Treating Drug Problems Volume 1 (1990) / Chapter Skim
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2 Ideas Governing Drug Policy
2 Ideas Governing Drug Policy
Pages 40-57
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From page 40... ...
As a result, there can be no detailed analysis of drug treatment without first understanding what these ideas are, where they come from, how they relate to each other, and how they have shaped the role and functions of treatment. That the governing ideas are plural reflects two underlying realities concerning drugs and society.
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From page 41... ...
THE CHARACTER OF GOVERNING IDEAS In a democracy, government policy is inevitably guided by commonly shared simplifications. This is true because the political dialogue that authorizes and animates government policy can rarely support ideas that are very complex or entirely novel.
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From page 42... ...
They provide the crucial context for understanding the nature of the drug treatment system, as well as the goals set for it and the financial arrangements that underlie it. THE SPECTRUM OF IDEAS ABOUT DRUGS The evolution of drug policy in the United States can be concisely and usefully described in terms of a simple spectrum or continuum of concepts that ranges from the least restrictive in approach to the most restrictive (Figure 2-1~.
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From page 43... ...
Three main parts of the spectrum are thus distinguished, constituting the three major governing ideas that underlie the historical evolution of drug policy in the United States. As little as 100 years ago the left side of the spectrum was mainly in evidence.
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From page 44... ...
This decline coincided with the growth of two other governing ideas: the criminal that drug abuse is a problem of shiftless living closely associated with crime and violence and the medical—that drug abuse is a medical problem arising from a misguided but understandable search for relief from painful or oppressive circumstances. Yet even before these newer ideas were articulated, libertarian thinking itself had begun to respond to shifts of several kinds that were stirring in the mid-nineteenth century.
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From page 45... ...
The third development was the increasing concern about a new type of drug user: the "pleasure user," for whom drugs were neither bound to tradition or custom nor a source of relief from physical pain. Although the pleasure user was sometimes stereotyped in racial terms associated originally with Chinese immigrants, later with African and Mexican Americans the model was just as often the European American urban criminal, a member of the underworld linked to prostitution, thievery, and saloon-going.
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From page 46... ...
the supply of those goods or services whose aggregate benefits most exceed their costs. This logic implies an economic cost/benefit standard by which to measure the worth of public or private purchases of drug treatment.
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From page 47... ...
Formulators of a view of drug use as a criminal matter were more impressed with the criminal associations and irresponsibility of disreputable drug users than with the commonalities in symptomatology with respectable users. The criminal view held that narcotic drug use was fundamentally immoral, ruinous behavior.
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From page 48... ...
The criminal view dominated the nation's drug control efforts for more than 40 years, during most of which Federal Narcotics Bureau Director Harry Anslinger was the leading figure of narcotics policy and dealers
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From page 49... ...
The beginnings of the national treatment effort lay within the federal prison-hospitals at Lexington, Kentucky, and Fort Worth, Texas. These facilities not only incarcerated criminals on narcotics convictions but also
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From page 50... ...
This notion was a more sophisticated version of the physiological ideas current among some of the physicians who, for a short period after 1919, operated medical maintenance clinics using morphine in a number of American cities until federal agents shut them all down by 1923. Federal agents also wanted to stop methadone maintenance at its inception but backed down from openly challenging its determined originators in court.
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From page 51... ...
A completely different treatment approach originated in California with Synanon, the original therapeutic community for drug addiction. Charles Dedench, founder of Synanon, drew some of its central treatment concepts from psychiatric therapeutic community in military medicine (Jones, 1953)
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From page 52... ...
This law mandated and supported the provision of treatment for drug abuse and alcoholism within community mental health centers, a major health policy initiative that originated during the Kennedy administration. At roughly the same time as the 1968 amendment, the Office of Economic Opportunity began to support community-based drug and alcohol treatment programs, particularly those that offered a variety of treatment alternatives.
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From page 53... ...
The Medical/Criminal Idea of Treatment and the Evolution of Governmental Roles The most important single federal treatment initiative since the founding of the Lexington and Fort Worth facilities was the "War on Drugs" of the Nixon administration. This effort directly enlisted community-based drug treatment in the task of decreasing criminal activity on the streets of the nation's big cities.
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From page 54... ...
Through an Executive Order in 1971 and subsequent legislation, the Special Action Office for Drug Abuse Prevention (SAODAP) was created in the Executive Office of the President; it was given an unusually broad mandate and the authority to organize, direct, and evaluate the federally supported drug treatment effort.
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From page 55... ...
Responsibility and authority were given to state agencies progressively, leading to the institution of relatively unfettered block grants to the states in 1981 for allocation among alcohol, drug, and mental health programs. Since 1981 the federal share of payment for drug treatment programs has dropped well below the state share, and federal activities in the treatment field, particularly the mission of NIDA, have concentrated on biomedical and, to a lesser degree, behavioral and social sciences research.
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From page 56... ...
CONCLUSION It would be natural to assume that drug treatment is the kept creature of medical approaches to the drug problem, that treatment programs are compatible only with medical ideas and must stand in a relationship of contradiction or antagonism to both libertarian and criminal ideas and institutions. Nevertheless, both in principle and in practice, drug treatment is a flexible set of instruments capable of achieving several socially desirable objectives and of serving more than one ideological master without necessarily losing its essential rehabilitative character.
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From page 57... ...
There continue to be strongly expressed as well as inchoate sentiments favoring libertarian approaches, but the net movement has been a massive transfer of public emphasis to enforcement and incarceration at the expense of the public treatment sector. That pendulum appears to have swung to its limit, and the opportunity for explicit reconsideration of the role, extent, and financing of public and private drug treatment is greater now than at any point since the mid-1970s.
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