Did Nixon Get the War on Drugs Right? Michael Massing's The Fix

The Fix by way of Michael Massing. Berkeley, CA: University of California Press, 2000, 335 pp., $ 25.00.

The mud jacket of Michael Massing's The Fix summarizes his thesis in daring crimson letters: "Under the Nixon Administration, America Had an Effective Drug Policy. WE SHOULD RESTORE IT. (Nixon Was Right)." That is a gorgeous unusual declare to make referring to an management that received place of work largely during the "Southern Strategy" that had at its center Nixon's declaration of a "War on Drugs" and whose insurance policies created the cocaine epidemic that brought about such a lot of new issues a decade later. At maximum, I’d agree that the Nixon management's pursuit of a essentially unhealthy coverage integrated some profitable efforts which were devalued by way of each next management. This used to be now not as a result of Nixon or his closest advisers have been proper about drug coverage however as a result of Nixon used to be extra focused on overseas coverage problems and his benign overlook of home coverage allowed quite a few certain traits to blossom in the middle of the mire of incompetence and corruption that characterised his presidency.

Perceptively concluding that "insurance policies being formulated in Washington nowadays endure little relation to what’s going down in the street," Massing makes an attempt to depict the true results of drug coverage on the boulevard degree. Unfortunately, he doesn't depend at the epidemiologic proof or learn the cautious analyses performed by way of researchers like myself who’ve systematically tested what’s in point of fact going down in the street. Instead he is determined by the journalist's standard – and in most cases deceptive – device of dramatic anecdotes.

Massing's anecdotal case is gifted during the tales of Raphael Flores and Yvonne Hamilton. Flores runs Hot Line Cares, a drop-in heart for addicts in Spanish Harlem. Hot Line Cares, which Flores based in 1970, is basically only a cramped place of work in of an in a different way deserted tenement the place Flores and his body of workers advise and help addicts who wish to get into remedy. Given the fragmented state of drug abuse remedy in New York City, and in maximum different American communities, it’s no simple job to attach addicts with suitable care or even more difficult to attach them with ok aftercare. Massing writes, "If a Holiday Inn is complete, it is going to no less than name the Ramada down the road to look if it has a emptiness. Not so two remedy methods"

Yvonne Hamilton is a crack addict seeking to get her existence in combination. Massing describes her trials and tribulations as she copes together with her sickness and makes her means thru New York City's remedy non-system. It is an affecting tale and neatly informed. The writer items it as a controversy for remedy and perversely as a controversy towards decriminalization or legalization. But she is without doubt one of the many examples that display that prohibition does now not save you habit. And enhancements in her drug downside appear to have much less to do with the remedy she did obtain than with adjustments in her existence scenario.

These two lives supply a touchstone to which his narrative will later go back. The center 3rd of the ebook shifts dramatically in tone as Massing chronicles the evolution of the warfare on medication in Washington. During Nixon's tenure, the federal government spent more cash on remedy (the "call for" aspect) than on preventing drug trafficking (the "provide" aspect), which he argues ended in declines in each drug overdoses and crime charges. As successive presidents felt drive to emphasise the "warfare" slightly than remedy, he asserts that the collection of persistent addicts skyrocketed. In the 3rd and final segment Massing returns to Spanish Harlem, the place Hamilton continues a hard battle to stay drug-free and Flores struggles to stay his heart afloat and to stay from falling into habit himself.

It is the second one a part of the ebook that’s the center of Massing's thesis. It is a story this is acquainted to these people who’re energetic within the box of drug coverage and, along with students, different newshounds have informed it sooner than – Dan Baum (1996) and Mike Gray (1998) doing so in particular neatly – however I can summarize (with some main points Massing neglected or neglected) the historical past of drug coverage beneath Nixon for the reader who isn’t accustomed to the tale.

In 1968, as Richard Nixon used to be making his comeback run for the presidency, he followed the "Southern Strategy" that has been the important thing to Republican victories in presidential races ever since. Since the top of Reconstruction each Democratic presidential candidate have been ready to depend at the votes of the "cast South" however the Northern Democrats' improve for civil rights have been the reason for expanding disaffection within the South, as epitomized by way of Strom Thurmond's unbiased 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 gained votes within the North in addition to the South. Nixon sought after to win the South, in addition to racists' votes within the North, with out offending extra conventional Republican electorate by way of an overtly racist marketing campaign. The resolution Nixon and his advisers discovered used to be to marketing campaign towards crime, which maximum Americans reasonably falsely equated with minorities. So what if the crime fee used to be in reality declining, Americans appear to all the time imagine that crime is expanding 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 discovered, used to be campaigning towards medication. Most Americans, once more falsely, equated drug customers with violent criminals. Better nonetheless, for that groovy "silent majority" whose votes they sought a marketing campaign towards medication symbolized a marketing campaign towards each Blacks and far hated hippies and anti-war protestors. When Nixon declared "warfare on medication" he used to be interesting to the basest components of the American citizens and it labored, simply because it has labored for different applicants since.

The luck of his anti-crime / anti-drug marketing campaign introduced Nixon with a major catch 22 situation when he took place of work – other folks have been anticipating effects. At first his management regarded as admitting that constitutionally crime keep watch over used to be a state duty and proposing to behave thru improve of coaching methods and grant-in-aid to state and native police forces, however his method had little political pizzazz and used to be in large part deserted after it failed to provoke the general public. Nixon had some concepts of his personal, comparable to a national obligatory loss of life penalty for promoting medication – a method that has been attempted in Red China and in Singapore and has obviously failed in each countries – however thankfully he used to be extra focused on overseas coverage and left the seek for a option to the drug downside within the fingers of John Ehrlichman and the White House Domestic Policy Council.

Within the Domestic Policy Council Egil "Bud" Krogh Jr., a tender legal professional who is healthier remembered as the person who headed the White House "plumbers" of Watergate repute, used to be charged with duty for locating a option to visibly have an effect on medication and crime sooner than the 1972 election. Massing portrays Krogh as one thing drawing near the tragic hero of the story, however I'm now not positive that many rather then Massing and Krogh himself hang this kind of certain view of his public provider. In any case, it’s true that Krogh performed a key position in shaping each the nice and the unhealthy within the Nixon management's drug insurance policies.

In one in every of his different roles as liaison to the federal government of the District of Columbia, Krogh had grow to be conversant in psychiatrist Robert Dupont who used to be operating probably the most early methadone repairs methods in DC. Krogh used to be reluctant to simply accept a repairs solution to habit however he did see that it used to be the only method that in reality had some proof of effectiveness. In June of 1970, Krogh despatched the Council's youngest legal professional Jeffrey Donfeld to talk over with methadone methods in New York and Chicago, together with the primary such program, which used to be directed by way of Vincent Dole and Marie Nyswander of Rockefeller University, and a "combined modality" style advanced by way of University of Chicago psychiatrists Jerome Jaffe and Edward Senay.

Donfeld used to be doubtful concerning the claimed effectiveness of methadone remedy and much more doubtful about its political acceptability – in phrases that experience since grow to be acquainted, he puzzled if it could ship the mistaken message. Donfeld discovered Jaffe particularly to be "politically delicate" to the emotional problems excited about methadone repairs. Donfeld believed that the "combined modality method," which he referred to as "other strokes for various other people", by way of providing a spread of remedies that integrated cleansing, drug-free, and upkeep approaches, successfully masked the methadone program from political grievance.

Much as Raphael Flores is the hero of the primary a part of the ebook, Jerome Jaffe is Massing's hero for the second one phase. Jaffe has described his assembly with an necessarily clueless Nixon. He sidestepped Nixon's concept of ​​the loss of life penalty for sellers and prompt that the only worth of legislation enforcement could be in pushing up the road worth of gear and thus encouraging extra addicts to hunt remedy – this concept used to be later taken up by way of Peter Reuter of the Rand Corporation however his analysis confirmed that the impact of competitive legislation enforcement on provide used to be necessarily nil and on worth used to be tiny.

Jaffe tried to make 4 issues in his assembly with the President an d each and every used to be to endure fruit in shaping the way forward for drug coverage beneath Nixon. The first used to be the desire for extra analysis and analysis of remedy. The enlargement of a small department throughout the National Institute of Mental Health right into a National Institute on Drug Abuse and a National Institute on Alcoholism and Alcohol Abuse grew partly out of this advice. Second, he famous that lately there have been a dozen other federal companies investment remedy that didn't even communicate to one another. He felt that coordination of a majority of these efforts used to be wanted in pursuit of a coherent nationwide technique. This ended in the introduction of the Special Action Office for Drug Abuse Prevention, which he used to be startled to seek out himself appointed director of, because the country's first "drug czar". Third, given the level of heroin habit, he advised that methadone repairs must now not be limited to a couple of small analysis initiatives however must be made extensively to be had. Fourth, he advised that investment for remedy be dramatically larger. These final two issues have been on the center of what Massing refers to as "The Fix".

Jaffe's first giant White House task used to be to broaden a plan for controlling the skyrocketing occurrence of heroin use amongst US servicemen in Vietnam, which concerned 10 to 15 p.c of all GIs in Vietnam if now not extra. Pentagon coverage used to be that heroin use used to be a criminal offense and that any serviceman who used heroin must be arrested and prosecuted. The results of this used to be an over-burdened army justice method however no relief in heroin use. Jaffe advised that the Pentagon must undertake a remedy method as a substitute of a punitive one.

Massing means that Jaffe's resolution relied for its effectiveness at the GIs' overpowering need to go back to the United States. He recommended the Pentagon to matter all GIs to urinalysis sooner than delivery them house. GIs who examined certain for heroin must keep in Vietnam for detox. The army's response to his plan used to be to object that it could play havoc with the advanced logistics of troop motion, to which Massing studies that Jaffe answered, "I will not imagine that the mightiest military on Earth can't get its troops to piss in a bottle "When his plan used to be carried out, Massing studies that the share of GIs the usage of heroin temporarily dropped by way of greater than part.

Jaffe himself tells it reasonably another way. It seems that as an educational and researcher he used to be conscious about the rising proof that the majority heroin customers don’t grow to be addicted and the early follow-u.s.appearing that lots of the troops who have been hooked on heroin in Vietnam abstained effectively, and in most cases with none remedy , after returning house (Jaffe and Harris, 1974). He didn't idiot himself into believing that the urine screening program in reality deterred heroin use a few of the troops whilst serving in Nam. What he anticipated used to be that when phrase of the urinalysis were given round heroin the usage of GIs who weren't addicted would prevent the usage of for the final weeks sooner than rotation house and best the in point of fact addicted could be not able to take action and thus fail the urine take a look at. This is it sounds as if what came about however it gave the politically helpful look of a a long way higher luck. The vintage follow-up learn about by way of Robins, et al. (1980) showed that lots of the GIs who become hooked on heroin whilst serving in Vietnam recovered totally and completely after returning to america and likewise discovered that restoration charges weren’t stepped forward by way of receiving remedy – a discovering the results of which I mentioned in numerous publications of that duration (Duncan, 1974, 1975, 1976 & 1977).

I imagine that the fast restoration of Vietnam addicts demonstrates that for lots of the GIs who become addicted, heroin use served as a coping mechanism for coping with the strain of serving in a warfare zone. The aid they acquired by way of the usage of heroin served as a adverse reinforcer and adverse reinforcement produces robust habituation. Once they returned house their heroin the usage of habits extinguished in an atmosphere the place for many of them it used to be not being strengthened. Those who continued of their habit, in step with Robins, et al. (1980), have been those who returned to stipulations of poverty, an alcoholic dad or mum, and so on. – precisely those who would proceed to desire a pressure reliever. Treatment used to be a long way much less related than environmental alternate, which is what Moos and his coleagues have discovered to be true for alcoholism remedy (Moos, Finney, & Cronkite, 1990; Finney & Moos, 1992).

As Massing studies, Jaffe used to be ready to persuade the Nixon management to extend investment for drug abuse remedy eightfold over what it have been when Nixon took place of work. For the one time thus far since America started its failed experiment with drug prohibition, the remedy price range used to be higher (twofold) than that for drug legislation enforcement. Massing attributes a decline in narcotics-related deaths and in crime charges to this price range building up and a greater than 300 p.c building up within the collection of individuals in remedy. It could be great for remedy advocates like me if that used to be true however no an expert analyst is more likely to agree that it’s.

While extra addicts in remedy more than likely performed some position in lowering the numbers of narcotics-related deaths, there have been two different components that more than likely performed a a long way higher position. First, used to be the advent in 1971 of naloxone (Narcan®), a complete narcotic antagonist, which changed nalorphone (Nalline®), a partial narcotic antagonist, because the drug of selection for treating narcotic overdoses. Second, used to be the rising approval for amphetamines and different stimulants leading to them changing heroin as the principle drug of habit in America. This may additionally have contributed to the reducing loss of life fee in a tertiary model by way of lowering call for for heroin and subsequently lowering the fee and extending the purity of heroin in the street which would scale back deaths that ceaselessly consequence from hypersensitive reactions to the impurities in illicit heroin.

There is powerful proof that the provision of methadone repairs in a group with massive numbers of heroin addicts will carry a few relief in charges of assets crimes, particularly the burglaries and petty thefts that addicts maximum ceaselessly have interaction in to lift cash to improve their addiction. It could be very most likely that the growth of this modality beneath Nixon and Jaffe did decrease crime charges. Crime charges, on the other hand, have been already trending downward and the continuation of that development used to be more than likely extra vital than any executive coverage.

The gravest defect of The Fix lies in its tacit assumption that the overall path and objective of our country's present drug coverage is okay and simply wishes some tinkering with its price range precedence to be able to "repair" it. Well, Nixon didn't repair it, nor will or can any long term president. The objective of getting rid of leisure drug use hasn’t ever been accomplished anyplace neither is there any excellent reason society must be higher for attaining this kind of objective.

I directed probably the most early remedy facilities to make use of the "combined modality" method that Jaffe advocated and I proceed to imagine in its worth. The fragmented state of maximum remedy products and services nowadays, so neatly illustrated by way of Massing's two examples, undoubtedly is a major barrier to the effectiveness of remedy. So I’d undoubtedly trust Massing that America would get advantages very much from each a go back to bigger investment for remedy and the usage of multimodality remedy. But no public well being downside will also be adequately managed thru remedy, or secondary and tertiary prevention as we in public well being want to name it. It is best thru number one prevention that an issue as giant as drug habit will also be meaningfully decreased. It undoubtedly can’t be decreased by way of working a method during which between a 3rd and two-thirds of the present sufferers don't want any remedy in any respect as a result of their drug use is leisure and now not addictive.

Effective number one prevention of drug abuse, on the other hand, must be one thing a long way other from telling other folks to "simply say no" and telling prophylactic lies to children in DARE categories. First of all, efficient prevention (number one, secondary or tertiary) will have to focal point on the real downside of habit slightly than on all use of sure decided on medication. Most customers of any of the generally used medication, except for nicotine customers, aren’t addicted, aren’t at nice chance of changing into addicted, aren’t doing any really extensive hurt to themselves, and aren't harming any person else by way of their use of the drug. Even a small percentage of tobacco people who smoke aren’t addicted and aren’t harming themselves by way of smoking. Society has no legitimate hobby in combating drug use however an overly transparent hobby in combating habit.

Second, number one prevention can’t be accomplished by way of scaring other folks – least of all by way of scaring them with lies. Programs like DARE make a powerful affect on many preadolescents and early young people who swear they’re by no means going to make use of medication however by way of their mid-teens maximum of them have realized thru commentary that a lot the DARE officer informed them used to be lies and they don’t seem to be best in a position to experiment with medication however cynical in viewing any legitimate warnings they could obtain from adults about actual dangers. Effective prevention will have to be in keeping with details now not scare tales. Instead of insisting that youngsters must keep drug-free endlessly, which nearly no person in our society is or must be, we must be instructing them the way to responsibly assess medication and scenarios of use in order that they are able to select correctly what and when and the way referring to drug use.

Criminalizing medication and drug use makes all ranges of prevention tougher. No drug consumer or abuser goes to be at an advantage for being arrested. Treatment within the legal justice method is a good suggestion for individuals who are arrested for actual crimes comparable to robbery or attack however remedy within the legal justice method is all the time preventing an uphill fight towards the hurt accomplished by way of the method. Numerous research have proven that any type of punishment for drug use will increase the chance that the drug consumer will grow to be or persist in being addicted.

Massing is an overly positive journalist however he doesn't have the background important to habits a significant research of drug coverage and its results. You can't discover ways to be a physicist by way of observing Nova specials and also you aren't going to realize a lot of an figuring out of drug coverage by way of studying books like The Fix. As an advent to the issues within the box it has benefit however I’d suggest the similarly neatly written journalistic accounts by way of Baum (1996) or Gray (1998).

References

Baum, D. (1996). Smoke and Mirrors: The War on Drugs and the Politics of Failure. New York: Little Brown.

Duncan, DF (1974). Reinforcement of drug abuse: Implications for prevention. Clinical Toxicology Bulletin, 4 (2), 69-75.

Duncan, DF (1975). The acquisition, repairs and remedy of polydrug dependence: A public well being style. Journal of Psychedelic Drugs, 7 (2), 207-213.

Duncan, DF (1976). Stress and adolescent drug dependence. Medical Science, 4, 381

Duncan, DF (1977). Life pressure as a precursor to adolescent drug dependence. International Journal of the Addictions, 12 (8), 1047-1056.

Finney, JW, and Moos, R.H. (1992). The long-term process handled alcoholism: II. Predictors and correlates of 10-year functioning and mortality. Journal of Studies on Alcohol, 53 (2), 142-153.

Gray, M. (1998). Drug Crazy: How We Got Into this Mess and How We Can Get Out of It. New York: Random House.

Jaffe, JH, and Harris, GT (1973). As a long way as heroin is worried, the worst is over. Psychology Today, 85, 68-79, 85.

Moos, RH, Finney, JW, and Cronkite, RC (1990). Alcoholism Treatment: Context, Process, and Outcome. New York: Oxford University Press.

Robins, LN, Helzer, JE, Hesselbrock, M, and Wish, E. (1980). Vietnam veterans 3 years after Vietnam: how our learn about modified our view of heroin. In: L. Brill and C. Winick (Eds), The Yearbook of Substance Use and Abuse, vol. II. New York: Human Sciences Press, pp. 213-230.

way of DF Duncan