Yes, Treatment, But...
It's true that drug treatment was unfairly maligned for a long time; it's also true that the public treatment system is sorely underfunded in many places. But that doesn't mean that throwing money at the existing treatment system amounts to a progressive drug policy. As it stands, the treatment available ranges from the highly effective to the utterly bogus. It needs to be reformed as well as expanded, and reformed in ways that make it more user-friendly for those who need help and more capable of addressing the complex social needs that addicts bring to treatment.
Drug treatment does indeed work under some conditions, but it works much better for some people than for others. Great numbers of addicts, moreover, including many of those with the most serious problems, never go into treatment at all--not because no treatment exists but because they don't want it. Of those who do go, great numbers drop out, especially in the "therapeutic community" programs, which often boast, on the surface, the best records of success (this tends to inflate our assessments of the effectiveness of treatment, which are typically based on the fraction of addicts who not only enter it but actually complete it). Nor is this lack of enthusiasm mysterious: Much of what passes for treatment today is woefully inadequate at best and deeply alienating at worst. It's often worst of all for women and the young. I used to work in a drug treatment program. Some of the "treatment" I saw I wouldn't wish on anybody--nor would I spend a dime of the public's money to buy more of it.
Treatment works best when it's linked to broader efforts to improve addicts' lives. And that suggests, again, why it's so unhelpful to separate treatment from social intervention--from "root causes." Over and over again, the research on treatment tells us that what makes long-run success likely is the realistic opportunity for a better and more stable life: a steady job, a family, a home, a future. Without that, treatment is all too often a revolving door. So treatment programs need to be linked to job training and placement, to family support, to housing advocacy. The best programs do this now, and in these comprehensive programs it's very difficult to define where "treatment" leaves off and intervention into "root causes" begins.
What progressives ought to be supporting, in short, is not "treatment" but those models of treatment that really work to change addicts' prospects over the long haul, and that embody humane values that we can wholeheartedly support. My guess is that Massing wouldn't disagree with that, but if I'm right, I wish he'd say so. And I think these caveats are especially crucial now, because we've seen a significant turn toward treatment in the past few years. The quick spread of treatment-oriented drug courts is probably the biggest piece of that shift, but there is also the remarkable Arizona initiative, which substitutes treatment for prison sentences for low-level offenders. Even "drug czar" Gen. Barry McCaffrey now says we should invest more in treatment. But the new acceptance of treatment has rarely been backed by much concern for whether the programs we're offering are any good, and if so, for whom.
So let us, by all means, work to close the "treatment gap." But let's also insist on closing the equally consequential gap between the crummy reality of too much of the treatment we now have and the treatment we could have if we took treatment and its clients more seriously. And let's insist on better living standards for the urban and rural dispossessed, so that we can truly reduce the demand for hard drugs--and the need for treatment--over the long haul.