Extent of Use Argued : Drug Furor: Overdue or Much Ado?

Police arrested her baby sitter. The boy was 14. He got caught with marijuana. What, Joyce Nalepka wondered, was the world coming to? And then she found out.

“Call me or my husband night or day,” she told the boy, not being one to give up on a youngster in trouble. He did call. He needed a ride to a rock concert. There were extra tickets--she and her sons could come along. When the houselights went down, the joints lit up. The air thickened. The cops just stood by.

Joyce Nalepka stalked out, her sons and the 14-year-old in tow. The next day, she called the U.S. Drug Enforcement Administration. A local matter, they said, adding that this was 1977 and some people, even her congressman, thought marijuana penalties ought to be eased. Then she telephoned the First Lady’s Office at the White House. A Rosalynn Carter aide told her he didn’t understand the fuss.

Church Door Slams

So she took her crusade door to door. One day she stopped at a red-brick church on a busy street. She rang the bell, and a white door opened. A woman read her petition and scowled. “I disagree wholeheartedly!” the woman said. The church door slammed. Joyce Nalepka remembers how that hurt. “I felt melted,” she said.

But now, nearly a decade later, mothers like Joyce Nalepka are no longer out of step with a breezily tolerant America. Ho-hum shrugs have given way to alarm. Much of the public, polls say, thinks drugs are a bigger problem than the economy, unemployment or the threat of war.

The President has declared a crisis and ordered drug testing for federal workers. His advisers liken the battle against drugs to the D-day invasion. Congress echoes with bold proposals about deploying the military.

Question of Proportion

Yet, for all those who say this attention is long overdue, others quietly say this is too much ado. Few doubt that America has a serious drug problem. But the question is one of proportion: Is the sky cloudy, or is the sky falling?

The distinction is a crucial one, for exaggeration damages credibility, and few matters require more straight talk than drugs. Hype can hurt efforts at drug prevention--a muddled enough task that finds educators groping around for a method that works.

The best evidence shows that drug abuse is not a fast poison ever more rapidly speeding through the nation’s bloodstream. Some people have turned to smoking cocaine in a more deadly form called “crack,” and more abusers are turning up in hospital emergency rooms. But the fraction of Americans using cocaine has not increased much over three years. In general, marijuana use has dropped; heroin use has stayed the same. If the nation has a drug crisis, by almost every standard its most stubborn ingredient is alcohol.

“In my lifetime, this is the third or fourth time interest in drugs has just taken off,” said Karst Besteman, deputy director of the National Institute on Drug Abuse from 1974 to 1980 and now head of an association that monitors drug problems. “We have a habit of getting onto the problem, getting excited for a while and then forgetting about it just as quickly. I think we’re seeing the hype now because some people are succumbing to drugs who we didn’t expect to go down the tubes.”

By the most commonly accepted measures--surveys by NIDA--the use of illicit drugs was most widespread in the early 1980s and late 1970s, back when the church door slammed on Joyce Nalepka’s earnest face.

Many Champions

A week ago, she was here in Washington for a conference of the National Federation of Parents for Drug-Free Youth. She is its president. No longer are her phone calls getting sloughed aside. Nancy Reagan came to speak. So did the U.S. secretary of education, the head of the DEA and the commissioner of baseball.

Nalepka was pleased that her cause now has so many champions. But it was also a little odd. It is as if for years she has been yelling that the barn is on fire and is now perplexed to see a bucket brigade so hastily being formed.

“America is so hype oriented,” said the mother from Silver Spring, Md. “I mean, it needed a star’s death to wake it up and that disturbs me.”

On June 19, the nation was startled by the cocaine death of college basketball star Len Bias. By all accounts, he was a clean-cut kid bouncing a ball through a storybook life. The tragedy lifted itself right off the sports pages and shot through the wind like an oncoming siren. Eight days later, cocaine also took the life of pro football’s Don Rogers.

Latest Craze

At the same time, the word crack was ranting its way into the national vocabulary. Like some movie monster that keeps changing shapes, the drug trade had hit upon its latest craze. America may have spun itself free of acid and speed and ‘ludes. But now there was crack. At only $10 a dose, it had priced itself into the ghetto and the schoolyard. A few highs, the experts said, and a user was hooked.

If the media had regarded drug abuse as a footsore story long ago sent off for a rest, newspapers, magazines and television now put drugs back out front in a sprint. The ink and electricity often mixed into a dour message: crisis. The message was unrelenting.

“The lack of attention previously underemphasized the problem, OK? That doesn’t mean that I don’t get tired sometimes of turning on my television set these days and only seeing drug abuse programs,” said Dr. Charles R. Schuster, NIDA’s director.

Lawmakers hopped on the issue like it was a swift freight with boxcars of votes. Sen. Daniel J. Evans (R-Wash.) observed that his colleagues were acting like “a congressional lynch mob . . . a sanctimonious election year stampede.”

Drug Bill

Congress volleyed back and forth with proposals that would have instituted a federal death penalty for drug-related murders, would have permitted the military to pursue and arrest drug suspects and would have allowed prosecutors to use illegally obtained evidence in court.

The final drug bill, passed Friday, included none of those measures, but it did put aside $1.7 billion, mostly for anti-drug police work.

In the meantime, Richard B. Wirthlin, the White House pollster, was studying his summertime numbers and noting that drugs had become the nation’s chief anxiety. President Reagan scooped up the issue, previously the more vigorous cause of his wife. On the evening of Sept. 14, they both spoke to the nation from their residence in the White House.

Drug pushers “are killing America and terrorizing it with slow but sure chemical destruction,” the President said. “Drug abuse is a repudiation of everything America is.” He mandated “a federal mobilization.” He asked for “a national crusade.”

Amid all this din and angst, it was easy to conclude that the nation was shoulder-deep in a new patch of quicksand.

Longstanding Problem

Often overlooked was evidence that America long had been stuck in this same muck--stuck, in fact, during the last six years, when federal contributions to state alcohol and drug treatment and prevention were cut by 30%, according to William Butynski, executive director of the National Assn. of State Alcohol and Drug Abuse Directors.

Besteman, formerly of NIDA, said, “We are paying for our neglect. . . . Every eight to 10 years, the issue gets hot, then it isn’t so hot. But this isn’t a problem you solve in five years, but maybe only in 10 or 20, if you work steadily.”

The extent of drug use, much like adultery, is no easy matter to research. Surveys ask people to confess something they do not usually admit.

“People have to believe the questioner has a good purpose and he’ll keep their confidentiality--two pretty big ifs,” said Dr. Lloyd Johnston, a University of Michigan researcher who studies the drug use of high school students.

For data, most experts turn to NIDA, the federal government’s main source of research about drugs. Yet even NIDA measures drug use among the general population only once every three years--less frequently than the government tracks many other health concerns. That means, year by year, nobody knows with complete satisfaction the answer to one of the most critical questions in the field: how many Americans are abusing what drugs.

Best Data Available

Nevertheless, NIDA’s “household survey” remains the best measure available. It allows respondents to return their answers in a sealed envelope. The latest NIDA sampling was done in 1985. Its results were not released until 10 days ago.

Those findings certainly repeat the sad truth that America has an unacceptable drug problem. About 12% of the respondents admitted that they had used some kind of illicit drug during the previous month, which is the NIDA standard for labeling someone a “current user.”

But that level was about the same as in the 1982 survey. And things were worse in 1979.

For instance, current marijuana use among 12- to 17-year-olds decreased from its peak of 16.7%, or 3.9 million users, in 1979 to 12.2%, or 2.7 million, in 1985. For 18- to 25-year-olds, current marijuana use has slid from 35.4%, or 11.2 million users, in 1979 to 27.4%, or 9 million, in 1982 to 21.6%, or 7.1 million, in 1985. For ages 26 and above, current use in 1985 was down from 6.5% in 1982 to 6.1%, which because of population fluctuation amounts to 8.4 million people in both cases.

Heroin has remained constant at about 500,000 users during these six years. Use of hallucinogens, such as LSD or mescaline, has halved.

Cocaine Increase

In the case of cocaine, considered the most serious new element in the drug problem, the number of current users--those who used the drug at least once in the previous month--went up between 1982 and 1985, but by less than one percentage point for all three age groups.

That rise is not to be taken lightly. It means the number of current users has increased from 4.2 million to 5.7 million people. This is most often pegged to the fact that cocaine has become easier to find--and at cheaper prices.

More troubling yet are data that come from NIDA’s Drug Abuse Warning Network, a count of drug-related emergency room visits and deaths in selected cities. Those numbers have tripled since 1981--a rise attributed to the spread of crack, the potency of the cocaine now being dealt and the physical problems that come after prolonged use.

“We have in our society a ‘b and b’ approach; if bodies aren’t lying in the street and bucks aren’t being spent, no one notices anything,” said Dr. Carlton Turner, director of the White House’s Drug Abuse Policy Office. “Well, the bodies started showing up.”

Crime Rise

Besides this health menace, crack is blamed in many cities for a dramatic surge in crime. In New York, where jails are overwhelmed by drug-related arrests, the city now plans to begin holding prisoners on an unused Staten Island ferry, which will float off Rikers Island.

Nevertheless, many experts urge caution, saying crack is not a wolf at every door. As bad as the problem is--and it particularly curses many inner-city neighborhoods--it is not yet the rampant evil so often portrayed.

“Crack is currently the subject of considerable media attention. The result has been a distortion of the public perception of the extent of crack use as compared to the use of other drugs . . .” the DEA said in a special report last month. “Crack appears to be a secondary rather than a primary problem in most areas.”

As the summer has cooled down into fall, so has some of the hype. Many of those involved, from the press to the professors to the politicians, agree all the talk about drugs has gone out too loudly and sometimes not very clearly. Still, some insist this may be to the good.

‘Vicarious Experience’

“A lot of the hysteria about crack has left people too scared to try it,” said Mark Kleiman, a research fellow in criminal justice at Harvard. “Sometimes, the media inadvertently builds up a market for a drug. But with crack we may have solved the problem through vicarious experience rather than direct experience.”

Turner, the White House adviser, said, “The hype will have a good effect over the long term. Americans are a tolerant people. It takes something to shake them up.”

Others take an opposite view, that scare tactics can be worse than no tactics at all. “It’s hard to believe anything’s a real problem when everything’s a crisis,” said Dr. Ray Lorion, director of the clinical psychology program at the University of Maryland.

Dr. Michael Newcomb, a research psychologist at UCLA, said, “The danger is, parents can be made to overreact if their kids try a little marijuana or a line of cocaine. If parents conclude from that that their kid is a druggie, if they label the kid a deviant, then the reaction is worse than the drug.”

Danger of Exaggeration

Dr. Craig Reinarman, a sociologist at Northeastern University in Boston who specializes in the history of drug problems, said, “The evidence during Prohibition and in the ‘60s suggests that if people hear warnings that are wildly exaggerated--that do not check out with their own experience--they’ll reject all warnings. . . .

“It’s about time to tell the truth. There are dangerous drugs out there, but not everyone--or even most everyone--who uses them is going to die or end up in the street.”

To many, the drug uproar also seems high-hat from a society with such a tolerance for the bottle and the tap.

“The biggest drug problem in the U.S. is alcohol: use, misuse and abuse, it’s all three,” said Dr. Morton Silverman, associate administrator for prevention at the U.S. Alcohol, Drug Abuse and Mental Health Administration. “The general public does not think twice about the consequences or side effects of alcohol.”

In fact, according to the National Assn. of State Alcohol and Drug Abuse Directors, treatment centers had more than 1.1 million admissions for alcohol problems in 1985. That contrasts with about 89,000 for heroin, 61,000 for marijuana and hashish and 40,000 for cocaine.

‘Both Are Very Dangerous’

“If we thought about cocaine and alcohol as being alike, we’d be closer to the truth than to think of them as differently as we do,” said Kleiman of Harvard, a former analyst at the U.S. Justice Department. “Both are very dangerous drugs to start with, because there’s a high risk of getting caught up in a pattern of abuse.”

What is certain, hype or not, is that more people are now ready to try the road not taken: drug abuse prevention, aimed at curbing the demand for drugs--eclipsed until lately by the higher drama of law enforcement efforts to interdict, seize and destroy supplies. Even cops, usually more at home making busts, are trying persuasion. The DEA, Customs Service and Coast Guard have begun anti-drug-abuse education programs.

“Supply reduction obviously can take us only so far,” said Dr. Barry Brown, director of prevention and communications at NIDA. “Demand reduction has certainly come of age.”

As the science of prevention has matured, researchers have identified some things that work and some that don’t.

Early Approach Urged

“Scare tactics don’t work,” said Maureen Sullivan, a NIDA prevention specialist. “That’s like taking high school seniors a week before the prom and having the police come in and do the death-on-the-highway thing. The week before the prom is too late. You have to approach it earlier--way back--and make this just one piece of an overall drug abuse prevention strategy.”

Another thing that does not seem to work--and could be harmful--is trying to teach children a simplified pharmacology course about which drugs are which, said Schuster, the NIDA director.

“If anything, the evidence we have indicates that kids who knew more about drugs used more drugs, and not vice versa,” he said.

Still another thing that does not seem successful, Schuster said, is “sort of children’s T-groups. Remember sensitivity training and all that? It was translated down to the classroom. . . . We said, ‘Well, if we get kids to feel good about themselves, and they feel they are nice human beings, then they obviously would not want to use drugs.’ But it really did not do anything in terms of preventing children from using drugs.”

But two things apparently do work. One of them, according to Catherine Bell, NIDA’s prevention research chief, is providing straightforward information about health dangers.

A Big If

“If the message is appropriate,” she said, “and the information is reliable and based upon pretty well accepted scientific facts, it indeed can motivate or change behavior.”

That is a big if during a season of hype, noted Lorion at the University of Maryland: “It’s like the scare stories--’The Country Is Going to Hell!’ You write about it, and then there’s a flurry of activity. And then there’s a new crisis, and nothing has happened and we haven’t gone to hell.”

The second effective tactic, many researchers agree, is to teach youngsters how to resist peer pressure. “You have to teach technique,” said Kleiman at Harvard. “Declining to use drugs gracefully is a social skill. . . . A lot of kids prefer a way of saying no without insulting their friends.”

While many of the prevention strategies have about them some of the common sense of a grandmother’s nostrum, NIDA also has its eye on more exotic, experimental and even controversial efforts. As an example, officials at NIDA cite Dr. Sheppard Kellam, director of prevention research at Johns Hopkins University in Baltimore.

Kellam’s work suggests that youngsters with certain behavior traits may be predisposed to drug problems and that there may be a way to “inoculate” them before they smoke their first joint or pop their first pill.

Study of First-Graders

For instance, he has studied first-grade boys who are both aggressive and shy--those who fight and break rules and are loners--and determined that they are more likely to become heavy users of alcohol, tobacco and marijuana than their peers.

The question, then, is what would happen if their shy-aggressive behavior could be “managed out” during the early grades--if various learning techniques could be used to “inoculate” them against the later behavior.

He is experimenting with these theories in Baltimore schools. Inevitably, such research raises questions about behavioral engineering, about whether trying to change some traits perceived to be bad may inadvertently suppress others thought to be good.

“It’s possible that with the 6-year-old little tykes we’re talking about, if we reward them for raising their hand and participating in class and for not fighting and breaking rules, we’re also inhibiting them in some other way . . . ,” Kellam conceded.

“(But) we may also be just increasing the child’s repertoire of behavioral responses, and may be in fact getting the child to do behaviors he wouldn’t ordinarily be doing--not losing what he’s got, but gaining other behavior. . . .”

Biology Study

Despite the emphasis on changing behavior, Kellam acknowledges that differences in traits like shyness and aggressiveness among children have very basic roots.

“Our best guess,” he said, “is that the biology of those kids is different.”

Biology is the primary focus of a body of work at NIDA’s Addictive Research Center, headed by Dr. Jerome Jaffe, who once directed President Richard M. Nixon’s war on drugs.

His researchers have interviewed youngsters who have been expelled from school, dividing them, by commonly accepted measures, into those who are the most and the least delinquent.

Then they measured their brain waves.

“What we found,” Jaffe said, “is that the brain waves of these two groups were very different. Although the groups were similar in terms of age, IQ and neighborhood, there were differences in the electrical activity of the brain.

Role of Brain Chemical

“Brain cells talk to each other by releasing chemicals from one nerve onto another. These chemicals excite or inhibit the nerve. Some researchers at the National Institute of Mental Health and also in Sweden have looked at the role of one of these chemicals, called serotonin. They have found that people who are more impulsive and aggressive have low serotonin levels.

“Now, once you’ve established there are differences between people who are vulnerable to drug abuse according to people who are more aggressive or delinquent, could this difference in brain waves that we see be in any way connected with low serotonin?

“Could changing serotonin change behavior? Could changing behavior change vulnerability to drug abuse?”

Those questions might seem far removed from the anxiety of a nation, the suffering of an addict and the simple logic of “Just Say No.”

But they are part of a problem that has cost billions of dollars, confounded a century of presidents and resisted solutions drug after drug and scare after scare.

It is a problem, Joyce Nalepka said, that requires not just a season of hype but the vigilance of a mother’s concern.

Staff writer Karen Tumulty and researchers Nina Green and Lorna Nones contributed to the reporting of this article.

U.S. DRUG AND ALCOHOL USE

SUBSTANCE USE 1979-1985 IN PERCENT

Alcohol Use

Age 12-17 1979 1982 1985 Used in Past Year 53.6 47.3 51.9 Used in Past Month 37.2 26.9 31.4 Age 18-25 Used in Past Year 86.6 83.4 87.2 Used in Past Month 75.9 67.9 71.5 Age 26 and above Used in Past Year 72.4 68.3 73.6 Used in Past Month 61.3 56.7 60.7

Marijuana Use

Age 12-17 1979 1982 1985 Used in Past Year 24.1 20.6 19.9 Used in Past Month 16.6 11.5 12.2 Age 18-25 Used in Past Year 46.9 40.4 36.8 Used in Past Month 35.4 27.4 21.6 Age 26 and above Used in Past Year 9.0 10.6 9.5 Used in Past Month 6.0 6.5 6.1

Heroin Use

Age 12-17 1979 1982 1985 Used in Past Year * * * Used in Past Month * * * Age 18-25 Used in Past Year .8 * 1.0 Used in Past Month * * * Age 26 and above Used in Past Year * * * Used in Past Month * * *

Nonmedical Use of Stimulants

Age 12-17 1979 1982 1985 Used in Past Year 2.2 5.6 4.2 Used in Past Month 1.2 2.6 1.6 Age 18-25 Used in Past Year 10.1 10.8 10.1 Used in Past Month 3.5 4.7 3.8 Age 26 and above Used in Past Year 1.3 1.7 2.6 Used in Past Month .5 .6 .7

Nonmedical Use of Sedatives

Age 12-17 1979 1982 1985 Used in Past Year 2.2 3.7 2.9 Used in Past Month 1.1 1.3 1.0 Age 18-25 Used in Past Year 7.3 8.7 5.1 Used in Past Month 2.8 2.6 1.6 Age 26 and above Used in Past Year .8 1.4 2.0 Used in Past Month * * .6

Cocaine Use

Age 12-17 1979 1982 1985 Used in Past Year 4.2 4.1 4.4 Used in Past Month 1.4 1.6 1.8 Age 18-25 Used in Past Year 19.6 18.8 16.4 Used in Past Month 9.3 6.8 7.7 Age 26 and above Used in Past Year 2.0 3.8 4.2 Used in Past Month .9 1.2 2.0

* less than one-half of 1%

Source: National Institute on Drug Abuse Household Surveys