Pubdate: Mon, 05 Feb 2001
Source: Newsweek (US)
Copyright: 2001 Newsweek, Inc.
Contact:  251 West 57th Street, New York, N.Y. 10019
Website: http://www.msnbc.com/news/NW-front_Front.asp
Author: Susan H. Greenberg
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

THE HELL OF ADDICTION

An American Epiphany: Perhaps The Only Way To Win The Drug War Is To Do 
More To Treat Its Victims

Feb. 12 issue - In the new U.S. thriller "Traffic," just opening on 
international screens, Michael Douglas plays Ohio judge Robert Wakefield, a 
Scotch-drinking conservative who is named the new U.S. drug czar. During an 
information-gathering trip to the Mexican border, he begins to see how 
complex and intractable the illegal-drug trade really is.

LOCAL HONEST COPS like Javier Rodriguez Rodriguez (Benicio Del Toro) might 
be able to withstand the temptation of taking bribes, but they are 
powerless to stop corruption among those around-and above-them. Wakefield's 
misgivings about his appointment parallel the growing realization that his 
own teenage daughter is addicted to crack.

Near the end of the movie, during his first official press conference, the 
drug czar deviates from his prepared text and launches into an impromptu 
speech about the futility of the fight against drugs. "I don't see how you 
wage war on your own family," he says, effectively resigning his post. A 
few scenes later, he and his wife are shown beside their daughter at a 
meeting for substance abusers. "We're here to listen," he says.

That's hardly the attitude the world has come to expect from the American 
drug czar. After all, U.S. prisons are filled with drug offenders; the 
number of inmates tripled over the past 20 years to nearly 2 million, with 
60 to 70 percent testing positive for substance abuse on arrest.

The country has spent billions of dollars attacking the problem at its 
roots: coca growers in Latin America, poppy cultivators in Asia, even 
domestic marijuana farmers.

But there is a growing consensus that the "war on drugs" has been lost; the 
United States is still the world's largest consumer of illegal substances; 
cocaine continues to pour over the border from Mexico. "Traffic" taps into 
the national frustration, depicting the horrors of both drugs and the drug 
war. Without taking sides, the film illuminates the national debate and 
poses an alternative that Americans seem increasingly willing to consider: 
finding new ways to treat, rather than merely punish, drug abuse.

WASTED MONEY?

Policy revolutions-like legalizing narcotics-remain a distant dream.

But there is growing public awareness that the money and energy wasted on 
trying to stanch the flow of drugs into the United States might be better 
spent on trying to curb demand instead.

Voters in several states are far ahead of the politicians, approving ballot 
initiatives that offer more treatment options. "Drug courts" that allow 
judges to use carrots and sticks to compel substance-abuse treatment have 
grown fiftyfold since the mid-1990s, part of a new understanding that, even 
with frequent relapses, treatment is much less expensive for society than 
jail and interdiction. Each of the former drug czars as well as the man 
rumored to be President Bush's choice for the job, retired Col. James 
McDonough, stress treatment and demand-side reduction as their first priority.

Drug addiction is increasingly being viewed more as a disease than a crime. 
Science is yielding clues about the "hedonic region" of the brain, while 
breakthrough medications and greater understanding of the mental-health 
problems that underlie many addictions are giving therapists new tools 
(following stories). California approved Proposition 36 last fall, a 
landmark referendum that offers treatment options in place of jail. New 
York is rewriting its draconian Rockefeller-era drug laws. The outgoing 
drug czar, Gen. Barry McCaffrey, says the phrase "drug war" should be 
retired in favor of "drug cancer." His No. 1 recommendation on leaving 
office last month was that insurance companies offer "parity" coverage for 
mental-health and drug disorders.

Even hard-liners like to say that Americans can no longer incarcerate their 
way out of the problem.

All this is a way of saying that American views are coming into line with 
Europe's. The allies' drug-use patterns are similar: marijuana is the most 
widely used illegal substance, and while cocaine is more prevalent in the 
United States, its use is rising across Europe. Amphetamines and ecstasy 
are the second and third most commonly consumed drugs in Europe, and their 
use-especially of ecstasy-is growing rapidly in America as well. In both 
places, heroin addiction remains the most deeply entrenched-and 
costly-public-health crisis.

In a dozen major American cities, men ages 20 to 54 are more likely to die 
of a heroin overdose than in a car accident. And according to the 
Lisbon-based European Monitoring Centre for Drugs and Drug Addiction, of 
the EU's 1.5 million estimated "problem" drug users, most are heroin addicts.

SHIFTING FOCUS

Officials across the continent have already begun shifting their focus from 
repressing drug flow to rehabilitating drug users.

The new European Union Drugs Strategy for 2000-2004 makes a commitment to 
increasing the number of successfully treated addicts.

Germany, Italy and Luxembourg have transferred responsibility for drug 
policy from their Ministries of the Interior to the Ministries of Health or 
Social Affairs. In Britain, Tony Blair's government has set up a National 
Treatment Agency to coordinate the efforts of social-service agencies and 
the Department of Health. And drug-prevention and support agencies there 
are getting about 30 percent more funding this year.

The first step in confronting addiction is understanding the addicted 
population. And often that means facing up to some uncomfortable facts.

In most places, drug users are getting younger and younger.

So some countries all over the world have begun targeting their efforts 
directly at young people. In tough areas of Greece and Finland, flashy new 
late-night cafes offer alternatives to doing drugs on the streets.

One British rehab project, the Ley Community, joined forces with Earthwatch 
to allow recovering addicts to go on scientific field trips, where they 
might study dinosaur footprints in north Yorkshire or birds on the Isle of 
Mull. Last year Hong Kong, alarmed by the number of teenagers crossing into 
southern China for raves in Shenzhen, announced plans for a new counseling 
center aimed exclusively at teenage abusers of psychotropic drugs, 
including ecstasy.

The government has also allocated $45 million to find new approaches for 
treating psychotropic drug abuse.

Addicts are increasingly being given a voice in formulating drug policy.

In Britain, the National Treatment Agency has consulted users' groups, and 
drug czars Keith Hellawell and Mike Trace often listen to the tales of 
users. "We're very much being brought into the debate in an interesting 
way," says Bell Nelles, general secretary of the Methadone Alliance, a 
users' lobby group. "We've cracked the credibility thing.

Now [users] are involved as part of the strategy."

THE EUROPEAN APPROACH

Some countries have no doubt gone further than America probably ever will. 
Needle exchanges are common all over the EU, as are "substitution 
treatment" programs, where users can exchange, say, a bag of heroin for a 
dose of methadone.

In France and Spain, pharmacists are allowed to distribute syringes and 
methadone.

Belgium recently decriminalized possession of marijuana for personal use, 
following similar moves by Spain, Portugal and Italy. Last year Germany 
legalized the use of sanitary "injection rooms," arguing that drug-related 
deaths have declined in cities like Frankfurt, where they are available.

The Netherlands, Spain and Switzerland also provide injection centers as a 
way to get users off the street and to reduce the spread of diseases 
through needle-sharing. Peter Cohen, director of the University of 
Amsterdam's Centre for Drug Research, maintains that cultural acceptance of 
drug use is growing so rapidly that soon it will be considered as 
unremarkable as "homosexuality, which [decades ago] was seen as an illness, 
but is now totally normal behavior."

That's pretty radical even for many Europeans. In America, old habits die 
harder. Washington still directs two thirds of the federal drug budget 
(including $1.3 billion in military assistance to Colombia) to law 
enforcement, while state legislatures-leery of seeming to coddle 
criminals-lag behind public opinion on funding treatment.

So-called "harm reduction" strategies like needle exchanges have a tough 
time winning approval, despite many studies proving that they save lives.

The new U.S. attorney general, John Ashcroft, has opposed not just needle 
exchanges and increased federal funding for treatment, but a 
taxpayer-supported media campaign aimed at teens. Courts-including many 
drug courts-won't often authorize methadone treatment, and junkies 
routinely fail to report overdoses to the authorities for fear of being 
arrested.

In "Traffic," the kids leave their overdosed friend at the hospital and run 
away-a common response.

But there are small signs of change all over the country.

In New Mexico, where GOP Gov. Gary Johnson is an outspoken drug reformer, 
the authorities are trying a new harm-reduction strategy to fight overdoses.

Last month New Mexico doctors were authorized to give addicts syringes full 
of Naloxone, commonly known as Narcan, an easy-to-inject medication that 
immediately counteracts the heroin and saves the life of the overdosing addict.

One test of the new public mood on drug enforcement will be if other states 
follow suit. New York is beginning to reassess it's tough drug laws, which 
date from the 1970s and the governorship of Nelson Rockefeller. Last month 
Gov. George Pataki, once a major hard-liner, proposed cutting the minimum 
sentences for serious drug felons from 15 years to eight and giving judges 
more discretion. "It was clear when we went through the clemency process 
that there were people who were caught up in the drug laws in ways that 
resulted in dramatically unfair sentences-people sentenced to 15 years when 
their involvement was minimal," Pataki says.

How does the rest of the world view America's new tack? Most Europeans 
think it's about time that their puritanical cousins got with the program. 
Indeed, a few critics in London have faulted "Traffic," which opened there 
to generally positive buzz on Jan. 26, for not going far enough in support 
of legalization. Hong Kong police fear that an increase in funding for 
treatment will mean a decrease in U.S. drug-enforcement help; in November, 
the then President Clinton asked Congress to remove Hong Kong from the list 
of major drug-transit territories. And while Mexican analysts are 
encouraged by America's new attention to demand reduction, they remain 
skeptical about Washington's true intentions. "The Americans have to fill 
all of those jails with [people] caught smoking a joint," says Haydee 
Rosovsky, who until recently headed Mexico's national anti-addiction program.

Changing the main national strategy from attacking drug pushers to 
rehabilitating addicts won't come easy. But slowly, steadily, Americans 
seem determined to try.

With Jonathan Alter in New York and Carla Power in London, Alan Zarembo in 
Mexico City and Mahlon Meyer in Hong Kong
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