How can we make this happen? According to federal estimates, the government would have to spend about $3.4 billion a year on top of current treatment expenditures to make help available to all who want it; the states would have to spend roughly an equivalent amount. If the current 67/33 percent split in the federal drug budget between the supply and demand sides were equalized, this would free up close to the sum in question at the federal level. Actually, a strong case could be made for reversing these proportions and allocating two-thirds to the demand side, but a 50/50 split seems as much as can be hoped for in the current political climate.

Finding a more effective means of preventing drug use among young people is another urgent need. Today, prevention consists mainly of Just Say No messages broadcast on TV or preached in the classroom. Unfortunately, research shows that such messages by themselves do not work. To succeed, prevention, like treatment, needs to focus on those most at risk. The problem is not so much with kids who smoke an occasional joint but with those who regularly use drugs and/or alcohol. For youths living in poor neighborhoods, effective prevention would mean more recreational programs, after-school activities and summer job opportunities (a key plank of the root-causes school). For more privileged students, prevention might take the form of early-warning systems in which teachers, counselors and parents work together to intervene with youths who show signs of getting into trouble with drugs, legal or otherwise.

As for the nation's drug laws, the goal should not be abolishing them--keeping drugs illegal can help contain abuse--but making them more rational so that small-time offenders are not hit with excessive penalties. And, whenever possible, nonviolent addicts and sellers who are arrested should be offered treatment as an alternative to incarceration. More generally, arresting low-level offenders should be society's last, not first, line of defense.

A word on marijuana. At present, almost 700,000 people a year are arrested for the sale or possession of pot. This is madness. Marijuana is far less toxic than heroin, cocaine or even alcohol, and the idea of putting people in jail for possessing it seems absurd. At the same time, marijuana is not innocuous, especially for young people, and we do not want to do anything that would make it even more available than it is now. Legalizing marijuana would certainly risk that. A far more rational approach would be to decriminalize the drug; people caught using pot in public would be subject to a civil penalty punishable by a fine, much as a traffic violation is. The production, importation and sale of marijuana, however, would remain illegal (though not subject to the ridiculously harsh penalties now in place). Decriminalization offers a realistic middle ground between the excesses of our current approach and the potential perils of legalization.

In my recent book The Fix, I argue that a public-health approach to the drug problem can work based on the one time we actually tried it--during the Nixon Administration. Nixon, a staunch law-and-order advocate, is remembered for having launched the war on drugs, but, drawing on his pragmatic instincts, he in fact made treatment his main weapon in that war. Confronting a national heroin epidemic, the White House created a special action office headed by physicians and addiction specialists, who spent hundreds of millions of dollars to set up a national network of clinics that offered help to all those who wanted it. The result was a marked decline in heroin-related crime, overdose deaths and hospital emergency-room visits. The national heroin epidemic was thus stanched.

Unfortunately, that network largely disintegrated during the Reagan years, so that by the time crack struck, treatment clinics were completely overwhelmed. Today, our drug problem is far larger and more complex than it was under Nixon. But the research confirming treatment's effectiveness has grown, too, and in light of the ongoing failure of the drug war, a public-health approach stressing treatment over prosecution, counseling over incarceration, would seem to offer our most humane, practical and politically viable alternative.

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