Attachment Files

Article - Toward a General Theory of Public Policy on Drug Abuse

Summary/Abstract

This essay presents a theoretical model for how public policy evolves in a time of simultaneously high levels of concern and frustration. My thesis is that there are four basic "temptations" toward which the public-- and policymakers-- are inclined..

Content

The late 1980s is a time of great public concern about drug abuse. In many surveys of the U.S. population, it is ranked #1 among the perceived problems faced by the nation. The problem is seen as waxing rather than waning, which has led to frustration and a desire to "do something effective" about it.

This essay presents a theoretical model for how public policy evolves in a time of simultaneously high levels of concern and frustration. My thesis is that there are four basic "temptations" toward which the public-- and policymakers-- are inclined, and that all expressions or actions are a pure form of, or a combination of, these temptations.

(1) The Socialist Temptation

In this view, drug abuse-- and many another social problem-- is caused by deprivation. Individuals who lack education, or employment opportunities, or decent housing, or proper healthcare, are at much higher risk for experiencing forms of physical, or psychological, or emotional, or existential discomfort. Use of psychoactive substances can alleviate this discomfort. But use often leads to abuse, and an underprivileged individual has fewer resources to help overcome abuse than are available to more privileged persons. In a vicious cycle, deprivation leads to abuse, which leads to further incapacitation and discomfort, which motivates continued abuse. The suffering of many individuals within a community demoralizes the remaining population. Whole social classes are weakened: "drink is the curse of the working class."

When the problem is thus perceived, there is a temptation to correct the situation by removing the deprivations. Create a minimum standard of living and some sort of equal opportunity for further advancement, and most substance abuse will vanish in the face of healthy social functioning, it is thought. Of course, this approach is expensive: the wealthier classes must be taxed to provide the resources to improve the lives of the less fortunate.

Adherents to the Socialist Temptation cite Sweden as the ideal. Most who espouse this Temptation are from the political left, and are comfortable with the notion of redistributing wealth to achieve social good. Their ideal drug treatment program is the thera-peutic community, which attempts to create a perfect socialist living/working environment within the limited confines of a Synanon or a Daytop.

(2) The Libertarian Temptation

The inclination here is to view substance use as a private matter. If people want to use cocaine, or heroin, or alcohol, that is their own choice, not to be interfered with by society unless their is a clear intrusion on the welfare of others. Drug abuse is seen as a victimless crime, and most related problems are regarded as stemming from misguided control policies.

The Libertarian Temptation is to legalize, or at least decrimi-nalize, all forms of drug use and possession. The existing system of interdiction and suppression would be replaced by one of light regulation and taxation. There would be just enough governmental involvement to avoid monopolies, toxic adulterants, deceptive advertising, or other gross abuses. People would be trusted to educate themselves out of self-abusive behavior. They would be left to learn from their mistakes-- and even if they suffered thereby, "tough luck, it's their free choice and they must take the consequences."

Closest to the Libertarian ideal is Amsterdam, although there might be some chafing at all the efforts which are made (at taxpayer expense) to soften the worst effects of drug abuse.

At the deepest heart of the Libertarian frame of mind is the desire to be left alone to pursue one's own path to personal happiness and exaltation. Adherents to this Temptation come from all parts of the political spectrum. It is an attractive philosophy for those who enjoy using substances to alter their own consciousnesses. Libertarians are likely to think of methadone maintenance as the best of a bad lot of American responses to its heroin problem.

(3) The Fascist Temptation

Many citizens think of society as consisting of a decent, law-abiding, non-abusing majority juxtaposed against an ugly, rebellious, drug-abusing minority. If, in addition, that minority is also seen as lacking in human worth and as sufficiently powerless, there is a great temptation to "get tough on drug abuse". Society's power is mobilized to make war on those who dare to engage in traffic and usage, in defiance of the norms of the majority. There is a focus on expressions to public power-- zero tolerance, airtight surveillance, police weaponry, mandatory prison sentences, etc.

A critical element of the Fascist Temptation is the infliction of punishment: the deviant must suffer, not just to "improve" his behavior but also to salve the morale of the law-abiding majority. Thus, the ideal punishment is prompt, painful, and public. The power of decent society is applied ruthlessly to destroy the corrupting elements in its midst.

The shining example for the Fascist Temptation is the suppression of opium use in China in the 1950s. Iran in the 1980s, and the U.S. in the Harry Anslinger/J. Edgar Hoover era, are also attractive models. The death of drug traffickers, either judicially or in the style of "Miami Vice", holds immense fascination. But the keynote is the dehumanization of those who abuse or traffic in drugs-- it's as if they have deliberately, wickedly opted out of the human family.

Perhaps the greatest danger of the Fascist Temptation is not that it wouldn't work, but that it would work very well indeed. The public might then be inclined to empower its fascist-minded policymakers with a much wider latitude of action. The same ruthless tactics which worked so well against the drug lords would then be applied to "problems" of labor relations, racial policy, sexual nonconformity, and so forth...

(4) The Laissez-Faire Temptation

The Socialist, Libertarian, and Fascist Temptations are all "activist" in the sense that each would require a radical alteration of existing economic and/or legal arrangements in this country. Radical proposals make many people uneasy-- they prefer to think that the status quo is adequate to handle the problem. These "Laissez-Faire" or "let it be" adherents believe that problems are essentially cyclical, and will go away on their own account without the necessity of any potent intervention. Their goal is to contrive to avoid any new laws, taxes, or policies, and instead to perpetuate existing mechanisms for handling the negative aspects of drug use.

The inclination is always toward the passive, but energetic tactics are sometimes required to delay, dilute, negate, or otherwise frustrate the radical enterprises of the more activist Temptations. Closest to the Laissez-Faire ideal is postwar England, with its marvelous ability to muddle through and somehow maintain a decent and well-mannered society in the face of appalling social problems and relative economic decline. In drug treatment policy, palliative outpatient detoxification programs are the ideal: cheap "band-aid" care to keep the users from getting too desperate, and to offer real help to the occasional addict who is truly ready.

It is also instructive to quote some favorite buzzwords or phrases for each school of thought.

For the Socialist Temptation, "justice", "equality", "redistribution of wealth", "client services", "meaningful work", "affirmative action", "benefits", and "they're depraved because they're deprived" all are valued concepts. For the Libertarian Temptation, "liberty", "privacy", "give them what they want", "get the government out of our private lives", and "personal choice" are music to the ears. With the Fascist Temptation, "crush", "war", "get tough", "sick and tired", "eliminate", "orderly society", and "beat some sense into them" stir the blood. As for the Laissez-Faire Temptation, "cost-effective", "declining indicators of abuse", "compromise", "modus vivendi", and "work through existing channels" have a pleasing sound.

In my belief, the point to be drawn from the above analysis is that the United States may be incapable of yielding to any of the above temptations except the Laissez-Faire. Unlike the situation in Iran, or China, or Sweden, or Holland, the first three Temptations are almost equally strong in this country. About one in five of the citizenry espouse the leftist values of a socialist approach to substance abuse. Perhaps 20% or 25% of us are truly libertarian, with a generous inclination to let people drink or smoke or inject whatever they wish. Somewhere between one-fourth and one-third cherish hard, tough opinions which, at least in the realm of substance abuse policy, can properly be termed fascist. These three factions tend to cancel one another out, and by default leave the field open to the adherents to Laissez-Faire public policies. Alert policymakers, aware of this state of affairs, shrewdly cater to the feelings of their entire constituency. The Socialist voters are assured that all Americans must be provided with a decent standard of living-- but the funds to provide for that standard always fall short, and there are never enough slots in therapeutic communities or other total-lifestyle treatment programs. It is intimated to the Libertarian adherents that private choice in substance use will be respected within limits-- but somehow, pesky police practices remain, fortunes continue to be wasted on hopeless suppression policies, and such sensible proposals as "low-threshold methadone maintenance" are ignored. The Fascist faction is soothed with talk of "zero tolerance" and "put the dealers out of business," but the enabling legislation is never passed, and the justice system continues to be a "velvet fist in an iron glove" to the addict or trafficker.

Thus will we muddle on, year after year, never able to give in fully to any clearly-expressed Temptation, holding only to a disguised loyalty to Laissez-Fairism, always with the fond and quite possibly justified hope that the problem will disappear without any drastic steps ever being taken. After all, substance abuse "crises" occurred several times in the past five hundred years and Western civilization did not collapse. The job of the drug abuse czar is to steer a course of glorious stasis, much as did Prime Minister Melbourne:

To promise, pause, prepare, postpone And end by letting things alone: In short, to earn the people's pay By doing nothing every day.

But there is always the possibility that some dire turn of events may alter the current nearly-equal balance among Socialist, Libertarian, and Fascist. Who can tell what the l990s will bring: an upsurge in Great Society-style empathy for the underprivileged? an exasperation with unenforceable prohibition laws? a series of flagrant atrocities by cocaine lords? Any of these could upset the equilibrium and tip the scales in favor of an activist Temptation, sufficient to encourage and enable policymakers to adopt measures which have not been possible in our country during this generation.