Yes, Treatment, But...
Michael Massing has written thoughtfully about the follies of American drug policy in the past, and I'm sympathetic to many things he says in this piece. It's true that progressives have often been unhappily divided over what to do about drugs, and that there has been an inadequate appreciation of the costs of drug abuse itself--as opposed to the costs of the drug war--among some on the left. And certainly, like most people I know, I think we need to shift toward more treatment and prevention, less incarceration and interdiction. But I find Massing's argument here less than convincing as a manifesto for a progressive drug policy, for a number of reasons.
One is the tendency to treat the several "main schools" of drug reform as if they were mutually exclusive, and in the process to caricature them. Since I'm probably one of those Massing has in mind when he talks about the "root causes" school (I'm delighted, by the way, to think that there's a whole school of us out there), I'll focus on that, though I think the problem also applies to his discussion of legalization and harm reduction.
There's more than a little straw-manning here; adherents of the "root-causes school" are said to believe that we must "first" deal with poverty and other social ills before we can do anything else about drugs, and then are accordingly dismissed as politically quixotic. But nobody I know actually says that. Certainly I don't. When I wrote a book about drugs a few years ago, I said we need a multilayered approach; we need better treatment, more harm-reduction programs, selective decriminalization, more creative adolescent prevention efforts and much more--all in the context of a broader "strategy of inclusion" that would systematically tackle the misery and hopelessness that, as study after study shows, has bred the worst drug abuse in America and elsewhere. That strategy involves investing in, among other things, family support centers, apprenticeship programs, paid family leaves, high-quality childcare and a lot else.
I didn't say we should provide these things instead of drug treatment, and I don't know anyone who has. For the life of me, I can't fathom how this amounts to a "prescription for paralysis." I'm frankly mystified by the argument that says we should talk about drug treatment rather than job training or a decent housing policy or family support. (Nor, for that matter, is it really clear that massive investment in treatment facilities is more politically feasible than, say, investment in better school-to-work programs.) Why not acknowledge that we need to move on all of these fronts in a comprehensive attack on drug abuse?
Massing's answer is, in part, that doing so would take us beyond the purview of "drug policy." Yep, it would; that's precisely why we need to do it. To say we can successfully attack the drug problem through "drug policy" alone is like saying we can solve the illness problem through the healthcare system alone--which we increasingly understand is the wrong way to think about health and illness. Or like saying that we can eliminate crime through the criminal justice system alone, which has helped to give us the biggest prison system in the world. It isn't, after all, differences in the availability of treatment that account for the wide differences in chronic hard-drug abuse between countries--why, for example, crack utterly devastated inner cities in the United States but had a far more muted impact in other industrial countries like Canada, Australia and the Netherlands.
So rather than counterposing separate "schools" of reform, we ought to be crafting an approach to drugs that operates on several levels at once. In that approach, of course, treatment should have a very important place. But we need to think about treatment more critically than Massing does.