Jail or Treatment?
Supply and demand—it's the part of the drug war that gets all the headlines. But treatment, not as costly, not nearly as newsworthy, has been proven to work. Drug treatment is the most effective way to reduce demand, but across the country, only 15 percent of those who need it get it. Just saying no is not enough.

The methadone clinic on Manhattan's Upper West Side doesn't have a sign on the door. The men and women who line up at 8:00 in the morning are here to get a powerfully addictive drug. It is methadone, the only substance proven to stop the cravings and withdrawal pains of heroin.

When methadone clinics first opened in New York in the 1970s treatment was readily available. In the early days of the drug war, heroin addiction was considered a public health problem; a national network of treatment programs proved successful in curbing demand. But today, with more than 250,000 heroin addicts in New York, there are only enough treatment dollars for 35,000 of them.

Heroin addicts are more likely to go to jail than get into treatment. A study in Iowa found $1 spent on treatment saves $4 in prison costs. A Rand Corporation study found treatment dollars are 21 times more effective than law enforcement in reducing drug demand. Methadone maintenance programs cost about $3,900 a year per patient. Jailing a drug addict costs $25,000 a year.

The methadone at the clinic is in a locked clear glass case. The red colored liquid snakes from the bottle through a long tube and squirts into a plastic cup. One gulp is all there is.

A combination of medication and counseling help heroin addicts return to a more normal life. View Photography>

One of these patients says he used heroin for the first time as a college freshman and became addicted on a trip to Asia. "I'm very fortunate, this is still an experimental program," he says.

He's been on methadone maintenance for more than five years, with a full-time job and regular counseling he qualified for the program.

"I do not crave the use of heroin. I don't dream about heroin; I don't have these overwhelming feelings that I need to use heroin. Besides not going into withdrawal, I'm not aware that I've taken any drug at all, except for the fact that I'm free from heroin."

This is the first new approach to heroin addiction since the 1970s. It was the Nixon administration that legalized the treatment in the early days of the drug war. At the time, federal treatment dollars were rising, from $43 million at the end of the 1960s to more than $420 million by 1973.

The primary drug of concern was heroin, even though there were less than a million addicts. Nixon was convinced that methadone treatment could reduce crime.

As a candidate, Nixon had called Washington, D.C., the crime capital of the nation. When he came to town as president, he became convinced drug treatment could be useful weapon in his war on crime.

At the time, the biggest federal drug treatment program was in Lexington, Kentucky. Opened in 1935, it housed some volunteer patients and more federal prisoners, but research showed that 90 percent of those treated at the Lexington facility relapsed in one year.

There was promising treatment research coming out of new programs in Chicago and Washington—programs would become the models for the first national strategy. But it would be unforeseen events that would drive the Nixon administration to be the first to support and fund voluntary drug treatment programs, as Michael Massing recounts in his book, The Fix.

"At the same time that the Nixon administration was looking for ways to bring down the crime rate in this country, they became concerned about heroin addiction in Vietnam," says Massing. "And so there was great fear that these G.I.s who were addicted to heroin were going to come back without any type of services for them, and they would know how to use weapons, and there were literally fears that they were going to go wild in the streets of our cities looking for heroin if nothing were done to stop them."

"Today, people don't even connect Vietnam with the evolution of American drug policy, " says Dr. Robert Dupont, who headed the Special Office for Drug Abuse and Prevention, created by the Nixon administration. "When Nixon declared war on drugs on January 1971 and started the first White House office, named the first White House drug czar, within 24 hours that czar was on a plane to Saigon. There was no mistaking what his priority was from the president."

The U.S. military welcomed the involvement. What they didn't entirely embrace was the requirement of Dr. Jerome Jaffey, head of the White House drug office: a drug test for returning vets.

"Of course, they were not into urine collection. That's not what they had in mind," Jaffey says. "They dubbed it "Operation Golden Flow." It was a brilliant idea."

"The rule was you had to have clean urine to go home. And everyone who had positive had to go to detox for a week, " explains Lee Robbins, a researcher at Washington University, who was hired to study the addiction rates among returning vets. It was the most extensive research on heroin addiction ever done, and the results were stunning.

Her research countered the accepted theory that once you start using heroin it was nearly impossible to stop. Three years after the war only 12 percent of the returning vets who said they were addicted were still using heroin. The vast majority were no longer users.

"We asked them 'Why not?' " adds Lee. "One said heroin in the United States was terrible. The heroin in Vietnam was 95 percent pure, and in the U.S., not more than 8 to 10 percent. And they said it was much too expensive. In Vietnam you could be an addict on $6 a day. And finally, they said their girlfriends and their parents didn't like it, so they quit. "

Robbins' findings went against the stereotype that bad character explains addiction. "I think it's a disease for some people," she says. "Some people can take it without much trouble, and a few people can't—and it's those people we need to protect."

It would be years before more extensive research showed addiction is a complex disorder influenced by genetics, gender, age, and social class. Users start taking drugs by choice, but some users need help to stop.

By the 1970s drug use was at an all-time high across the country. The war on drugs was a culture war as Robert Dupont was named drug czar in the Ford administration.

"As illegal drug use became more widespread, it jumped the boundary of bad character and became part of the youth culture. It became part of the youth rebellion; it became part of the scene in the United States, and not only did the stereotype change but the reality changed. "

Heroin use had almost disappeared. Cocaine wasn't yet the monster it would become. The network of treatment centers opened by the Nixon administration was funded through the Ford and Carter years. But when Ronald Reagan was election, there was a new focus on the War on Drugs.

In an unusual address to the nation, the President and Nancy Reagan unveiled a national campaign.

"Winning the crusade against drugs will not be achieved by just throwing money at the problem. Nothing would be more effective than for Americans to simply quit using illegal drugs. It's time, as Nancy said, for Americans to just say no to drugs."

"It was really with the election of Ronald Reagan that the treatment budget was gutted, " says author Michael Massing. "There was, within one year, a 25 percent cut across the board in federal dollars for treatment. And the whole administration was antagonistic to providing taxpayers' dollars to addicts who, in their view, brought on their own condition, were guilty of bad moral character."

As Ronald Reagan was cutting treatment programs, there was growing concern about a new drug that began with a glut of cocaine in the Bahamas. People there had starting to smoke a cooked cocaine paste. It was called rock, it was called growl, and the substance would eventually become known everywhere as crack.

When the first reports from the Bahamas reached Jim Hall, head of a Miami drug policy center, he was alarmed. He knew crack would come to Miami. "Crack smoking was cheap, and it was a much better deal for the dealer. They got twice as much product from cocaine, and they had customers who would rush back to buy again and again and again. So it was the dealer's dream and the user's nightmare."

Law enforcement was completely unprepared, says Izzy Gonzales, who was a Miami street cop in 1984.

"I'd stopped the guy right in Little Havana," he says, "and he had a Marlboro box of cigarettes. I picked this up, and it was full of these rocks, and I spilled the rocks on my hand, and I couldn't figure out what they were. And a manhole sewer, I tossed them in there. Of course, the guy started to cry. I had no idea. I had no clue."

As the crack epidemic swept the country, emergency rooms were overwhelmed because there was really no place else to go, says Massing.

"The whole treatment industry was in a state of virtual collapse. And suddenly, with crack, you had a new generation of addicts created overnight or within a year. You had a huge increase in the U.S. addict population. I remember going up to a facility in the early 1990s. There were people in the lobby, they had the shakes, they were withdrawing from crack, and there was no place to put them."

The War on Drugs had abandoned treatment for punishment. By the late 1990s, the prison population had tripled.