated treatment seldom yields a change in motivation. I attended NA meetings with my friend, helped explain the 12-step process to him, and was there with him through the whole 6 month process. The day after mandated treatment ended, my friend began using again.

    The problem with court mandated sentences, as it stands now in most cases around the world, is that recovery functions as putative endeavor. The emphasis is on “the long term protection of the community” and not the long term recovery of an individual with an addictive disorder. This makes many mandated individuals spiteful of governmental coercion, even if it means they pocket a get-out-of-jail-free card.

    I do think the emphasis should be on treatment. But the individual needs to be motivated to change. Court programs, some of which are being developed in Decatur and Atlanta with help from Miriam Boeri, focus on giving an individual options for recovery within a structured program. Rather than 12-step, pee tests, and “check-ins” which made up the bulk of my friend’s program, these new programs being developed have options to chose recovery through a combination of physical activity, spiritual exercises, behavioral-cognitive therapy, group therapy, financial counseling, among others. An individual needs to complete a required number of activities per month but the types of activities within each category vary, giving the individual incentives to chose something that might resonate with them. The more an individual identifies with his or her recovery process, the better chance they have to continue such a program once the mandated process stops.

    Motivational interviewing would also be a great addition to the required recovery tool-belt.

    I don’t disagree with court mandated sentences, but I do disagree with how they are actually applied in most cases.

    Great post, though. I’m going to be reading these links for days :-)

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  7. Mark Flanagan says:

    Oops! I didn’t mean to block quote the second half of my response. I meant to block-quote your post about mandated sentences, and then continue in normal font. I’m ever learning the blog-o-sphere.

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  8. daniel.lende says:

    NPR provides good coverage of a new US Senate report that “U.S. Drug War Spending Is Injustifiable.”

    Here is the money quote:

    “We are wasting tax dollars and throwing money at a problem without even knowing what we are getting in return,” said Sen.Claire McCaskill (D-Mo.).

    But what’s more disturbing is the White House response:

    White House officials say the expanding U.S. counter-narcotics effort occupies a growing portion of time for President Obama’s national security team even though it garners few headlines or congressional hearings in Washington.

    This is what they’re spending their time on, a war that isn’t even a war, that an international commission and a Senate committee have identified as a failed approach, and something that has other ways to tackle how this relates to security?

    No, sorry, not just spending time – a growing portion of it…

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  9. daniel.lende says:

    Just wanted to add my two-cents about mandated treatment. Maia is right, there are some bad mandated treatment programs out there, as her book Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids documents.

    And like Maia says, mandated treatment raises thorny ethical, legal, and therapeutic issues. So does the over-arching Drug War. Two of my main points is that we have to address these complexities if we’re going to do something more effective, and we have to experiment with different approaches and in different places to get a better idea of what can work where.

    Mandating abstinence could be one part of that. Mandating treatment could be another, where it’s a short-course like I suggest as an idea or something more traditional.

    As Mark illustrates, Miriam Boeri and drug courts in Georgia are doing innovative things (see her paper, Social Recovery, Social Capital, and Drug Courts), and that’s exactly the sort of thing I advocate. I wouldn’t want to take an option off the table as we aim to develop that innovation.

    My experience with mandated treatment is different, and based in my years as a counselor in Colombia and then a researcher of a program where a large proportion of the adolescents there came from the criminal justice system. There was good coordination between the justice system, the goverment family well-being system, and the treatment center. It worked well, and the program was as successful as other treatment programs at the time. So I do think a policy of mandated treatment can be executed well.

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  10. Maia Szalavitz says:

    Daniel, but why insist on mandating treatment? Why not mandate avoidance of the problem drug (with maintenance allowed and with testing by the justice system) and separate the treatment system and the justice system?

    If you mandate abstinence, the patient gets to choose the treatment (if anything) and if they can’t do it without treatment, they discover that quickly.

    (In Mark Kleiman’s version of this system, they get mandated into treatment or get 1 day of jail immediately on failing a certain number of tests as a way of using the system to provide consequences that are annoying, fast, and definite which are more effective at changing behavior than consequences that are devastating, not linked in time with the offense and unpredictable).

    If they can do it without treatment, you’ve saved money and wasted no one’s time. If not, you’ve helped them realize that they need help and can’t do it on their own—which is often what it takes to get people to be motivated in treatment.

    This also forces treatment centers to be more user-friendly because they have to work to attract clients, they can’t just sit back and get them with no strings attached from the government.

    If you were building cars that no one wanted to buy, would you solve the problem by having the government mandate that people buy them? By having people’s partners force them to buy them? Or would you try to attract customers by making a better product? I think you get much better treatment if people have to choose it themselves. In fact, research by William Miller on alcoholism found that if you mandated abstinence or moderate drinking, *both* approaches were less effective than if you allowed people to choose the approach they preferred. Why is mandating treatment rather than offering choices better than this system? I think we have to get beyond the idea that we need to force addicts into treatment— if we don’t, we’ll never get better treatment and we’ll never get beyond the drug war because the idea that addicts won’t seek help without force is part of what maintains it.

    Ironically, of course, people seek help for alcohol and nicotine all the time with no force at all.

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  11. daniel.lende says:

    Just came across this piece by former police chief Norm Stamper, Drug Warrior No More. A personal retrospective, he writes this at the end:

    According to Harvard economist Jeffrey Miron, drug legalization would save $77 billion a year. It would free up close to half the nation’s prison cells, reserving them for violent offenders. We would be able to invest substantially more time, money, and imagination in prevention, education, and drug treatment. And, we would make our communities much safer and healthier.

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  13. I bet we see marijuana legalized in 5 years or less.

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  14. Alan Raymond Muller says:

    Here in California we have proposition 36 diverting people from prison terms who are caught with prohibited drugs listed in the federal schedule. But only you are not dealing them. Treatment is mandated along with random drug testing. and attendance at Narcotics Anonymous All very twelve step oriented The whole chorus of the “god” as you know him crowd- Judges, Probation Officers, Public Defenders, Drug courts, all twisting your arm with the threat of prison or jail
    Not only is theology rammed down your throat but if you complain too loudly you are marked “unnameable to treatment” and sent back to the criminal justice system.
    As an atheist you choice is to embrace a religious belief in the supernatural or go to prison
    Maybe the weirdest thing is that Marijuana under prop 36 is treated just like the federal statues , declaring that marijuana has no medical use and is a schedule one drug . As you may know Proposition 36 was passed in 2000 Fully four years after prop 215 (which made it legal to possess if recommended by a doctor for medical use ) Both Torquemada and Franz Kafka would marvel. Also that the local prohibitionist claims that marijuana is addictive , ” Just look at all them folks in treatment” , injects Propaganda to the mix . Huge amounts of money are collected by shaking down parents at $1000 a whack for no frills treatment ( as public funding has dried up. )
    That or make Junior go to the joint and have a criminal record

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  15. Pingback: Newtown and Violence – No Easy Answers | Neuroanthropology

  16. Pingback: Drugs as Tools of Social War and Violence | meli13ism

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