Bush Plans to Spend Millions Arresting Drug Dealers and Treating Addicts. Doesn’t He Know What the Experts Say? : NOTHING WORKS

JAMES A. VAN HORN JR. sits at a table in the spacious Congressional Room of the Capital Hilton in Washington, listening as a parade of federal bureaucrats prescribe their latest remedies for America’s drug problem. The husky, heavily bearded mayor of Artesia doesn’t need to be reminded of the facts that brought him here: The county of Los Angeles has 80,000 known gang members. That’s the equivalent of four Army divisions, he’ll tell you. They control the streets and franchise the drug trade. The police are outmanned and outgunned.

So far, there have only been a few murders, only one drug-dealing gang in Van Horn’s predominantly working- class, industrial community. But, as he likes to say: “The hoodlums of Los Angeles don’t know any boundaries.”

So heavily does the problem of drugs weigh on the spirits of Van Horn and most American mayors that they have changed the name of their annual “National Conference on Crime” in Washington this year to “National Conference on Crime and Drugs.” And most invoke the imagery of war when they call on the federal government to help them eliminate the scourge of drugs. “The country doesn’t need a federal narcotics czar. It needs a supreme allied commander,” Van Horn tells the mayors. He envisions that commander leading an army with a single-minded mission: to squelch the drug hoodlums and wipe out the supply of drugs.

But what he hears from the experts he’d hoped to count on to lead the war against drugs drives him to fury. Some of the federal bureaucrats in the forefront of the war are urging the mayors to focus on cutting the demand for drugs, not the supply.

“I’ve been in law enforcement for 24 years,” Thomas C. Kelly, the smiling, smooth-shaven deputy administrator of the federal government’s Drug Enforcement Administration, tells the mayors, “but I’m not ashamed to tell you that law enforcement is not the answer to our problem.”

On hearing that, Van Horn steps up to a microphone near his table and bellows into it angrily. “You see, guys, the Viet Cong is abroad in our society,” he shouts. “We have guerrillas in the street armed with AK assault rifles. Our job now is to get our streets back.” The mayor demands that the United States recall its troops from Europe, where, he says, they are unwanted anyway, and enlist them in the fight against drugs. All the money saved from closing bases overseas could then fund more police. “What we don’t need,” he says to a reporter later, “are bureaucrats who sit in Washington and pontificate about demand. I’m sick of it.”

The meeting of the nation’s mayors reflects a bitter truth about the nature of the country’s fearsome drug problem: While public pressure mounts and politicians sound ever-more-strident calls for a renewed war on drugs, a deep sense of pessimism pervades the ranks of the specialists who deal most directly with narcotics and narcotics addicts. They’ve been thwarted, they say, at every turn.

Peter Reuter is an Australian researcher for the RAND Corp. whose work is highly regarded by specialists on all sides of the narcotics field. “At the moment,” he says, sitting in his book-lined office in Washington, “the conventional wisdom is (that) nothing works. It’s a view that comes out of despair.”

Reuter does not share this despair completely, but he contributed to it last year with a pair of reports crammed with statistical evidence indicating that the much-publicized patrolling of borders and policing of the streets during the past eight years have failed to damage the drug trade significantly.

President Bush is not ready to accept this dismal view. He and federal drug czar William J. Bennett often invoke furious allusions to war when they talk about drugs. Last month, in his first dramatic act as director of the White House Office of National Drug Control Policy, Bennett excoriated the Washington drug scene as being “out of control,” scorned the leaders of the city and sent a task force of federal agents into the battle. Bennett’s tone was so belligerent that Rep. Lawrence J. Smith (D-Fla.) mocked him for trying to act like “a supercop with a red cape and blue suit.”

Despite all the rhetoric, however, Bush and his officials acknowledge that the paramilitary approach so dear to the hearts of many politicians falls short of a complete answer. And there is little doubt that Bennett, as he develops the national drug-control strategy he’s required to outline under the 1988 law that created his job, will underscore the more soft-spoken themes already voiced by the DEA’s Kelly and by the President.

Bush proclaimed in a Feb. 10 address to a joint session of Congress that “the scourge of drugs must be stopped.” He asked for almost a billion dollars more in spending “to escalate the war against drugs . . . on all fronts.” He said the money should be spent on border controls, tough law enforcement, education and research.

“But for all we do in law enforcement, in interdiction and treatment,” Bush went on, “we will never win this war on drugs unless we stop the demand for drugs.” The President was echoing a prevalent view in the federal government these days that sounds like an answer to a sphinx’s riddle: If you can’t cut the demand for drugs, it’s a hopeless task trying to cut off the supply; if you can cut the demand, it won’t matter what happens to the supply.

Even as Washington prepares to pour millions of new dollars into the nation’s struggle, the people closest to the problem--from front-line police officers to doctors and scientists probing the roots of drug use--admit that they have little confidence in anything they’ve tried so far.

The Failure of the Reagan War

THE REAGAN ADMINISTRATION put most of its faith and resources into the paramilitary approach to fighting drugs. Treatment and education were neglected while federal narcotics agents, customs officers, Coast Guardsmen, border guards, local police, prosecutors and judges concentrated on fighting the system that supplies the drugs. The statistics seemed impressive: Seizures of cocaine and heroin, numbers of arrests, length of jail terms all increased dramatically. But so did the supply of drugs.

The value of such policing was directly challenged last year in the depressing reports done by research teams working under Reuter at the RAND Corp., the prestigious research institute that often prepares studies for the Department of Defense.

In the first report, requested by the Pentagon, the RAND team concluded that the U.S. government, despite having spent more than $700 million a year on trying to stop cocaine from crossing the borders, had accomplished little more than increasing the earnings of producers in Colombia, Peru and Bolivia. Whenever cocaine is seized, smugglers simply buy more from the producers and try again to slip it into the United States. The total seized by the Coast Guard and Customs Bureau increased from 1.7 metric tons of cocaine in 1981 to 27.2 metric tons in 1986. (One metric ton is about 2,205 pounds.)

But the researchers insisted that these enormous seizures--usually ballyhooed as battlefield victories--only reflect the increase in the amount of cocaine entering the United States. Citing official surveys, the RAND report estimated that cocaine imports jumped from between 38 tons and 68 tons in 1981 to between 111 tons and 153 tons in 1985. The cost of cocaine in the United States, according to the Department of Justice, dropped from $60,000 a kilogram in 1981 to $35,000 a kilogram in 1986, another sign that, despite the war, cocaine was more--not less--plentiful in the United States.

“If . . . the United States wished to prevent the smuggling of Japanese-manufactured automobiles, it could probably succeed with relatively little effort,” Reuter wrote. “ . . . Cocaine represents almost the opposite kind of target. . . . A single cargo plane, fully loaded, could supply the nation’s current demand for a year.”

The second RAND report--an analysis of the war on drugs in Washington prepared for the Greater Washington Research Center--was even more discouraging for police and narcotics agents. Despite all the abuse heaped upon Washington these days as a glaring failure in law enforcement, many politicians and drug experts were praising it just a couple of years ago as a grand success. Specialists had looked on the capital as a model city in terms of its attempt to wipe out the drug trade through tough enforcement. Washington police had organized sweeps of drug markets without letup. In six years, the number of arrests for drug trafficking increased more than 12 times, from 408 in 1981 to 5,274 in 1986. Prosecutors indicted a heavy percentage of those arrested, juries convicted them, and judges doubled the average length of prison sentences.

Yet the researchers could find no evidence that law enforcement had hurt the drug trade. Police raids of markets often did little more than drive these markets to other streets. The street price of drugs even declined. The percentage of arrested Washingtonians testing positive for cocaine increased from 15% in March, 1984, to 60% in December, 1987. Studying results from these tests and from polls of the rest of the population, Reuter wrote: “The available drug-use indicators show no decline. Indeed they point to growing use for more dangerous drugs”--mainly crack, a cheaper and smokable form of cocaine.

“More disturbing,” the report went on, “is the possibility that the intensified enforcement has raised the violence of the drug trade, simply because the participants feel more threatened. . . . Dealers threatened with a high probability of a lengthy prison sentence following arrest have strong incentives for resistance.”

As crack dealers fought over territory in a new market, murders increased steadily in Washington, reaching a record of 372 last year.

In this climate of escalating violence, the federal narcotics czar allocated most of the $70 million to $80 million to be poured into the city’s “drug emergency assistance program” into more law-enforcement measures: a task force of 57 federal agents to wipe out the city’s open-air drug markets, a new detention center and a new prison. He also assigned 25 FBI agents and 10 U.S. military lawyers to augment the task force’s investigations.

But, following the latest strategy, Bennett did not ignore treatment and education, promising to build three new clinics to treat a total of 300 outpatients and to increase federal spending for drug-prevention programs in the Washington schools to $1.4 million.

Still, the Bennett program evokes little enthusiasm from most specialists. Says James Fyfe, a tall, baggy-sweatered former New York City policeman who is now a professor of criminal justice at American University in Washington: “It’s like little Peter putting his finger in the dike. He can’t keep his finger in there forever. Someday you have to fix the dike.” Fyfe insists that Washington will never solve the inner-city problems of drugs and crime until American society faces up to the root causes of poverty and racial discrimination that spawn the problems.

But most law-enforcement officials do not intend to wait for that utopia. They are placing their hopes of cutting the demand for drugs on education and treatment--even though most of these hopes are founded on meager evidence. Relatively little education and treatment has been tried. In 1986, according to the RAND Corp., federal, state and municipal governments spent $6 billion on drug law enforcement nationally and less than $600 million on education and treatment. Surely, some officials believe, the drug problem can be eased dramatically by putting far more money into education and treatment than ever before. But experience to date offers little certainty of their effectiveness.

The Trials of Treatment

JAMES P. MORAN JR. is the genial mayor of Alexandria, Va., a town in the Washington suburban area that encompasses some of the area’s most affluent--and some of its poorest--neighborhoods. Moran started a treatment program a few years ago to treat heroin addicts by substituting oral doses of methadone, an addictive, though less harmful, drug. The clinic, supported by local taxes, is the only one of its kind in Northern Virginia, and an average of 160 addicts, a few driving 50 to 60 miles each way, show up every day. The clinic recommends three years of treatment, but many patients drop out sooner. Studies show that methadone-treated patients, even if their habit cannot be broken, tend to avoid heroin and crime and have no need for the needles that spread AIDS. But Moran is unhappy with his program’s results.

“It’s not only that it costs more than a luxury hotel,” he says. “You also have to factor in the low rate of success.” He estimates that, as in most methadone programs, only 15% to 20% of those treated at the Alexandria clinic break their addiction to heroin. If you tack on the cost of unsuccessful treatments to that of the few successes, the mayor went on, you come up with a figure of $60,000 for every addict treated successfully. “It’s just not worth it,” Moran says. “We’re not successful with treatment. Most of the money you put into treatment is wasted right now.”

In the past, with the federal government viewing addiction as more of a police problem than a health problem, there were not enough treatment facilities to meet the demand. Yet, when treatment expands under Bennett’s developing proposals to cut drug use, the results could still disappoint the public. Methadone treatment--regarded as the most successful way to break the heroin habit--has a relapse rate estimated at 80%. Cocaine treatment is discouraging as well. Scientists have not developed any legal drug like methadone to substitute for cocaine, so doctors depend mainly on counseling, trying to rebuild the personality of a patient and hoping to eliminate the problems that made cocaine attractive in the first place.

Although smoking cocaine or crack is regarded as just as addictive as injecting heroin because it is absorbed so quickly by the body, snorting cocaine is considered less addictive. That may explain why treatment for cocaine is somewhat more successful than treatment for heroin. But the record is hardly impressive. In 1986, for example, doctors could classify only 38% of the patients completing cocaine treatment in southern Maryland as cured or free of drugs.

Researchers actually know very little about the causes and treatment of addiction. They cannot even agree on a definition of an addict. Dependence on a drug is both psychological and physical. According to a 1981 study, for example, heroin addicts tend to lose their craving when they can’t get drugs in prison, but the craving returns once they are released.

The main goal of a treatment clinic, then, is to keep addicts away from a drug while helping them overcome the withdrawal pains. Doctors have two methods: detoxification--where no other drug substitutes for the withdrawn drug--and, in the case of heroin addicts, methadone substitution. In an influential book, James B. Bakalar and Lester Grinspoon of the psychiatry department of the Harvard Medical School concluded that detoxification usually offers only temporary relief, while substituting one opiate for another is not a cure but simply a way of reducing the inconvenience of addiction.

“Evaluations of drug-treatment programs,” Bakalar and Grinspoon write, “show that once detoxification or methadone maintenance has ended, we have no clear idea of what to do.”

According to a nationwide study by the National Institute of Drug Abuse, a majority of patients treated for heroin or heavy cocaine addiction were using drugs again at least once a week within a year after they finished treatment. Doctors have recorded cures mainly with patients breaking a mild dependence on marijuana or alcohol. Many psychologists insist that relapse is almost certain whenever a supposedly cured addict returns to the same environment that made drugs irresistible in the first place--poverty, unemployment and despair, in the case of most inner-city addicts. “Recovery from drug dependency is a long process,” Reuter wrote in his report on Washington, “often requiring the dependent person to rebuild his life.” It’s a challenge for any treatment program.

PLAN B: EDUCATION

IF TREATMENT, police work and the Border Patrol have failed, the current reasoning goes, perhaps we should stress prevention. There is a kind of desperation in this last hope, a dependence born of pessimism. Says Reuter with a smile: “As an Australian, I can say this: Americans are big on prevention. An ounce of prevention is worth God-knows-how-many kilos of cure.” He is not mocking American faith in education but warns that much of the hope could be shattered.

“We don’t have any data (showing) it prevents future use,” says William Claiborn, who runs the Alexandria, Va., drug-education program. “We have faith and hope that it works.”

Critics believe that some education programs have been crippled by exaggerating the dangers of drugs. Principals and teachers, watched closely by city officials, feel pressured not to teach pupils that marijuana, although harmful, is less addicting than cigarettes. A Department of Education pamphlet, issued by Bennett when he was secretary of education, insisted that “cocaine in any form can cause cardiac arrest and death.” Yet the late Norman E. Zinberg, a Harvard University psychiatrist regarded as one of the nation’s leading specialists on drug problems, concluded that “despite the publicity surrounding individual cases, death from cocaine caused by heart stoppage is rare.” Failing to acknowledge such information, school programs can lose credibility.

But more-honest programs could be even more harmful. “Several studies have demonstrated that drug education . . . has usually resulted in an increase in use,” Zinberg wrote recently.

There is a good deal of controversy, as well, over media campaigns. Some educators believe that sports stars who have broken a drug habit can drive the anti-drug message home to youngsters. But “messages from athletes who have been treated for alcohol or drug abuse, whatever the intent,” wrote Reuter, “may just reinforce the impression that this is what stars do, and you can get away with it.”

The most prominent media campaign in recent years was the Just Say No drive of Nancy Reagan. Her aim was to persuade schoolchildren to reject any drug offered them “by just saying no.” Although it is hard to prick holes in this kind of publicity, many critics insisted that it diverted attention and resources to a minor part of the drug problem. Just Say No, with all its emphasis on children forming anti-drug clubs and signing anti-drug pledges, was aimed at middle-class America. It is much like joining the Boy Scouts. Desperately impoverished children in the South Bronx tend not to become Scouts; neither do they sign pledges for Nancy Reagan.

Critics like Zinberg also believe that Nancy Reagan oversimplified the problem. “The Just Say No attitude,” he said, “doesn’t leave much room for experimentation. If you think that any thing less than stamping out drug use is condoning it, you can’t get anywhere.”

A LAST RESORT: LEGALIZATION

LEGALIZATION IS SO delicate a subject that a criminal court judge in a large city will only speak about it softly, carefully and anonymously in the privacy of his chambers. “For a kid on the streets,” he says, “the choice is working at McDonald’s for $3.35 an hour for four hours a day or earning a thousand dollars a day with drugs. You and I would make the same choice in their situation. The decision is based on rationality.

“I know of no judge who will hesitate about locking up an addict and throwing the key away if he has committed a crime injuring someone,” the judge goes on. “And yet, every time I do this, I realize that I am driving up the black market price of drugs.”

Such talk often leads to more discussion of the possibility of some kind of legalization of drugs to put an end to the incredibly lucrative black market, but the subject never gets very far. Proponents of legalization feel certain that it would reduce murders and other crime but have a harder time making a case that it would cut drug use.

The question is still largely academic, anyhow. The idea of legalization is too abhorrent for most Americans and their politicians to contemplate. American views on the subject are so strong that officials have difficulty initiating any program that seems to allow any use of drugs without punishment.

Yet, for the first time in decades, a few distinguished voices were raised last year in favor of some kind of legalization of drugs that might put them in somewhat the same legal category as alcohol and tobacco--two harmful, addictive substances that are frowned on but not treated by society as criminal and evil. Mayor Kurt Schmoke of Baltimore, a former federal prosecutor and Rhodes scholar, shocked the U.S. Conference of Mayors last year by proposing that they look into legalization. “Profit is the engine driving drug traffickers,” Schmoke wrote later. Legalizing drugs, he said, would “take the profit out of their enterprise.”

A similar call came from Ethan A. Nadelman, a Princeton public affairs professor, in the prestigious quarterly Foreign Policy. But even while proposing legalization, Nadelman recognized the near-futility of raising the issue with policy makers. “Indeed, the very suggestion of such a possibility quickly conjures up images of an America transformed into a modern-day Sodom and Gomorrah,” he wrote. “Yet there are powerful reasons to at least attempt a reasoned analysis of the costs and benefits of current drug policies.”

The calls for legalization have whipped up hardly any support. In the three-day Washington conference on crime and drugs in early February, the mayors never mentioned legalization, not even to knock it down.

DANGERS OF THE WAR MENTALITY

FEDERAL DRUG czar Bennett, in his belligerent mood, and with Atty. Gen. Dick Thornburgh and Secretary of Housing and Urban Development Jack Kemp at his side, announced the federal war on the Washington drug market at a highly publicized news conference. Marion Barry, the troubled black mayor of largely black Washington, was nowhere in sight. The mood, the tone and the setting exacerbated one of the concerns of many critics of federal policy--the fear that the war on drugs may turn into a war on blacks.

Bennett’s aggressive manner, in fact, seems to have evoked a good deal of sympathy for Barry, long under a cloud because of his reported personal contacts with alleged drug dealers. “I wonder if Bennett would have said the same things and done the same things,” says Fyfe of American University, “if the mayor was white and there was a different population in the city.”

It’s no coincidence, some observers believe, that the government’s fierce crackdown on drug users is occurring when the user population has shifted from being largely white to largely nonwhite. Statistics indicate that the decline in use of cocaine by middle-class whites has been paralleled by an increase in the use of cocaine--in the form of crack--among poor blacks. Mark Gold, who runs a New Jersey telephone hot-line service on cocaine problems, reported that, in 1983, 50% of the calls came from college-educated cocaine users, a figure that dropped to 16% in 1987. At the same time, the percentage of calls from unemployed cocaine users increased from 16% to more than 50%.

Heavily financed education and treatment programs could further widen this gap, feeding speculation that the drug problem could be perceived as a black problem in a few years.

“If this war heats up,” said Zinberg just before his death April 2, “it will not be just a war on drugs but a war mobilized by the reigning cultural majority, the franchised and employed, against a minority--an essentially disenfranchised and deeply alienated segment of our society.”

Endorsing this theory, David F. Musto of Yale University, a prominent historian of American drug policy, insists that “a two-tier system” is developing in American attitudes toward drugs. Middle-class whites, according to Musto, are realizing that drug use “is damaging to their long-term interests.” But “these restraints don’t exist in the inner city,” he says. As a result, there is continued and even growing drug use among poor blacks, who feel they do not have jobs or educational opportunities to lose, he says. And middle-class whites who give up drugs “become very intolerant” and look on drug users “as beyond the pale.”

Yet speculation about a war on drugs turning against blacks does not sound persuasive to black leaders. Most want to drive drugs from their communities and, like President Bush, insist that this can be done only through a war on many fronts.

Speaking anonymously again in his chambers, the criminal court judge, who believes that many of the nation’s tough policies are self-defeating, deplored the attitude of those black leaders. “One major problem,” he says, “is that the minority community is the strongest that believes a war on drugs is necessary. They are afraid that anything else represents an attempt by others to abandon their community.”

The imagery of war creates other problems. The rigidity of public attitudes toward drugs makes research difficult. All the bluster blurs scientific focus. It is difficult, for example, to regard addicts as victims of a disease when the drumbeat of war makes them seem like enemies of the state. Moreover, while some specialists believe in the eventual success of treatment and education, they fear that both will show such slow progress that Congress and the public, in a mood for quick and total victories, will give up on them.

As the Bush Administration formulates its own version of the war on drugs, the nation seems to be in for a good deal more anger and frustration--much like the dramatic outburst of Mayor Van Horn of Artesia at the mayors’ conference. And that, some scholars fear, could leave the country with problems even more damaging than drugs.

“What will happen to the enormous fear and hostility that are building up on drugs?” Musto asks philosophically. “People can get so angry at the drug use in the inner city that they will believe everyone there is a drug user.” As a result, the historian warns, most Americans could lose the patience to invest the time and money needed to create the schools, jobs and community spirit that could drive drugs from the inner cities in the long run.

“You don’t want to have public policies that cause more harm than good,” he says.