It's Time for Realism
There is much to admire in harm reduction. Its encouragement of tolerance for drug addicts provides a welcome alternative to the narrow moralism of the drug war. At times, though, harm reductionists take tolerance too far. In their eagerness to condemn the drug war, they sometimes fail to acknowledge the damage that drug addiction itself can inflict. While rightly condemning the political hysteria surrounding "crack babies," for instance, harm reductionists tend to overlook the havoc crack has wrought on inner-city families. And, while commendably calling for more needle-exchange programs, they rarely acknowledge that syringes are often handed out indiscriminately at these exchanges, with little effort to intervene with addicts and get them to address their habits.
Nonetheless, harm reduction--by recognizing that chronic users are at the core of the nation's drug problem and that they constitute a public-health rather than law-enforcement problem--can help point the way toward a more rational drug policy. The key is to develop a policy that is as tough on drug abuse as it is on the drug war.
In formulating such a policy, a good starting point is a 1994 RAND study that sought to compare the effectiveness of four different types of drug control: source-control programs (attacking the drug trade abroad), interdiction (stopping drugs at the border), domestic law enforcement (arresting and imprisoning buyers and sellers) and drug treatment. How much additional money, RAND asked, would the government have to spend on each approach to reduce national cocaine consumption by 1 percent? RAND devised a model of the national cocaine market, then fed into it more than seventy variables, from seizure data to survey responses. The results were striking: Treatment was found to be seven times more cost-effective than law enforcement, ten times more effective than interdiction and twenty-three times more effective than attacking drugs at their source.
The RAND study has generated much debate in drug-research circles, but its general conclusion has been confirmed in study after study. Yes, relapse is common, but, as RAND found, treatment is so inexpensive that it more than pays for itself while an individual is actually in a program, in the form of reduced crime, medical costs and the like; all gains that occur after an individual leaves a program are a bonus. And it doesn't matter what form of treatment one considers: methadone maintenance, long-term residential, intensive outpatient and twelve-step programs all produce impressive outcomes (though some programs work better for certain addicts than for others).
To be effective, though, treatment must be available immediately. Telling addicts who want help to come back the next day or week is a sure way to lose them. Unfortunately, in most communities, help is rarely available immediately; long waiting lists are the rule. In New York State alone, it is estimated that every year 100,000 people who would take advantage of drug or alcohol treatment if it were available are unable to get into a program.
Such numbers reflect the government's spending priorities. Of the $18 billion Washington spends annually to fight drugs, fully two-thirds goes to reduce the supply of drugs and just one-third to reduce the demand. In all, less than 10 percent of federal funds go to treat the hard-core users, who constitute the real heart of the problem. Closing the nation's treatment gap should be a top priority for the government.