America's 'other' drug strategy

Officials and doctors may talk about reducing demand, but the emphasis is still on prison cells, not on treatment centers and education

 

(CNN) -- It is lemonade-stand economics: If you cannot get enough people to buy your product, you will stop trying to sell that product.

"Supply-and-demand applies to illicit drugs, too," said Mike Townsend, executive vice president of the Partnership for a Drug-Free America. "If there's no demand for drugs in this country, there won't be any drugs dealt in this country."

Recent headlines have been all about reducing the drug supply.

President Bill Clinton has just delivered a $1.3 billion aid package to Colombia designed to help that country's government reduce the production of tons of cocaine and heroin, most of which ends up in small plastic bags in American hands.

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Heroin and cocaine flows

"They're the source of more than 90 percent of the cocaine that comes into America and more than 70 percent of the heroin," said Barry McCaffrey, director of the White House office on drug control policy.

But many drug treatment specialists say reducing supply is only one part, and the minor part, of a successful anti-drug strategy.

"There's no way you can seal the borders, close all the coke labs, shut down the making and distribution of drugs," said Dr. Mitch Rosenthal, president of Phoenix House, a national network of drug treatment centers. "In the end, you've got to reduce demand."

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CNN Senior Interactive Correspondent Beth Nissen reports on the call to reduce demand for illegal drugs in the U.S.

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Demand for cocaine and heroin is generally lower now than it was five years ago, especially among the young. But there is still a sizable and lucrative U.S. market for both drugs.

The government's Office of National Drug Control Policy estimates that 5 million Americans use cocaine or its derivatives. Another "few million" use heroin, especially the newer smokable form of that drug.

About 5 million Americans are classified as chronic drug addicts, most of them addicted to either cocaine or heroin.

"It's very difficult to reduce demand -- but it's very possible," said Rosenthal.

'We can reclaim millions of lives'

By the estimates of many police departments and law enforcement agencies, at least half the demand for illicit drugs comes from those addicted to these drugs.

"Drug treatment is key to reducing drug demand," said Rosenthal. "And we can now say: Treatment works for heroin addiction; treatment works for cocaine addiction."

That statement could not have been made 10 years ago. "Advances in science over the last decade have fundamentally revolutionized everything we think about the nature of drug abuse and addiction," said Dr. Alan Leshner, director of the National Institute on Drug Abuse, a division of the National Institutes of Health.

The most important scientific finding can be simply stated. "Drug addiction is a brain disease," said Leshner.

"Addiction is not a decision, not a bad choice, not a moral failing. It's true that you initially choose to use drugs. But as you use drugs over time, your brain gets changed. You suddenly lose control over that drug use and you become a compulsive drug user. And that's the essence of addiction."

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U.S. Drug Seizures

Classifying addiction as a disease means treating it as a disease -- prescribing medicine, along with behavior modification counseling and 12-step programs. There are scores of new drugs now in clinical trials that may help mute or block the cravings for heroin and for cocaine.

"We have to either change the brain back, or compensate for the brain change," said Leshner. "Just saying, 'Cut that out,' isn't an effective technique with a drug addict. We need to have professional treatment, professional interventions."

Leshner and other treatment professionals say the treatment success rate for drug addiction is now comparable to treatment success rates for other chronic disorders, such as hypertension or diabetes or asthma.

Knowing how to treat drug addiction does not make treatment any quicker -- or less expensive.

"The same way you might have to try many different treatments to get somebody's blood pressure under control, you need to try different treatments to get somebody's addiction under control," said Leshner. "It takes time."

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View a photographic essay of U.S. efforts to combat drug trafficking

"We have the notion that if we can detoxify somebody, get somebody drug-free in seven or 28 days, that is sufficient," said Rosenthal. "But you can't change the chemistry and the psychology and the social functioning of somebody in 28 days. That often takes at least a year of residential treatment to accomplish."

But 12 months in residential treatment is expensive. Too few insurance policies reimburse for even one-month programs. And even those who have insurance coverage face a critical shortage of treatment spaces.

"In Los Angeles, for example, they have only 150 beds for kids aged 13 to 18 who need residential treatment for drug abuse," said Rosenthal. "They need 2,000. Other states have NO beds of this kind."

What most states have instead are cells. "What we have done in America is put both adolescents and adults who have drug problems in jail," said Rosenthal.

A record 2 million Americans are in prison -- and an estimated 70 percent of them have a history of drug use or abuse. Yet there is little public will to fund drug treatment for those in prison or jail.

"I don't think drug treatment has ever been popular," said Bill Delahunt, a Massachusetts congressman who advocates greater funding for drug prevention and treatment. "We look at those who need drug treatment and say 'It's THEIR problem.' Well, the reality is, it's OUR problem. Until we treat 'them,' we are going to have instability and social unrest and consequences that we all feel and we all have to pay for."

"We are under-spending on treatment," said Rosenthal. "We are making a great mistake in America in not understanding that we can reclaim millions of lives, lives of people caught up in drugs, lives which would otherwise be wasted."

Ecstasy has become a popular drug among teen-agers  

Kids in the crosshairs

Every supplier of every product knows that you will not be in business long if you do not grow your business. For drug suppliers, that means getting new customers: first-timers, teen-agers, sixth-graders.

"You've got to get to children between the sixth grade and the 12th grade and reduce the rate of gateway drug-taking behavior -- this has to be the heart and soul of the national drug strategy," said McCaffrey. "If you don't use drugs until you're 21, the chances of you ever becoming a chronic addict are remote."

Child development and education specialists say the past decade of school-based drug education programs and public service anti-drug campaigns have helped determine what works -- and what does not -- to prevent drug experimentation and drug use.

"The messages have to have the ring of truth and credibility," said Mike Townsend, whose non-profit organization, Partnership for a Drug-Free America, has produced 600 high-quality anti-drug ads for print and television broadcast. "They can't seem like advertising and they can't seem like 'spin' -- kids have a very finely tuned sense when it comes to spin and baloney."

What drug education veterans say works best is factual, unexaggerated, non-hyperbolic information about legal and illegal drugs, and the physical, emotional, legal and social consequences of taking them. That kind of information -- delivered early and often; delivered at school and at home -- can change young attitudes toward drugs, and lower drug use.

  INTERACTIVE
Drugs enter through South Florida

"We know that the biggest factors in determining whether or not a kid will try drugs are their perceptions of risk -- 'How will this harm me? Harm my chances of getting good grades? Of making the team?'" said Townsend. "And also their perceptions of approval or disapproval -- 'What will people think of me? What will my parents think of me?'"

That may come as a surprise to several million parents of detached and disdainful teens and pre-teens. But Townsend said the research data are clear: Most kids do care what their parents think of them, and do listen to what their parents say to them.

"Kids who learn about the dangers of drugs from their parents are half as likely to get in trouble with drugs," he said. "Unfortunately, only about a quarter of kids say their parents are talking to them about drugs. We have got to get parents to close that gap."

It is not just the young who need drug education. Law enforcement and drug treatment specialists say adults also need reminders: That the marijuana of today is far more potent and chemical-laced than the joints they toked in college; that Ecstasy tablets may look like prescription pills but are not quality controlled; that the new smokable and snort-able heroin from Colombia can be 90 percent pure, and far more dangerous than the heroin junkies used to shoot with a needle.

"A lot of Americans just don't understand that high-purity heroin stuck up your nose can kill you dead from a heroin overdose just as effectively as injecting," said McCaffrey.

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Cocaine Price Chart

What some researchers call the "cocktail crowd" is being courted by drug dealers offering high-quality cocaine and heroin for low prices -- home delivery often included. Street prices for both drugs are at a 10-year low. In many American cities and suburbs, the price of a heroin high is about $10 -- the cost of a movie ticket and a soft drink.

"As people are feeling more affluent and as price has gone down for drugs, we're seeing an increase in heroin use, particularly among young professionals, and we believe there's been an increase in cocaine use, particularly among the well-to-do," said Leshner.

Emergency rooms are already charting more drug reactions and overdoses. Treatment centers are seeing a slight but steady increase in adult patients who have cocaine and heroin problems. "Having a big drug supply that is potent and inexpensive will make the temptation much, much greater," said Rosenthal.

All about changing attitudes

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U.S. drug policy czar Barry McCaffrey is interviewed about Colombia

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The temptation to take drugs is seen as a modern scourge, but it is an ancient problem: Drug-taking may not be human nature, but it is second nature.

"Drug-taking, or taking something to change the way we feel, is part of the human experience," said Rosenthal. "People try and alter the way they feel with food, with alcohol, with nicotine, with prescription drugs, and some with illicit drugs."

Rosenthal sees Americans, especially, as interested in what is sometimes termed "better living through chemistry."

"Americans in the 21st century believe that for whatever ails you, there is some pill, some chemical, that is going to make you feel better," said Rosenthal. "Whether you are a kid starting college, or somebody who has lost a parent, or somebody who worries about asking the boss for a raise, there is a belief that you can get a drug that is going to make things easier."

Dr. David Musto, a Yale University professor of child psychology and the history of medicine, said America has, in its short history, gone through cycles: alternating periods of drug-taking and abstinence; then a period of tolerance, and now prohibition.

Musto said when Americans see drugs are an impediment to achievement -- see liquor turning working men into lushes -- there is temperance. When they see drugs as an aid to achievement -- see cocaine as a way to work all night until the Tokyo market opens -- there is tolerance.

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View a photographic essay of a drug bust

"When deToqueville came to America in the 1830s, he wrote in his diary that there is nothing worse to see than an American who feels he has missed a shortcut," said Musto. "There is a continuous American goal, which is to be the best and achieve everything you can."

Achieving a successful drug strategy -- reducing the damage done by cocaine and heroin, and by the newer wave of "designer" drugs such as Ecstasy, MDMA, GHB, methamphetamines -- will likely require a reduction of both supply and demand.

Of the two, reducing demand may prove easier. Musto and others point to the example of tobacco, one of the most commonly used addictive substances in American history.

Supplies of tobacco remain high. But demand for tobacco products has dropped sharply.

A range of effective and available treatments, from the nicotine patch to hypnosis, has helped reduce tobacco use and addiction. More important, society at large has finally taken in years of public health warnings on the dangers of tobacco and concluded that the costs in health care and human lives are unacceptable.

"When I was in college in the 1950s, everyone was expected to smoke," said Musto. "Now our tobacco controls are a topic of enormous wonderment to many people in Europe -- they can't believe how we've turned against tobacco."

"It shows that over a period of time, you can create a tremendous change in attitude toward a substance and in demand for that substance," he said, "and eventually in the harm done by that substance."


RELATED SITE:
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