The Repair by Michael Massing. Berkeley, CA: College of California Press, 2000, 335 pp., $25.00.
The mud jacket of Michael Massing’s The Repair summarizes his thesis in daring purple letters: “Below the Nixon Administration, America Had an Efficient Drug Coverage. WE SHOULD RESTORE IT. (Nixon Was Proper).” That could be a fairly extraordinary declare to make relating to an administration that gained workplace largely by the “Southern Technique” that had at its coronary heart Nixon’s declaration of a “Conflict on Medication” and whose insurance policies created the cocaine epidemic that induced so many new considerations a decade later. At most, I’d agree that the Nixon administration’s pursuit of a essentially unhealthy coverage included some worthwhile efforts which have been devalued by each subsequent administration. This was not as a result of Nixon or his closest advisers have been proper about drug coverage however as a result of Nixon was extra focused on international coverage points and his benign neglect of home coverage allowed a lot of optimistic developments to blossom within the midst of the mire of incompetence and corruption that characterised his presidency.
Perceptively concluding that “insurance policies being formulated in Washington in the present day bear little relation to what’s going down on the road,” Massing makes an attempt to depict the true results of drug coverage on the road degree. Sadly, he would not depend on the epidemiologic proof or learn the cautious analyses carried out by researchers like myself who’ve systematically examined what is actually going down on the road. As an alternative he depends on the journalist’s normal — and normally deceptive — device of dramatic anecdotes.
Massing’s anecdotal case is introduced by the tales of Raphael Flores and Yvonne Hamilton. Flores runs Scorching Line Cares, a drop-in heart for addicts in Spanish Harlem. Scorching Line Cares, which Flores based in 1970, is actually only a cramped workplace in of an in any other case deserted tenement the place Flores and his employees advise and help addicts who wish to get into therapy. Given the fragmented state of drug abuse therapy in New York Metropolis, and in most different American communities, it’s no simple job to attach addicts with acceptable care and even more durable to attach them with ample aftercare. Massing writes, “If a Vacation Inn is full, it would at the very least name the Ramada down the road to see if it has a emptiness. Not so two therapy packages”
Yvonne Hamilton is a crack addict making an attempt to get her life collectively. Massing describes her trials and tribulations as she copes along with her sickness and makes her manner by New York Metropolis’s therapy non-system. It’s an affecting story and nicely informed. The creator presents it as an argument for therapy and perversely as an argument towards decriminalization or legalization. However she is likely one of the many examples that present that prohibition doesn’t stop dependancy. And enhancements in her drug drawback appear to have much less to do with the therapy she did obtain than with modifications in her life scenario.
These two lives present a touchstone to which his narrative will later return. The center third of the ebook shifts dramatically in tone as Massing chronicles the evolution of the warfare on medicine in Washington. Throughout Nixon’s tenure, the federal government spent extra money on therapy (the “demand” aspect) than on stopping drug trafficking (the “provide” aspect), which he argues led to declines in each drug overdoses and crime charges. As successive presidents felt stress to emphasise the “warfare” reasonably than therapy, he asserts that the variety of continual addicts skyrocketed. Within the third and final part Massing returns to Spanish Harlem, the place Hamilton continues a tough battle to stay drug-free and Flores struggles to maintain his heart afloat and to maintain from falling into dependancy himself.
It’s the second a part of the ebook that’s the coronary heart of Massing’s thesis. It’s a story that’s acquainted to these of us who’re lively within the discipline of drug coverage and, along with students, different journalists have informed it earlier than — Dan Baum (1996) and Mike Grey (1998) doing so significantly nicely — however I’ll summarize (with some particulars Massing missed or omitted) the historical past of drug coverage below Nixon for the reader who will not be acquainted with the story.
In 1968, as Richard Nixon was making his comeback run for the presidency, he adopted the “Southern Technique” that has been the important thing to Republican victories in presidential races ever since. Because the finish of Reconstruction each Democratic presidential candidate had been in a position to depend on the votes of the “stable South” however the Northern Democrats’ help for civil rights had been the reason for rising disaffection within the South, as epitomized by Strom Thurmond’s impartial run for President towards Truman in 1948. Then, in 1964, Alabama Governor George Wallace’s bid for the Democratic nomination for President confirmed that racism received votes within the North in addition to the South. Nixon needed to win the South, in addition to racists’ votes within the North, with out offending extra conventional Republican voters by an brazenly racist marketing campaign. The reply Nixon and his advisers discovered was to marketing campaign towards crime, which most Individuals fairly falsely equated with minorities. So what if the crime price was truly declining, Individuals appear to all the time consider that crime is rising simply as they appear to all the time blame it on cultural or racial outsiders.
Even higher than campaigning towards crime, the Nixon staff quickly realized, was campaigning towards medicine. Most Individuals, once more falsely, equated drug customers with violent criminals. Higher nonetheless, for that nice “silent majority” whose votes they sought a marketing campaign towards medicine symbolized a marketing campaign towards each Blacks and far hated hippies and anti-war protestors. When Nixon declared “warfare on medicine” he was interesting to the basest parts of the American voters and it labored, simply because it has labored for different candidates since.
The success of his anti-crime/anti-drug marketing campaign introduced Nixon with a severe dilemma when he took workplace – individuals have been anticipating outcomes. At first his administration thought of admitting that constitutionally crime management was a state duty and proposing to behave by help of coaching packages and grant-in-aid to state and native police forces, however his method had little political pizzazz and was largely deserted after it did not impress the general public. Nixon had some concepts of his personal, similar to a nationwide obligatory demise penalty for promoting medicine – a method that has been tried in Crimson China and in Singapore and has clearly failed in each nations – however luckily he was extra focused on international coverage and left the seek for an answer to the drug drawback within the arms of John Ehrlichman and the White Home Home Coverage Council.
Throughout the Home Coverage Council Egil “Bud” Krogh Jr., a younger lawyer who is healthier remembered as the person who headed the White Home “plumbers” of Watergate fame, was charged with duty for locating a method to visibly impression medicine and crime earlier than the 1972 election. Massing portrays Krogh as one thing approaching the tragic hero of the story, however I am unsure that many apart from Massing and Krogh himself maintain such a optimistic view of his public service. In any case, it’s true that Krogh performed a key function in shaping each the nice and the unhealthy within the Nixon administration’s drug insurance policies.
In certainly one of his different roles as liaison to the federal government of the District of Columbia, Krogh had change into acquainted with psychiatrist Robert Dupont who was working one of many early methadone upkeep packages in DC. Krogh was reluctant to simply accept a upkeep method to dependancy however he did see that it was the one method that really had some proof of effectiveness. In June of 1970, Krogh despatched the Council’s youngest lawyer Jeffrey Donfeld to go to methadone packages in New York and Chicago, together with the primary such program, which was directed by Vincent Dole and Marie Nyswander of Rockefeller College, and a “blended modality” mannequin developed by College of Chicago psychiatrists Jerome Jaffe and Edward Senay.
Donfeld was doubtful in regards to the claimed effectiveness of methadone therapy and much more doubtful about its political acceptability – in phrases which have since change into acquainted, he puzzled if it might ship the fallacious message. Donfeld discovered Jaffe specifically to be “politically delicate” to the emotional points concerned in methadone upkeep. Donfeld believed that the “blended modality method,” which he referred to as “totally different strokes for various people”, by providing a spread of therapies that included cleansing, drug-free, and upkeep approaches, successfully masked the methadone program from political criticism.
A lot as Raphael Flores is the hero of the primary a part of the ebook, Jerome Jaffe is Massing’s hero for the second half. Jaffe has described his assembly with an primarily clueless Nixon. He sidestepped Nixon’s concept of the demise penalty for sellers and instructed that the one worth of legislation enforcement may be in pushing up the road worth of medicine and thus encouraging extra addicts to hunt therapy – this concept was later taken up by Peter Reuter of the Rand Company however his analysis confirmed that the impact of aggressive legislation enforcement on provide was primarily nil and on worth was tiny.
Jaffe tried to make 4 factors in his assembly with the President an d every was to bear fruit in shaping the way forward for drug coverage below Nixon. The primary was the necessity for extra analysis and analysis of therapy. The growth of a small division throughout the Nationwide Institute of Psychological Well being right into a Nationwide Institute on Drug Abuse and a Nationwide Institute on Alcoholism and Alcohol Abuse grew partially out of this advice. Second, he famous that at the moment there have been a dozen totally different federal businesses funding therapy that did not even speak to one another. He felt that coordination of all these efforts was wanted in pursuit of a coherent nationwide technique. This led to the creation of the Particular Motion Workplace for Drug Abuse Prevention, which he was startled to search out himself appointed director of, because the nation’s first “drug czar”. Third, given the extent of heroin dependancy, he urged that methadone upkeep shouldn’t be restricted to a couple small analysis tasks however ought to be made extensively out there. Fourth, he urged that funding for therapy be dramatically elevated. These final two factors have been on the coronary heart of what Massing refers to as “The Repair”.
Jaffe’s first huge White Home task was to develop a plan for controlling the skyrocketing prevalence of heroin use amongst U.S. servicemen in Vietnam, which concerned 10 to fifteen p.c of all GIs in Vietnam if no more. Pentagon coverage was that heroin use was against the law and that any serviceman who used heroin ought to be arrested and prosecuted. The results of this was an over-burdened navy justice system however no discount in heroin use. Jaffe urged that the Pentagon ought to undertake a therapy method as an alternative of a punitive one.
Massing means that Jaffe’s answer relied for its effectiveness on the GIs’ overpowering want to return to the US. He suggested the Pentagon to topic all GIs to urinalysis earlier than delivery them residence. GIs who examined optimistic for heroin must keep in Vietnam for detox. The navy’s response to his plan was to object that it might play havoc with the complicated logistics of troop motion, to which Massing experiences that Jaffe replied, “I can’t consider that the mightiest military on Earth cannot get its troops to piss in a bottle” When his plan was applied, Massing experiences that the proportion of GIs utilizing heroin rapidly dropped by greater than half.
Jaffe himself tells it fairly in another way. It seems that as a tutorial and researcher he was conscious of the rising proof that almost all heroin customers don’t change into addicted and the early follow-ups exhibiting that a lot of the troops who have been hooked on heroin in Vietnam abstained efficiently, and normally with none therapy, after returning residence (Jaffe and Harris, 1974). He did not idiot himself into believing that the urine screening program truly deterred heroin use among the many troops whereas serving in Nam. What he anticipated was that after phrase of the urinalysis acquired round heroin utilizing GIs who weren’t addicted would cease utilizing for the final weeks earlier than rotation residence and solely the actually addicted can be unable to take action and thus fail the urine take a look at. That is apparently what occurred nevertheless it gave the politically helpful look of a far higher success. The traditional follow-up research by Robins, et al. (1980) confirmed that a lot of the GIs who grew to become hooked on heroin whereas serving in Vietnam recovered absolutely and completely after returning to the US and in addition discovered that restoration charges weren’t improved by receiving therapy – a discovering the implications of which I mentioned in a number of publications of that interval (Duncan, 1974, 1975, 1976 & 1977).
I consider that the fast restoration of Vietnam addicts demonstrates that for a lot of the GIs who grew to become addicted, heroin use served as a coping mechanism for coping with the stress of serving in a warfare zone. The aid they obtained by utilizing heroin served as a destructive reinforcer and destructive reinforcement produces highly effective habituation. As soon as they returned residence their heroin utilizing conduct extinguished in an atmosphere the place for many of them it was not being strengthened. Those that endured of their dependancy, in accordance with Robins, et al. (1980), have been those who returned to circumstances of poverty, an alcoholic mother or father, and so on. – precisely those who would proceed to want a stress reliever. Therapy was far much less related than environmental change, which is what Moos and his coleagues have discovered to be true for alcoholism therapy (Moos, Finney, & Cronkite, 1990; Finney & Moos, 1992).
As Massing experiences, Jaffe was in a position to persuade the Nixon administration to extend funding for drug abuse therapy eightfold over what it had been when Nixon took workplace. For the one time thus far since America started its failed experiment with drug prohibition, the therapy finances was bigger (twofold) than that for drug legislation enforcement. Massing attributes a decline in narcotics-related deaths and in crime charges to this finances enhance and a greater than 300 p.c enhance within the variety of individuals in therapy. It could be good for therapy advocates like me if that was true however no educated analyst is more likely to agree that it’s.
Whereas extra addicts in therapy in all probability performed some function in decreasing the numbers of narcotics-related deaths, there have been two different elements that in all probability performed a far higher function. First, was the introduction in 1971 of naloxone (Narcan®), a full narcotic antagonist, which changed nalorphone (Nalline®), a partial narcotic antagonist, because the drug of selection for treating narcotic overdoses. Second, was the rising recognition of amphetamines and different stimulants leading to them changing heroin as the first drug of dependancy in America. This may occasionally even have contributed to the lowering demise price in a tertiary trend by decreasing demand for heroin and due to this fact decreasing the worth and rising the purity of heroin on the road which would cut back deaths that usually consequence from allergic reactions to the impurities in illicit heroin.
There’s sturdy proof that the supply of methadone upkeep in a neighborhood with giant numbers of heroin addicts will deliver a few discount in charges of property crimes, particularly the burglaries and petty thefts that addicts most frequently have interaction in to boost cash to help their behavior. It is extremely probably that the growth of this modality below Nixon and Jaffe did decrease crime charges. Crime charges, nevertheless, have been already trending downward and the continuation of that pattern was in all probability extra vital than any authorities coverage.
The gravest defect of The Repair lies in its tacit assumption that the overall path and objective of our nation’s present drug coverage is ok and simply wants some tinkering with its finances priorities with the intention to “repair” it. Properly, Nixon did not repair it, nor will or can any future president. The objective of eliminating leisure drug use has by no means been achieved wherever neither is there any good motive why society ought to be higher for attaining such a objective.
I directed one of many early therapy facilities to make the most of the “blended modality” method that Jaffe advocated and I proceed to consider in its worth. The fragmented state of most therapy providers in the present day, so nicely illustrated by Massing’s two examples, definitely is a severe barrier to the effectiveness of therapy. So I will surely agree with Massing that America would profit vastly from each a return to higher funding for therapy and the usage of multimodality therapy. However no public well being drawback could be adequately managed by therapy, or secondary and tertiary prevention as we in public well being favor to name it. It’s only by major prevention that an issue as huge as drug dependancy could be meaningfully lowered. It definitely can’t be lowered by working a system during which between a 3rd and two-thirds of the present sufferers do not want any therapy in any respect as a result of their drug use is leisure and never addictive.
Efficient major prevention of drug abuse, nevertheless, needs to be one thing far totally different from telling individuals to “simply say no” and telling prophylactic lies to children in D.A.R.E. lessons. To start with, efficient prevention (major, secondary or tertiary) should concentrate on the precise drawback of dependancy reasonably than on all use of sure chosen medicine. Most customers of any of the extensively used medicine, excluding nicotine customers, usually are not addicted, usually are not at nice threat of changing into addicted, usually are not doing any substantial hurt to themselves, and are not harming anybody else by their use of the drug. Even a small proportion of tobacco people who smoke usually are not addicted and usually are not harming themselves by smoking. Society has no legitimate curiosity in stopping drug use however a really clear curiosity in stopping dependancy.
Second, major prevention can’t be achieved by scaring individuals — least of all by scaring them with lies. Applications like D.A.R.E. make a robust impression on many preadolescents and early adolescents who swear they’re by no means going to make use of medicine however by their mid-teens most of them have discovered by remark that a lot the D.A.R.E. officer informed them was lies and they don’t seem to be solely able to experiment with medicine however cynical in viewing any legitimate warnings they could obtain from adults about actual dangers. Efficient prevention should be primarily based on details not scare tales. As an alternative of insisting that children ought to keep drug-free endlessly, which nearly nobody in our society is or ought to be, we ought to be educating them the way to responsibly assess medicine and conditions of use in order that they’ll select properly what and when and the way relating to drug use.
Criminalizing medicine and drug use makes all ranges of prevention harder. No drug person or abuser goes to be higher off for being arrested. Therapy within the legal justice system is a good suggestion for many who are arrested for actual crimes similar to theft or assault however therapy within the legal justice system is all the time combating an uphill battle towards the hurt accomplished by the system. Quite a few research have proven that any type of punishment for drug use will increase the probability that the drug person will change into or persist in being addicted.
Massing is a really fantastic journalist however he would not have the background essential to conduct a significant evaluation of drug coverage and its results. You possibly can’t study to be a physicist by watching Nova specials and you are not going to achieve a lot of an understanding of drug coverage by studying books like The Repair. As an introduction to the issues within the discipline it has benefit however I’d advocate the equally nicely written journalistic accounts by Baum (1996) or Grey (1998).
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